Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania

Autoři: James Samwel Ngocho aff001;  Melissa H. Watt aff003;  Linda Minja aff004;  Brandon A. Knettel aff003;  Blandina T. Mmbaga aff001;  Petal P. Williams aff002;  Katherine Sorsdahl aff002
Působiště autorů: Kilimanjaro Christian Medical University College, Moshi, Tanzania aff001;  Alan J Flisher Centre for Public Mental Health University of Cape Town, Cape Town, South Africa aff002;  Duke Global Health Institute, Duke University, Durham, North Carolina, United States of America aff003;  Kilimanjaro Clinical Research Institute, Moshi, Tanzania aff004;  Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa aff005
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0224515



Mental health disorders in pregnant women living with HIV are associated with poor maternal and child outcomes, and undermine the global goals of prevention of mother-to-child transmission of HIV (PMTCT). This study aimed to determine prevalence of depression and anxiety and identify factors associated with these common mental health disorders among HIV-infeced pregnant women in Tanzania.


We enrolled 200 pregnant women living with HIV from antenatal care clinics in the Kilimanjaro region. Women were eligible if they were in the second or third trimester of pregnancy and had been in PMTCT care for a minimum of one month. Data were collected via interviewer administered surveys. Participants self reported depression symptoms (Edinburgh Postnatal Depression Scale, EPDS) and anxiety symptoms (Brief Symptom Index, BSI). Multivariate logistic regression models examined factors associated with depression, anxiety, and comorbid depression and anxiety.


25.0% of women met screening criteria for depression (EPDS ≥10). Depression was significantly associated with being single (aOR = 4.2, 95% CI = 1.1–15.5), food insecurity (aOR = 2.4, 95% CI = 1.0–6.4), and HIV shame (aOR = 1.2, 95% CI = 1.1–1.3). 23.5% of participants met screening criteria for anxiety (BSI ≥1.01). Anxiety was associated with being single (aOR = 3.6, 95%CI = 1.1–11.1), HIV shame (aOR = 1.1, 95% CI = 1.1–1.2) and lifetime experience of violence (aOR = 2.3, 95% CI = 1.0–5.1). 17.8% of the sample met screening criteria for both depression and anxiety. Comorbid depression and anxiety was associated with being single (aOR = 4.5, 95%CI = 1.0–19.1), HIV shame (aOR = 1.2, 95%CI = 1.1–1.3) and lifetime experience of violence (aOR = 3.4, 95% CI = 1.2–9.6).


Depression and anxiety symptomatology was common in this sample of pregnant women living with HIV, with a sizable number screening positive for comorbid depression and anxiety. In order to successfully engage women in PMTCT care and support their well-being, strategies to screen for mental health disorders and support women with mental illnesses are needed.

Klíčová slova:

Depression – HIV – HIV clinical manifestations – HIV diagnosis and management – HIV epidemiology – Mental health and psychiatry – Pregnancy – Tanzania


1. UNAIDS data 2018 | UNAIDS [Internet]. [cited 2 Jun 2019].

2. Unaids. UNAIDS Data 2017. Programme on HIV/AIDS. 2017. 978-92-9173-945-5

3. Manyahi J, Jullu BS, Abuya MI, Juma J, Ndayongeje J, Kilama B, et al. Prevalence of HIV and syphilis infections among pregnant women attending antenatal clinics in Tanzania, 2011. BMC Public Health. 2015;15: 501. doi: 10.1186/s12889-015-1848-5 25994129

4. Walensky RP, Paltiel a D, Losina E, Mercincavage LM, Schackman BR, Sax PE, et al. The survival benefits of AIDS treatment in the United States. J Infect Dis. 2006;194: 11–9. doi: 10.1086/505147 16741877

5. Hartzell JD, Janke IE, Weintrob AC. Impact of depression on HIV outcomes in the HAART era. J Antimicrob Chemother. 2008;62: 246–255. doi: 10.1093/jac/dkn193 18456650

