title: The impact of a livelihood program on depressive symptoms among people living with HIV in Cambodia.
abstract: BACKGROUND
  Psychological and social problems are major concerns in this era of successful antiretroviral therapy. Although livelihood programs have been implemented extensively to improve the daily living conditions of people living with HIV in Cambodia, no studies have yet investigated the impacts of these programs on the mental health of this vulnerable population. Therefore, we examined the impact of a livelihood program on depressive symptoms and associated factors among people living with HIV in Cambodia.
  
  
  METHODS
  A quasi-experimental, nonequivalent comparison group study was conducted in six provinces of Cambodia in 2014. Data were collected from an intervention group comprising 357 people living with HIV who had participated in the livelihood program and a comparison group comprising 328 people living with HIV who had not participated in this program. Multiple logistic regression analysis was carried out to examine the association between livelihood-program participation and depressive symptoms as measured by the depressive symptoms subscale of the 25-item Cambodian version of the Hopkins Symptom Checklist. A propensity score matching was used to examine the effect of the livelihood program on depressive symptoms while controlling for selection bias.
  
  
  RESULTS
  Overall, 56.0% and 62.7% of the participants in the intervention and comparison groups, respectively, met the Hopkins Symptom Checklist threshold for depressive symptoms. The multiple logistic regression analysis showed that the participants in the intervention group had significantly lower odds of having depressive symptoms (adjusted odds ratio 0.68, 95% confidence interval 0.52-0.88). The analysis from propensity score matching indicated that the livelihood program helped mitigate depressive symptoms among the participants in the intervention group (T=-1.99).
  
  
  CONCLUSIONS
  The livelihood program appeared to help mitigate the burden of depressive symptoms among people living with HIV in Cambodia. Thus, this program should be scaled up and modified to better improve participants' mental health.
authors: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Mayumi
authors: M
authors: Shimizu
authors: KHANA Center for Population Health Research, Phnom Penh, Cambodia.
authors: Siyan
authors: S
authors: Yi
authors: KHANA Center for Population Health Research, Phnom Penh, Cambodia.
authors: Sovannary
authors: S
authors: Tuot
authors: KHANA Center for Population Health Research, Phnom Penh, Cambodia.
authors: Samedy
authors: S
authors: Suong
authors: KHANA Social Enterprise, Phnom Penh, Cambodia.
authors: Samrithea
authors: S
authors: Sron
authors: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Akira
authors: A
authors: Shibanuma
authors: Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; mjimba@m.u-tokyo.ac.jp.
authors: Masamine
authors: M
authors: Jimba
keywords: Cambodia; depressive symptoms; livelihood program; people living with HIV; quasi-experimental nonequivalent comparison group study