Keira Lowther1, Lucy Selman2, Richard Harding2, Irene J Higginson2. 1. Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, United Kingdom. Electronic address: Keira.lowther@kcl.ac.uk. 2. Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, United Kingdom.
Abstract
BACKGROUND: Advances in HIV care have resulted in increasing numbers of HIV patients receiving antiretroviral therapy and achieving viral control. This has led to a focus on the biomedical aspects of care, leaving the data on psychological and social problems relatively neglected; in fact they have never before been systematically reviewed. If present and unmanaged, psychological and social problems are associated with unnecessary suffering and non-adherence to medication, with potentially serious clinical and public health consequences. OBJECTIVE: To assess the prevalence of depression and anxiety reported in the literature, and the presence or absence of the experience of stigma among HIV positive people on antiretroviral therapy. DESIGN AND REVIEW METHODS: A systematic review in line with PRISMA guidelines. The prevalence data from retained studies were analysed by study location and data quality. DATA SOURCES: Five databases were systematically searched (Embase, PsychINFO, MEDLINE and British Nursing index and Web of Science) from 1996 (first availability of highly effective antiretroviral therapy) to August 2013 using a predefined search strategy. RESULTS: Sixty-six original studies identified the prevalence of depression, anxiety and presence or absence of the experience of stigma. The mean point prevalence of depression was 33.60% (SD 19.47) with lower reported point prevalence in high income countries (25.81% (15.21)) compared to low and middle income countries (41.36% (21.42)). The one-to four-week period prevalence of depression was 39.79% (21.52), similar in high income countries and low and middle income countries. The point prevalence of anxiety was 28.38% (17.07), with a higher prevalence in low and middle income countries (33.92% (10.64)) compared with high income countries (21.53% (22.91)) with wide variability. The mean point prevalence of stigma was 53.97% (22.06) and 1 year period prevalence 52.11% (25.57). Heterogeneity in both sampling and methodology prevented meta-analysis of this data. CONCLUSION: HIV positive patients on antiretroviral therapy report a higher prevalence of depression and anxiety than the general population, which nursing assessment and practice should address. Over half of HIV positive people report experiencing stigma. The difficulties with heterogeneous studies should be addressed through the development of a cross-culturally validated, multidimensional assessment tool in this population, and an increase in data disaggregated by risk groups.
BACKGROUND: Advances in HIV care have resulted in increasing numbers of HIV patients receiving antiretroviral therapy and achieving viral control. This has led to a focus on the biomedical aspects of care, leaving the data on psychological and social problems relatively neglected; in fact they have never before been systematically reviewed. If present and unmanaged, psychological and social problems are associated with unnecessary suffering and non-adherence to medication, with potentially serious clinical and public health consequences. OBJECTIVE: To assess the prevalence of depression and anxiety reported in the literature, and the presence or absence of the experience of stigma among HIV positive people on antiretroviral therapy. DESIGN AND REVIEW METHODS: A systematic review in line with PRISMA guidelines. The prevalence data from retained studies were analysed by study location and data quality. DATA SOURCES: Five databases were systematically searched (Embase, PsychINFO, MEDLINE and British Nursing index and Web of Science) from 1996 (first availability of highly effective antiretroviral therapy) to August 2013 using a predefined search strategy. RESULTS: Sixty-six original studies identified the prevalence of depression, anxiety and presence or absence of the experience of stigma. The mean point prevalence of depression was 33.60% (SD 19.47) with lower reported point prevalence in high income countries (25.81% (15.21)) compared to low and middle income countries (41.36% (21.42)). The one-to four-week period prevalence of depression was 39.79% (21.52), similar in high income countries and low and middle income countries. The point prevalence of anxiety was 28.38% (17.07), with a higher prevalence in low and middle income countries (33.92% (10.64)) compared with high income countries (21.53% (22.91)) with wide variability. The mean point prevalence of stigma was 53.97% (22.06) and 1 year period prevalence 52.11% (25.57). Heterogeneity in both sampling and methodology prevented meta-analysis of this data. CONCLUSION: HIV positive patients on antiretroviral therapy report a higher prevalence of depression and anxiety than the general population, which nursing assessment and practice should address. Over half of HIV positive people report experiencing stigma. The difficulties with heterogeneous studies should be addressed through the development of a cross-culturally validated, multidimensional assessment tool in this population, and an increase in data disaggregated by risk groups.
Authors: Vera Caine; Judy Mill; Kelly O'Brien; Patricia Solomon; Catherine Worthington; Margaret Dykeman; Jacqueline Gahagan; Geoffrey Maina; Anthony De Padua; Cheryl Arneson; Tim Rogers; Jean Chaw-Kant Journal: J Assoc Nurses AIDS Care Date: 2015-11-07 Impact factor: 1.354