Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes
•Pharmacological interventions showed the greatest improvement in depression scores.•Meta-analysis showed non-significant improvements in immune status.•Antidepressants alone might not address ART non-adherence associated with MDD.•A combination of psychological and pharmacological treatment is reco...
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| Veröffentlicht in: | Brain, behavior, and immunity behavior, and immunity, 2018-10, Vol.73, p.261-273 |
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| creator | Passchier, Ruth Verity Abas, Melanie Amna Ebuenyi, Ikenna D. Pariante, Carmine M. |
| description | •Pharmacological interventions showed the greatest improvement in depression scores.•Meta-analysis showed non-significant improvements in immune status.•Antidepressants alone might not address ART non-adherence associated with MDD.•A combination of psychological and pharmacological treatment is recommended.
This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p |
| doi_str_mv | 10.1016/j.bbi.2018.05.010 |
| format | Article |
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This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = −0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.</description><identifier>ISSN: 0889-1591</identifier><identifier>EISSN: 1090-2139</identifier><identifier>DOI: 10.1016/j.bbi.2018.05.010</identifier><identifier>PMID: 29768184</identifier><language>eng</language><publisher>Netherlands: Elsevier Inc</publisher><subject>Adult ; Africa South of the Sahara ; Anti-HIV Agents - therapeutic use ; CD4 ; Depression ; Depression - psychology ; Depression - therapy ; Depressive Disorder, Major - immunology ; Depressive Disorder, Major - psychology ; Depressive Disorder, Major - therapy ; Early Medical Intervention - methods ; Female ; HIV - immunology ; HIV Infections - immunology ; HIV Infections - psychology ; HIV/AIDS ; Humans ; Immunopsychiatry ; Intervention ; Male ; Medication Adherence - psychology ; Meta-analysis ; Middle Aged ; Psychoneuroimmunology ; Review ; Sub-Saharan Africa ; Treatment Outcome ; Viral load</subject><ispartof>Brain, behavior, and immunity, 2018-10, Vol.73, p.261-273</ispartof><rights>2018 Elsevier Inc.</rights><rights>Copyright © 2018 Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-3ed8bf9cd0e48ca49f9d6f4196aff65e6a2ebe1f1d89d26b7680f6ea5d3428033</citedby><cites>FETCH-LOGICAL-c396t-3ed8bf9cd0e48ca49f9d6f4196aff65e6a2ebe1f1d89d26b7680f6ea5d3428033</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.bbi.2018.05.010$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29768184$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Passchier, Ruth Verity</creatorcontrib><creatorcontrib>Abas, Melanie Amna</creatorcontrib><creatorcontrib>Ebuenyi, Ikenna D.</creatorcontrib><creatorcontrib>Pariante, Carmine M.</creatorcontrib><title>Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes</title><title>Brain, behavior, and immunity</title><addtitle>Brain Behav Immun</addtitle><description>•Pharmacological interventions showed the greatest improvement in depression scores.•Meta-analysis showed non-significant improvements in immune status.•Antidepressants alone might not address ART non-adherence associated with MDD.•A combination of psychological and pharmacological treatment is recommended.
This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = −0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.</description><subject>Adult</subject><subject>Africa South of the Sahara</subject><subject>Anti-HIV Agents - therapeutic use</subject><subject>CD4</subject><subject>Depression</subject><subject>Depression - psychology</subject><subject>Depression - therapy</subject><subject>Depressive Disorder, Major - immunology</subject><subject>Depressive Disorder, Major - psychology</subject><subject>Depressive Disorder, Major - therapy</subject><subject>Early Medical Intervention - methods</subject><subject>Female</subject><subject>HIV - immunology</subject><subject>HIV Infections - immunology</subject><subject>HIV Infections - psychology</subject><subject>HIV/AIDS</subject><subject>Humans</subject><subject>Immunopsychiatry</subject><subject>Intervention</subject><subject>Male</subject><subject>Medication Adherence - psychology</subject><subject>Meta-analysis</subject><subject>Middle Aged</subject><subject>Psychoneuroimmunology</subject><subject>Review</subject><subject>Sub-Saharan Africa</subject><subject>Treatment Outcome</subject><subject>Viral load</subject><issn>0889-1591</issn><issn>1090-2139</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kU1v3CAQhlHVqtmm_QG9VJyqXuwO_gq0p1WULylSD0l6RRiGLCvbuIA32p_UfxnSTXLsCUY874yYh5DPDEoGrPu-LfvelRUwXkJbAoM3ZMVAQFGxWrwlK-BcFKwV7Ih8iHELAG3N-HtyVImTjjPerMjfM2tRJ7fDCWOk3lKDc8hX5yfqpoQhv6RcRGp9oDP6eUA6uJ2b7umDSxt6efU7g_Rm6YsbtVFBTXRtg9PqB13TuI8JR5WcpgF3Dh_oVzpiUoWa1LCP7t_EOe71xg_-PoeGDLhxXKbX2i9J-xHjR_LOqiHip-fzmNydn92eXhbXvy6uTtfXha5Fl4oaDe-t0Aaw4Vo1wgrT2YaJTlnbtdipCntklhkuTNX1eRFgO1StqZuKQ10fk2-HvnPwfxaMSY4uahwGNaFfoqyggZO2bbjIKDugOvgYA1o5BzeqsJcM5JMhuZXZkHwyJKGV2VDOfHluv_QjmtfEi5IM_DwAmD-ZVxZk1A4njcaFbEoa7_7T_hHRo6VA</recordid><startdate>201810</startdate><enddate>201810</enddate><creator>Passchier, Ruth Verity</creator><creator>Abas, Melanie Amna</creator><creator>Ebuenyi, Ikenna D.