6. Fadzil A, Balakrishnan K, Razali R, Sidi H, Malapan T, Japaraj RP, et al. Risk factors for depression and anxiety among pregnant women in Hospital Tuanku Bainun, Ipoh, Malaysia. Asia-Pacific Psychiatry. 2013;5: 7–13. doi: 10.1111/appy.12036 23857831

7. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158: 725–730. doi: 10.1176/appi.ajp.158.5.725 11329393

8. Stringer EM, Meltzer-Brody S, Kasaro M, Stuebe AM, Wiegand S, Paul R, et al. Depression, pregnancy, and HIV: the case to strengthen mental health services for pregnant and post-partum women in sub-Saharan Africa. The lancet Psychiatry. 2014;1: 159–62. doi: 10.1016/S2215-0366(14)70273-1 26360580

9. Bell AF, Andersson E. The birth experience and women’s postnatal depression: A systematic review. Midwifery. 2016;39: 112–123. doi: 10.1016/j.midw.2016.04.014

10. Villar-Loubet OM, Illa L, Echenique M, Cook R, Messick B, Duthely LM, et al. Prenatal and Mental Health Care Among Trauma-Exposed, HIV-Infected, Pregnant Women in the United States. J Assoc Nurses AIDS Care. 2014;25. doi: 10.1016/j.jana.2013.06.006 24274993

11. Fisher J, de Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: A systematic review. Bull World Health Organ. 2012;90: 139–149. doi: 10.2471/BLT.11.091850 22423165

12. Sowa NA, Cholera R, Pence BW, Gaynes BN. Perinatal depression in HIV-infected African women: a systematic review. J Clin Psychiatry. 2015;76: 1385–96. doi: 10.4088/JCP.14r09186 26528645

13. Starace F, Ammassari A, Trotta MP, Murri R, De Longis P, Izzo C, et al. Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31 Suppl 3: S136–9. 31:S136-S139@2002

14. Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS. 2008;22: 973–81. doi: 10.1097/QAD.0b013e3282f9b67a 18453857

15. Antelman G, Kaaya S, Wei R, Mbwambo J, Msamanga GI, Fawzi WW, et al. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. United States; 2007;44: 470–477. doi: 10.1097/QAI.0b013e31802f1318 17179766

16. Ickovics JR, Hamburger ME, Vlahov D, Schoenbaum EE, Schuman P, Boland RJ, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA. 2001;285: 1466–1474. doi: 10.1001/jama.285.11.1466 11255423

17. Talge NM, Neal C, Glover V. Antenatal maternal stress and long-term effects on child neurodevelopment: How and why? J Child Psychol Psychiatry Allied Discip. 2007;48: 245–261.

18. Getinet W, Amare T, Boru B, Shumet S, Worku W, Azale T. Prevalence and Risk Factors for Antenatal Depression in Ethiopia: Systematic Review. Depress Res Treat. Hindawi Limited; 2018;2018: 3649269. doi: 10.1155/2018/3649269 30112199

19. Shannon M, Lee KA. HIV-infected mothers’ perceptions of uncertainty, stress, depression and social support during HIV viral testing of their infants. Arch Womens Ment Health. 2008;11: 259–67. doi: 10.1007/s00737-008-0023-8

20. Yonah G, Fredrick F, Leyna G. HIV serostatus disclosure among people living with HIV/AIDS in Mwanza, Tanzania. AIDS Res Ther. 2014;11: 5. doi: 10.1186/1742-6405-11-5 24450933

21. Kaaya SF, Mbwambo JK, Kilonzo GP, Van Den Borne H, Leshabari MT, Fawzi MCS, et al. Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania. Tanzan J Health Res. 2010;12: 23–35. doi: 10.4314/thrb.v12i1.56276 20737826

22. Tanzania Ministry of Health and Social Welfare. National Guidelines for Comprehensive Care Services for Prevention of Mother-to-Child Transmission of HIV and Keeping Mothers Alive. Cartographic Perspectives. 2013.

