Psychiatric morbidity in HIV-positive subjects: A study from India☆
Introduction
The relationship between HIV-AIDS and psychiatric disorders is well recognized to be both uni- and bi-directional, and influenced by a variety of factors like stigma, educational level, concurrent substance abuse, presence of AIDS in the spouse, family support, neurocognitive disturbances, opportunistic infections and medication side-effects, treatment adherence and the course of HIV infection [1]. The introduction of highly active antiretroviral therapy (HAART) having transformed the HIV infection from a quickly fatal to a chronic disease [2] is another contributing variable.
One meta-analysis and other large studies in HIV-positive subjects reported prevalence rates of 20–50% for depressive symptoms, 4–23% for major depressive disorder (MDD), up to 13% for dysthymia and 2–40% for substance abuse/dependence (predominantly for alcohol) [3], [4], [5]. The HIV studies from the US have reported an annual prevalence of 47.9% for psychiatric disorders including MDD in 36%, dysthymia in 26.5%, generalized anxiety disorder in 15.8%, panic attacks in 10.5%, substance abuse in 21% and dual diagnosis in 8% subjects [6], [7].
In comparison, the prevalence of the commonest psychiatric syndrome, i.e., depression, has been reported as 2–56% in sub-Saharan Africa [8], [9], [10], [11], [12], [13], [14] and 10–40% in India [15], [16]. The variation is probably explained by the differences in study population, study design, age, sex, education, ethnicity and stage of HIV/AIDS [17]. One important factor in this context is the translation, modification and standardization of the Western assessment tools for the non-Western populations [18]. An example is the multilingual WHOQOL-100 questionnaire which shows similar basic factors inherent to the quality of life across cultures worldwide [19].
With a prevalence of 0.36% and 2.47 million afflicted persons, HIV-AIDS is a new epidemic in India [20]. Similar to the global scenario, the commonest route is the high-risk sexual behavior; except for the northeastern states where injecting drug use is a bigger contributor [21], [22]. Yet, the existing psychiatric research on HIV-AIDS in India has focused mostly on co-prevalence of intravenous drug abuse and, to a lesser extent, on psychiatric morbidity [1], [13], [23]. With this background, the present research attempted to assess the psychiatric morbidity in HIV-positive outpatient subjects in north India.
Section snippets
Location, ethical clearance, and design
The study was conducted at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, a 1500-bed multispecialty teaching hospital providing services to approximately 40 million people in north India.
As an MD Psychiatry research thesis of the first author, the research had received institutional ethical clearance, was time bound, and involved a cross-sectional design, a purposive sampling procedure, and one-time assessment of each subject.
Subjects
The sample consisted of
Demographic profile
The subjects in the HIV group were younger, less educated, and males, with higher proportion of skilled workers, Sikhs, and village dwellers than in the RA group (Table 1).
Disease profile
The self-reported source of HIV infection was most commonly sexual contact (58%, equal across men and women); 35% of subjects reported ‘not suspecting any source’; and injecting drugs, blood products, and artificial insemination were suspected only in 2%, 4%, and 1% of cases, respectively. The mean CD4 count at intake into
Discussion
The demographic profile of our HIV group generally matches the one reported from India [5], [32] and the West [33]. The nonheterosexual orientation in 2% of our sample tallies with a 2005 Indian report of homosexual transmission in 0.74% cases [34], although the Western studies report higher proportion of homo-/bisexuals (64.7–91%) [35], [36].
Compared to the literature, the rates in our HIV group are similar for depression (24% vs. 15.5–30%) [33], [34], [37], but lower for other disorders:
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Disclaimer: No conflict of interest in this research. The researchers or this research was not funded by any agency.