Coping strategies for depression among HIV-positive women in Gondar town health facilities, Northwest, Ethiopia: A cross-sectional study.

Abstract

Background: Most women living with HIV in low- and middle-income countries remain undiagnosed and untreated for depression. Even though depression has an adverse effect on treatment outcome and disease progression, less attention is given. The progression of depression is influenced by coping mechanism. The aim of this study was to identify the coping strategies used by depressed women living with HIV in Gondar town health facilities, north west, Ethiopia.

Methods: Health institution based cross-sectional study was conducted in Gondar town health facilities, in north-western Ethiopia. All women living with HIV (n = 1043) were screened for depression symptoms using the validated Patient Health Questionnaire, 9 item version (PHQ-9). Those who scored ten or more, "moderate depression among women living with HIV," (n = 435) were included in this study. The BRIEF Coping with Problem Experienced (COPE-28) scale was used to assess coping strategies. Construct validity of the brief COPE was evaluated using confirmatory factor analysis with AMOS 23 software. Linear regression model was fitted and beta coefficients were used to interpret the significant factors for coping strategies at p- values < 0.05 with 95% confidence interval.

Results: Dysfunctional coping strategy was more widely practiced than emotional focused or problem focused coping strategies. From the emotional coping strategy, spiritual believes and praying coping were the most frequently used coping strategies in the study group. Time taken to initiate antiretroviral therapy (ART) less than 5 years and the increment of viral load were significantly associated with dysfunctional coping strategy. Having 1-2 children and fear of COVID-19 were the significant factors for problem focused coping strategy. An increment in emotion focused coping was associated with food insecurity. Social support and distance from health institutions 5 km or more were found to have a positive association with problem and emotion-focused coping strategies. Conversely, time taken to initiate antiretroviral therapy (ART) 5 years and more negatively correlated with both problem and emotion-focused coping mechanisms.

Conclusion: The study revealed that all coping strategies were utilized by depressed women living with HIV (WLWHIV). Strengthening spiritual coping styles proved beneficial in reducing depression among these individuals. It is recommended that depressed WLWHIV practice problem and emotion-focused coping strategies. Additionally, social support enhances both problem and emotion-focused coping approaches. Factors contributing to dysfunctional coping included having started ART less than five years ago and high viral load levels. Therefore, providing holistic support for depressed WLWHIV is essential to improve their mental health.