title: Impact of HIV antiretroviral therapy on depression and mental health among clients with HIV in Uganda.
abstract: OBJECTIVE
  With wide-reaching harmful effects of depression, and the absence of psychiatric treatment in most HIV care programs in sub-Saharan Africa, we examined the effects of antiretroviral therapy (ART) on depression and other mental health indicators.
  
  
  METHODS
  602 patients (302 non-ART, 300 ART) were followed for the first 12 months of HIV care in Uganda, with assessments at entry into care and Months 6 and 12. Mental health was assessed with measures of depression, hopelessness, and internalized HIV stigma; physical health functioning was assessed as an explanatory variable.
  
  
  RESULTS
  Thirteen percent had clinical depression, 57% had elevated depressive symptoms, and CD4 cell count was negatively correlated with measures of depression at baseline. Significant reductions in elevated depressive symptoms (time: odds ratio [95% confidence interval] = 0.53 [0.43-0.64]) and hopelessness (time: β = -0.12, p < .001) were observed in both the ART and non-ART groups, but the drop in depression was greater among ART patients in intention-to-treat multivariate analysis (ART × time: p < .001). When added to the regression models, change in physical health functioning predicted positive longitudinal change on measures of depression, hopelessness, and internalized stigma (all p values < .001), yet ART status remained a significant independent predictor of each (ART × time: p values ranged from < .05 to < .001). Most mental health benefits of ART were experienced in the first 6 months of care.
  
  
  CONCLUSIONS
  These findings demonstrate the mental health benefits of HIV care and ART. However, in some people, mental health problems persist once physical health is stabilized, in which case mental health treatment may be needed.
authors.affiliation: RAND Corporation, Santa Monica, California 90407, USA. gwagner@rand.org
authors.forename: Glenn J
authors.initials: GJ
authors.lastname: Wagner
authors.forename: Bonnie
authors.initials: B
authors.lastname: Ghosh-Dastidar
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Garnett
authors.forename: Cissy
authors.initials: C
authors.lastname: Kityo
authors.forename: Peter
authors.initials: P
authors.lastname: Mugyenyi
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000208:ethnology / Q000523:psychology; D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015331:Cohort Studies; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology*; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology / Q000523:psychology*; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D007389:Internal-External Control; D008297:Male; D009042:Motivation; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology; D057545:Social Stigma; D014454:Uganda
chemical_list: D019380:Anti-HIV Agents