Understanding depression and the PHQ-9 items among people living with HIV

A multiple methods qualitative study in Yaoundé, Cameroon

Bibliographic Data

ID21257408
AuthorsNatalia Zotova (0000-0001-5396-8304, Albert Einstein College of Medicine, corresponding author), Dana Watnick (0000-0002-8886-9848, Albert Einstein College of Medicine), Rogers Ajeh (0000-0002-5361-5063), Rogers Awoh Ajeh, Elodie Flore Tchiengang Moungang, Julie Laure Nguemo Noumedem, Guy Calvin Nko'o Mbongo'o, Guy Calvin Nko’o Mbongo’o (Université de Dschang), Kathryn Anastos (0000-0002-0769-6405, Albert Einstein College of Medicine), Marcel Yotebieng (0000-0003-2110-2631, Albert Einstein College of Medicine)
Year2024
Volume6
Pages100353
Publication date2024-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueSSM - Mental Health (JOURNAL)
Journal identifiersISSN: 2666-5603 • E-ISSN: 2666-5603
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.ssmmh.2024.100353
PMID39749043
OpenAlexW4403117654
LanguageEN
Citations received1
References cited42

People living with HIV (PLWH) are disproportionately affected by depression, which often remains underdiagnosed and untreated, negatively impacting quality of life and treatment outcomes. Low resource settings often lack clinical professionals to identify depression, therefore screening tools such as the PHQ-9 allow for broader depression screening. This qualitative study among PLWH in Yaoundé Cameroon aimed to a) explore local understandings of depression and mental distress and b) assess comprehension and interpretation of the PHQ-9 items and response categories. This study was nested in a larger study that assessed performance of the PHQ-9 among PLWH in Central, East, and West Africa. In Yaoundé, Cameroon, 30 in-depth interviews (IDIs) and 24 cognitive interviews (CIs) were conducted with PLWH to explore how depression is experienced and to examine understanding and interpretation of the PHQ-9 items. Thematic analysis was used to identify emergent themes across IDIs focusing on shared understandings of depression. An interpretivist content analysis of CIs incorporated understandings of PHQ-9 items into cognitive processes of interpretation, retrieval, judgment, and response formulation. Out of 54 unique study participants, 15% (n = 8) had depressive symptoms (PHQ-9 score >9). The PHQ-9 items related to somatic manifestations of depression were understood as intended by most participants, while other items were not consistently understood and interpreted. “Thinking too much” and similar cognitive manifestations were central for local understandings of depression. Cognitive and somatic symptoms commonly intertwined and were often linked to experiences living with HIV. Local understanding of depression may not align with Western defined depression criteria, and symptoms related to HIV may conflate symptoms of depression. Incorrect interpretations of almost half of the PHQ-9 items suggests this tool may have limited validity in PLWH, and warrants the need for further testing and adaptation. Further research should be done to develop culturally relevant screening tools among PLWH. • People living with HIV (PLWH) are disproportionately affected by depression, which necessitates the need for depression screening. • Low-resource settings with high burden of HIV benefit from the use of structured screening tools such ad the PHQ-9. • Excess thought, sleep and appetite problems, and fatigue were central for understandings of depression among Cameroonian PLWH. • Cognitive and somatic symptoms commonly intertwined and were often linked to experiences living with HIV • Poor overlap between local understandings of depression and the PHQ-9 items suggests limited validity of the screener in PLWH

Environmental health · Family medicine · Psychiatry · Qualitative research · Social science · Sociology · Clinical Psychology · Family Caregiving in Mental Illness · HIV/AIDS Research and Interventions · Medicine · Mental Health Treatment and Access · Psychology