HIV-Devastated Villages Show High Rates of Depression

The most frequently cited problems were poverty, increased numbers of orphans, and lack of child care. However, many persons also cited psychological problems, and those individuals were interviewed further to learn about the psychological difficulties. These individuals were also asked to name other community members who were especially knowledgeable about the subject of mental health problems stemming from HIV disease, and they were interviewed as well.

Interview results revealed that two similar, but not identical, psychological syndromes seemed to be prevalent among Rakai and Masaka villagers as a result of the HIV epidemic. They were called “Okwekubaziga” and “Yo’kwekyawa” and included symptoms such as feeling sad, feeling lonely, worrying too much, low energy, crying easily, feeling no interest in things, feeling worthless, and thoughts of killing oneself. In fact, when the symptoms of the two syndromes were pooled, they included all nine DSM-IV “A” criteria for major depression.

However, “Okwekubaziga” appeared to correspond more closely to a classic major depressive episode as defined by DSM-IV, whereas “Yo’kwekyawa” appeared to be more of a major depression with mood-congruent psychotic features. The reason is that the latter included, along with the depressive symptoms, symptoms such as “bad, criminal, or reckless behavior” and “hating the world and wanting vengeance” that may have been driven by a delusional belief system.

Neither syndrome contained any symptoms of PTSD. In fact, none of the study informants reported any symptoms specific to that disorder among their villagers.

The results have some practical implications. For instance, Bolton is now conducting a clinical trial to determine whether group interpersonal therapy is effective in countering depression in Ugandans who live in communities where HIV infection rates are extremely high. If it is found to be effective, then World Vision Uganda will include group interpersonal psychotherapy for depression among its humanitarian aid to Ugandans, Wilk told Psychiatric News.

Also, if Ugandans are effectively treated for their HIV-provoked depression, then they might be less likely to engage in behaviors that spread HIV, Wilk and Bolton pointed out in their study report. The reason? People are more likely to engage in behaviors that spread HIV when they are depressed than when they are not, other investigators have found.

The study was part of the Complex Emergency Response and Transition Initiative, a project of the Africa Bureau of the U.S. Agency for International Development. The study was also conducted in collaboration with World Vision Uganda.