title: Prevalence of depressive symptoms in pregnant and postnatal HIV-positive women in Ukraine: a cross-sectional survey.
abstract: BACKGROUND
  Perinatal depression among HIV-positive women has negative implications for HIV-related and other maternal and infant outcomes. The aim of this study was to investigate the burden and correlates of perinatal depression among HIV-positive women in Ukraine, a lower middle income country with one of the largest HIV-positive populations in Europe.
  
  
  METHODS
  Cross-sectional surveys nested within the Ukraine European Collaborative Study were conducted of HIV-positive women at delivery and between 1 and 12 months postpartum. Depressive symptoms in the previous month were assessed using a self-report screening tool. Other data collected included demographics, antiretroviral therapy (ART)-related self-efficacy, and perceptions of risks/benefits of interventions to prevent mother-to-child transmission (PMTCT). Characteristics of women with and without a positive depression screening test result were compared using Fisher's exact test and χ2 test for categorical variables.
  
  
  RESULTS
  A quarter (27% (49/180) antenatally and 25% (57/228) postnatally) of participants screened positive for depressive symptoms. Antenatal risk factors were living alone (58% (7/12) vs. 25% (42/167) p = 0.02), being somewhat/terribly bothered by ART side effects (40% (17/43) vs. 23% (30/129) not /only slightly bothered, p = 0.05) and having lower ART-related self-efficacy (43% (12/28) vs. 23% (25/110) with higher self-efficacy, p = 0.05). Postnatally, single mothers were more likely to screen positive (44% (20/45) vs. 21% (18/84) of cohabiting and 19% (19/99) of married women, p < 0.01) as were those unsure of the effectiveness of neonatal prophylaxis (40% (20/45) vs. 18% (28/154) sure of effectiveness, p < 0.01), those worried that neonatal prophylaxis could harm the baby (30% (44/146) vs. 14% (10/73) not worried p < 0.01) and those not confident to ask for help with taking ART (48% (11/23) vs. 27% (10/37) fairly confident and 15 % (4/26) confident that they could do this). Of women who reported wanting help for their depressive symptoms, 82% (37/45) postnatally but only 31% (12/39) antenatally were already accessing peer counselling, treatment adherence programmes, support groups or social services.
  
  
  CONCLUSIONS
  A quarter of women screened positive for depression. Results highlight the need for proactive strategies to identify depressive symptoms, and an unmet need for provision of mental health support in the perinatal period for HIV-positive women in Ukraine.
authors.affiliation: Population, Policy and Practice Programme, UCL Institute of Child Health, University College London, London, UK. heather.bailey@ucl.ac.uk.
authors.forename: Heather
authors.initials: H
authors.lastname: Bailey
authors.affiliation: Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
authors.forename: Ruslan
authors.initials: R
authors.lastname: Malyuta
authors.affiliation: Perinatal Prevention of AIDS Initiative, Odessa, Ukraine.
authors.forename: Igor
authors.initials: I
authors.lastname: Semenenko
authors.affiliation: UCL Institute of Child Health, University College London, London, UK.
authors.forename: Claire L
authors.initials: CL
authors.lastname: Townsend
authors.affiliation: UCL Institute of Child Health, University College London, London, UK.
authors.forename: Mario
authors.initials: M
authors.lastname: Cortina-Borja
authors.affiliation: UCL Institute of Child Health, University College London, London, UK.
authors.forename: Claire
authors.initials: C
authors.lastname: Thorne
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D015331:Cohort Studies; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy / Q000523:psychology* / Q000635:transmission / Q000821:virology; D006306:Health Surveys; D006801:Humans; D059012:Lost to Follow-Up; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D049590:Postpartum Period; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy / Q000821:virology; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000523:psychology* / Q000821:virology; D011263:Pregnancy Trimester, Third; D015995:Prevalence; D012307:Risk Factors; D014455:Ukraine / Q000453:epidemiology
chemical_list: D044966:Anti-Retroviral Agents
keywords: Antiretroviral therapy; Depression; Eastern Europe; HIV infection; Postpartum period; Pregnancy; Prevention of mother-to-child transmission; Ukraine