</creator><creator>Pariante, Carmine M.</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201810</creationdate><title>Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes</title><author>Passchier, Ruth Verity ; Abas, Melanie Amna ; Ebuenyi, Ikenna D. ; Pariante, Carmine M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c396t-3ed8bf9cd0e48ca49f9d6f4196aff65e6a2ebe1f1d89d26b7680f6ea5d3428033</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Africa South of the Sahara</topic><topic>Anti-HIV Agents - therapeutic use</topic><topic>CD4</topic><topic>Depression</topic><topic>Depression - psychology</topic><topic>Depression - therapy</topic><topic>Depressive Disorder, Major - immunology</topic><topic>Depressive Disorder, Major - psychology</topic><topic>Depressive Disorder, Major - therapy</topic><topic>Early Medical Intervention - methods</topic><topic>Female</topic><topic>HIV - immunology</topic><topic>HIV Infections - immunology</topic><topic>HIV Infections - psychology</topic><topic>HIV/AIDS</topic><topic>Humans</topic><topic>Immunopsychiatry</topic><topic>Intervention</topic><topic>Male</topic><topic>Medication Adherence - psychology</topic><topic>Meta-analysis</topic><topic>Middle Aged</topic><topic>Psychoneuroimmunology</topic><topic>Review</topic><topic>Sub-Saharan Africa</topic><topic>Treatment Outcome</topic><topic>Viral load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Passchier, Ruth Verity</creatorcontrib><creatorcontrib>Abas, Melanie Amna</creatorcontrib><creatorcontrib>Ebuenyi, Ikenna D.</creatorcontrib><creatorcontrib>Pariante, Carmine M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Brain, behavior, and immunity</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Passchier, Ruth Verity</au><au>Abas, Melanie Amna</au><au>Ebuenyi, Ikenna D.</au><au>Pariante, Carmine M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes</atitle><jtitle>Brain, behavior, and immunity</jtitle><addtitle>Brain Behav Immun</addtitle><date>2018-10</date><risdate>2018</risdate><volume>73</volume><spage>261</spage><epage>273</epage><pages>261-273</pages><issn>0889-1591</issn><eissn>1090-2139</eissn><abstract>•Pharmacological interventions showed the greatest improvement in depression scores.•Meta-analysis showed non-significant improvements in immune status.•Antidepressants alone might not address ART non-adherence associated with MDD.•A combination of psychological and pharmacological treatment is recommended.
This meta-analytic review evaluated the effectiveness of depression interventions on the psychological and immunological outcomes of people living with HIV in sub-Saharan Africa. 14 studies, yielding 932 participants were eligible. A random-effects models indicated that depression interventions were followed by large reductions in depression scores (effect size = 1.86, 95% CI = 1.71, 2.01, p < 0.01). No significant effect on immune outcome was observed, however there was a trend toward immune improvement of medium effect size (effect size on CD4 count and/or viral suppression = 0.57, 95% CI = −0.06, 1.20, p = 0.08). Pharmacological interventions appeared to have a significantly larger improvement in depression scores than psychological interventions. The greatest improvement in immune status was demonstrated in psychological treatments which incorporated a component to enhance HIV medication adherence, however these results did not reach significance. Small sample sizes and highly heterogeneous analysis necessitate caution in interpretation. The results of this meta-analysis should thus be treated as preliminary evidence and used to encourage further studies of immunopsychiatry in HIV in sub-Saharan Africa.</abstract><cop>Netherlands</cop><pub>Elsevier Inc</pub><pmid>29768184</pmid><doi>10.1016/j.bbi.2018.05.010</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Africa South of the Sahara Anti-HIV Agents - therapeutic use CD4 Depression Depression - psychology Depression - therapy Depressive Disorder, Major - immunology Depressive Disorder, Major - psychology Depressive Disorder, Major - therapy Early Medical Intervention - methods Female HIV - immunology HIV Infections - immunology HIV Infections - psychology HIV/AIDS Humans Immunopsychiatry Intervention Male Medication Adherence - psychology Meta-analysis Middle Aged Psychoneuroimmunology Review Sub-Saharan Africa Treatment Outcome Viral load |
| title | Effectiveness of depression interventions for people living with HIV in Sub-Saharan Africa: A systematic review & meta-analysis of psychological & immunological outcomes |
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