Increased Depression during COVID-19 Lockdown Associated with Food Insecurity and Antiretroviral Non-Adherence among People Living with HIV in Uganda.
Increased Depression during COVID-19 Lockdown Associated with Food Insecurity and Antiretroviral Non-Adherence among People Living with HIV in Uganda.
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DOI：
10.1007/s10461-021-03371-0
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发表时间：
2022-07
影响因子：
4.4
通讯作者：
Linnemayr S
中科院分区：
文献类型：
--
作者：
Wagner GJ;Wagner Z;Gizaw M;Saya U;MacCarthy S;Mukasa B;Wabukala P;Linnemayr S
COVID-19大流行造成的健康和经济威胁可能成为艾滋病毒感染者的巨大痛苦来源，进而影响其艾滋病毒疾病的管理。我们研究了从封锁前到封锁后限制的抑郁变化以及抑郁症状升高的相关性，包括抗逆转录病毒治疗（ART）依从性。参与者在乌干达参加了一项ART依从性干预的随机对照试验。在2020年3月疫情相关封锁开始前，我们进行了全面的12个月随访评估;在三个月后封锁结束时，我们进行了混合方法的电话评估。在整个研究期间，包括封锁期间和之后，以电子方式监测ART依从性。用8项患者健康问卷（PHQ-8）评估抑郁症，其中得分> 9表示抑郁症状升高的阳性筛选。280名参与者完成了12个月和封锁后的评估。从第12个月（n = 17，6.1%）到锁定后评估（n = 50，17.9%; McNemar检验< .001），抑郁症状升高的比率几乎增加了两倍。在双变量分析中，封锁后抑郁症状的升高与女性、第12个月经济困难的指标（失业、低收入、高度粮食不安全）以及3个月封锁期间ART依从性较低有关[平均值为71.9%（SD = 27.9），而非抑郁者为80.8%（SD = 24.1）; p = 0.041]。在多元回归分析中，当其他相关因素被控制时，更高的食品不安全[adj. OR（95% CI）= 4.64（2.16-9.96）]和流行病对ART依从性产生负面影响的看法[adj. OR（95% CI）= 1.96（1.22-3.16）]仍然与抑郁症状升高的可能性更大相关。定性数据表明，经济压力（缺乏食物，工作和金钱）是导致抑郁症状升高的关键因素，这些压力导致由于缺乏食物和压力引起的健忘而错过ART剂量。在COVID-19封锁期间，抑郁症状显著增加，与食品不安全和ART依从性降低有关。需要建立识别和治疗抑郁症和粮食不安全的机制，以帮助艾滋病毒感染科普和减轻可能阻碍疾病管理和获得粮食的意外危机的有害影响。
The health and economic threats posed by the COVID-19 pandemic can be sources of great distress among people living with HIV, which in turn can impact the management of their HIV disease. We examined change in depression from pre- to post-lockdown restrictions and correlates of elevated depressive symptoms, including antiretroviral therapy (ART) adherence. Participants enrolled in a randomized controlled trial of an ART adherence intervention in Uganda. The month-12 follow-up assessment was fully administered just prior to the start of the pandemic-related lockdown in March 2020; at the conclusion of the lockdown three months later, we administered a mixed-methods phone-based assessment. ART adherence was electronically monitored throughout the study period, including during and after the lockdown. Depression was assessed with the 8-item Patient health questionnaire (PHQ-8), on which scores > 9 signify a positive screen for elevated depressive symptoms. A sample of 280 participants completed both the month-12 and post-lockdown assessments. Rates of elevated depressive symptoms nearly tripled from month 12 (n = 17, 6.1%) to the post-lockdown assessment (n = 50, 17.9%; McNemar test < .001). Elevated depressive symptoms at post-lockdown were associated with being female, indicators of economic struggles at month 12 (unemployment, low income, high food insecurity), and lower ART adherence during the 3-month lockdown period [mean of 71.9% (SD = 27.9) vs. 80.8% (SD = 24.1) among those not depressed; p = .041] in bivariate analysis. In multiple regression analysis, higher food insecurity [adj. OR (95% CI) = 4.64 (2.16–9.96)] and perception that the pandemic negatively impacted ART adherence [adj. OR (95% CI) = 1.96 (1.22–3.16)] remained associated with a greater likelihood of elevated depressive symptoms, when other correlates were controlled for. Qualitative data suggested that economic stressors (lack of food, work, and money) were key contributors to elevated depressive symptoms, and these stressors led to missed ART doses because of lack of food and stress induced forgetfulness. Elevated depressive symptoms significantly increased during the COVID-19 lockdown and was associated with food insecurity and reduced ART adherence. Mechanisms for identifying and treating depression and food insecurity are needed to help PLHIV cope with and mitigate the harmful effects of unexpected crises that may impede disease management and access to food.
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