23. Watt MH, Cichowitz C, Kisigo G, Minja L, Knettel BA, Knippler ET, et al. Predictors of postpartum HIV care engagement for women enrolled in prevention of mother-to-child transmission (PMTCT) programs in Tanzania. AIDS Care. 2019;31: 687–698. doi: 10.1080/09540121.2018.1550248 30466304

24. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150: 782–6. doi: 10.1192/bjp.150.6.782 3651732

25. Shrestha SD, Pradhan R, Tran TD, Gualano RC, Fisher JRW. Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: A systematic review. BMC Pregnancy Childbirth. BMC Pregnancy and Childbirth; 2016;16.

26. Derogatis LR, Melisaratos N. The Brief Symptom Inventory: an introductory report. Psychol Med. 1983;13: 595–605. doi: 10.1017/S0033291700048017 6622612

27. Kalichman SC. Psychological and social correlates of high-risk sexual behaviour among men and women living with HIV/AIDS. AIDS Care. 1999;11: 415–27. doi: 10.1080/09540129947794 10533534

28. Speizer IS, Santelli JS, Afable-Munsuz A, Kendall C. Measuring Factors Underlying Intendedness of Women’s First and Later Pregnancies. Perspect Sex Reprod Health. 2004;36: 198–205.

29. Garcia-Moreno C, Jansen H a FM, Ellsberg M, Heise L, Watts CH. WHO Multi-country Study on Women ‘ s Health and Domestic Initial results on prevalence. Genetics. 2005;151: 277–83.

30. Holzemer WL, Uys LR, Chirwa ML, Greeff M, Makoae LN, Kohi TW, et al. Validation of the HIV/AIDS Stigma Instrument—PLWA (HASI-P). AIDS Care. 2007;19: 1002–12. doi: 10.1080/09540120701245999

31. Neufeld SAS, Sikkema KJ, Lee RS, Kochman A, Hansen NB. The development and psychometric properties of the HIV and Abuse Related Shame Inventory (HARSI). AIDS Behav. 2012;16: 1063–74. doi: 10.1007/s10461-011-0086-9 22065235

32. Knueppel D, Demment M, Kaiser L. Validation of the Household Food Insecurity Access Scale in rural Tanzania. Public Health Nutr. 2010;13: 360–7. doi: 10.1017/S1368980009991121 19706211

33. Broadhead WE, Gehlbach SH, de Gruy FV, Berton HK. The Duke-UNC Functional Social Support Questionnaire: Measurement of Social Support in Family Medicine Patients. Med Care. 1988;26: 709–723. doi: 10.1097/00005650-198807000-00006 3393031

34. Shacham E, Reece M, Monahan PO, Yebei V, Omollo O, Ong’or WO, et al. Measuring psychological distress symptoms in individuals living with HIV in western Kenya. J Ment Heal. 2008;17: 424–434. doi: 10.1080/09638230701530192

35. Kapetanovic S, Christensen S, Karim R, Lin F, Mack WJ, Operskalski E, et al. Correlates of perinatal depression in HIV-infected women. AIDS Patient Care STDS. 2009;23: 101–108. doi: 10.1089/apc.2008.0125 19196032

36. Kaida A, Matthews LT, Ashaba S, Tsai AC, Kanters S, Robak M, et al. Depression during pregnancy and the postpartum among HIV-infected women on antiretroviral therapy in Uganda. J Acquir Immune Defic Syndr. 2014;67 Suppl 4: S179–87. doi: 10.1097/QAI.0000000000000370 25436816

37. Rochat TJ, Richter LM, Doll HA, Buthelezi NP, Tomkins A, Stein A. Depression Among Pregnant Rural South African Women Undergoing HIV Testing. JAMA. 2006;295: 1373. doi: 10.1001/jama.295.12.1373

