Demographic, psychosocial, and health-related factors associated with depressive symptoms in older adults receiving antiretroviral therapy in a South African metropolitan
1
Centre for Health Systems Research & Development, University of the Free State, Bloemfontein, South Africa
2
Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, United States
3
Department of Psychology, University of the Free State, Bloemfontein, South Africa
4
Free State Department of Health, University of the Free State, Bloemfontein, South Africa
5
Department of Psychiatry, University of the Free State, Bloemfontein, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Globally, mental health disorders, including depression, present a key challenge among older people living with HIV (OPLHIV) – defined as those aged 50 years and older. Evidence, largely from high-income countries, highlights a complex interplay between aging, HIV, and psychosocial vulnerability. However, data from sub-Saharan Africa remains limited. This study examined demographic, psychosocial, and health-related factors associated with depressive symptoms among OPLHIV receiving antiretroviral therapy (ART) in a South African metropolitan area.
METHODS:
Data were gathered cross-sectionally through fieldworker-administered interviews with 382 OPLHIV attending primary health care facilities. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic variables included age, sex, education level, and home language. Psychosocial variables comprised HIV-related stigma, substance use as a coping strategy, and perceived social support. Health-related variables included comorbidity status and self-rated health satisfaction. Multivariable linear regression was used to identify factors associated with depressive symptoms.
RESULTS:
Participants’ mean age was 57.4 (standard deviation [SD]: 5.5) years. Overall depressive symptom burden was low (mean PHQ-9 score = 2.0; SD: 3.7). Higher PHQ-9 scores were significantly associated with greater HIV disclosure concerns (B = 0.207, p = 0.007) and higher educational attainment (B = 1.013, p < 0.001). Sesotho home language was associated with lower PHQ-9 scores compared to other languages (B = -0.738, p = 0.031), while lower self-rated satisfaction with health was associated with higher scores (B = -0.545, p = 0.029). Support from friends was inversely associated with depressive symptoms, suggesting a protective effect (B = -0.222, p < 0.001).
CONCLUSIONS:
Despite a low overall prevalence of clinically significant depression, symptoms were patterned by HIV-related stigma, social support, coping behaviour, and contextual factors. These findings suggest the need for targeted, preventive mental health interventions that integrate stigma reduction, substance use screening, and social support strengthening with HIV screening services.
Globally, mental health disorders, including depression, present a key challenge among older people living with HIV (OPLHIV) – defined as those aged 50 years and older. Evidence, largely from high-income countries, highlights a complex interplay between aging, HIV, and psychosocial vulnerability. However, data from sub-Saharan Africa remains limited. This study examined demographic, psychosocial, and health-related factors associated with depressive symptoms among OPLHIV receiving antiretroviral therapy (ART) in a South African metropolitan area.
METHODS:
Data were gathered cross-sectionally through fieldworker-administered interviews with 382 OPLHIV attending primary health care facilities. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Demographic variables included age, sex, education level, and home language. Psychosocial variables comprised HIV-related stigma, substance use as a coping strategy, and perceived social support. Health-related variables included comorbidity status and self-rated health satisfaction. Multivariable linear regression was used to identify factors associated with depressive symptoms.
RESULTS:
Participants’ mean age was 57.4 (standard deviation [SD]: 5.5) years. Overall depressive symptom burden was low (mean PHQ-9 score = 2.0; SD: 3.7). Higher PHQ-9 scores were significantly associated with greater HIV disclosure concerns (B = 0.207, p = 0.007) and higher educational attainment (B = 1.013, p < 0.001). Sesotho home language was associated with lower PHQ-9 scores compared to other languages (B = -0.738, p = 0.031), while lower self-rated satisfaction with health was associated with higher scores (B = -0.545, p = 0.029). Support from friends was inversely associated with depressive symptoms, suggesting a protective effect (B = -0.222, p < 0.001).
CONCLUSIONS:
Despite a low overall prevalence of clinically significant depression, symptoms were patterned by HIV-related stigma, social support, coping behaviour, and contextual factors. These findings suggest the need for targeted, preventive mental health interventions that integrate stigma reduction, substance use screening, and social support strengthening with HIV screening services.
| eISSN: | 2654-1459 |
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