Understanding the influence of depression on self-efficacy, work status and condom use among HIV clients in Uganda

Objectives: Depression is common among persons living with HIV/AIDS in sub-Saharan Africa, yet few studies in the region have assessed the relationship of depression to economic wellbeing and risk-reduction behavior. Among HIV clients in Uganda, we examined whether depression is directly related to self-efficacy, work status, and condom use, as well as indirectly through its interaction with physical health functioning. Methods: Baseline data from a prospective longitudinal cohort of 602 clients entering HIV care were examined. In separate multivariate analyses, we examined whether depression [both depressive severity and clinical depression, as measured by the nine-item Patient Health Questionnaire (PHQ-9)], physical health functioning, and their interaction were predictors of current work status, consistent condom use, and general self-efficacy, controlling for measures of social support, stigma, and demographics. Results: Mean PHQ-9 score was 5.2 (S.D.=3.9; range=0-24) and 13% had scores >= 10 (indicator of clinical depression). Not being depressed, better physical health, and their interaction were predictors of working, while lower depressive severity, lower physical health, and their interaction were associated with always using condoms. Better physical health was predictive of greater self-efficacy, but not depression; general self-efficacy was predictive of both work status and condom use. Conclusions: Effective diagnosis and treatment of depression may be critical to maximizing the benefits of HIV treatment with regard to both HIV prevention and restoring the social and economic health of persons living with HIV. (c) 2010 Elsevier Inc. All rights reserved.