38. Kaaya SF, Blander J, Antelman G, Cyprian F, Emmons KM, Matsumoto K, et al. Randomized controlled trial evaluating the effect of an interactive group counseling intervention for HIV-positive women on prenatal depression and disclosure of HIV status. AIDS Care. 2013;25: 854–62. doi: 10.1080/09540121.2013.763891 23383726

39. Smith Fawzi MC, Kaaya SF, Mbwambo J, Msamanga GI, Antelman G, Wei R, et al. Multivitamin supplementation in HIV-positive pregnant women: impact on depression and quality of life in a resource-poor setting. HIV Med. 2007;8: 203–12. doi: 10.1111/j.1468-1293.2007.00454.x 17461847

40. Derogatis LR, Lipman RS, Rickels K, Uhlenhuth EH, Covi L. The Hopkins Symptom Checklist (HSCL). A measure of primary symptom dimensions. Mod Probl Pharmacopsychiatry. 1974;7: 79–110. doi: 10.1002/bs.3830190102 4607278

41. Hirschfeld RMA. The Comorbidity of Major Depression and Anxiety Disorders: Recognition and Management in Primary Care. Prim Care Companion J Clin Psychiatry. 2001;3: 244–254. doi: 10.4088/pcc.v03n0609 15014592

42. van Heyningen T, Honikman S, Myer L, Onah MN, Field S, Tomlinson M. Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Arch Womens Ment Health. Archives of Women’s Mental Health; 2017; 1–11. doi: 10.1007/s00737-017-0768-z 28852868

43. Blaney NT, Fernandez MI, Ethier K a, Wilson TE, Walter E, Koenig LJ. Psychosocial and behavioral correlates of depression among HIV-infected pregnant women. AIDS Patient Care STDS. 2004;18: 405–15. doi: 10.1089/1087291041518201 15307929

44. Tsai AC, Bangsberg DR, Frongillo EA, Hunt PW, Muzoora C, Martin JN, et al. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012;74: 2012–9. doi: 10.1016/j.socscimed.2012.02.033 22513248

45. Sorsdahl K, Slopen N, Siefert K, Seedat S, Stein DJ, Williams DR. Household food insufficiency and mental health in South Africa. J Epidemiol Community Health. 2011;65: 426–31. doi: 10.1136/jech.2009.091462 20427548

46. Bennetts A, Shaffer N, Manopaiboon C, Chaiyakul P, Siriwasin W, Mock P, et al. Determinants of depression and HIV-related worry among HIV-positive women who have recently given birth, Bangkok, Thailand. Soc Sci Med. 1999;49: 737–49. doi: 10.1016/s0277-9536(99)00108-2 10459886

47. Bennett DS, Traub K, Mace L, Juarascio A, O’Hayer CV. Shame among people living with HIV: a literature review. AIDS Care. 2016;28: 87–91. doi: 10.1080/09540121.2015.1066749 26296135

48. Olaore IB, Olaore AY. Is HIV/AIDS a consequence or divine judgment? Implications for faith-based social services. A Nigerian faith-based university’s study. SAHARA J J Soc Asp HIV/AIDS Res Alliance. Taylor & Francis; 2014;11: 20–5. doi: 10.1080/17290376.2014.910134

49. Arkell J, Osborn DPJ, Ivens D, King MB. Factors associated with anxiety in patients attending a sexually transmitted infection clinic: Qualitative survey. Int J STD AIDS. 2006;17: 299–303. doi: 10.1258/095646206776790097 16643678

50. Colombini M, James C, Ndwiga C, Team I, Mayhew SH. The risks of partner violence following HIV status disclosure, and health service responses: Narratives of women attending reproductive health services in Kenya. J Int AIDS Soc. 2016;19: 1–7. doi: 10.7448/IAS.19.1.20766 27037140

Článek vyšel v časopise


2019 Číslo 10