Predictors of depression and psychometric evaluation of the Beck Depression Inventory-II (BDI-II) among adults on highly active antiretroviral therapy in Maiduguri, North-Eastern Nigeria

Abstract

Background: Depression is the commonest neuropsychiatric disorder among people living with HIV (PLHIV) but it remains highly underdiagnosed among this vulnerable group due mainly to low index of suspicion on the part of clinicians and the lack of brief, reliable and valid screening instruments in the very busy clinics of sub-Saharan Africa. Objective: This study assessed the predictors of depression among adults on highly active antiretroviral therapy (HAART) at the University of Maiduguri Teaching Hospital (UMTH) as well as evaluated the psychometric properties of the shorter version Beck Depression Inventory (BDI-II) among the subjects. Methods: This was a two-staged cross sectional survey conducted on 303 adults on HAART who were selected through the systematic random sampling technique at theARTclinic of the UMTH. In the first stage, anonymous sociodemographic questionnaire and the BDI – II were administered, while in the second stage, subjectswhomet the cut off score of 18 together with 30% of those with lower scores were administered the depressive disorder module of the composite international diagnostic interview (CIDI) as the gold standard. Bivariate and logistic regression analyses were used to determine the predictors of depression while Cohen's Kappa, Cronbach's alpha and the validity coefficients were computed to determine the psychometric properties. Results: Over 20% of the subjects were depressed. Female gender, past history of psychiatric illness, family history of psychiatric ailment and short duration of HIV seropositivity were significant predictors of depression with the following odds ratios; O.R. = 2.820, p = 0.006, O.R. = 23.420, p = <0.001, O.R. = 7.872, p = 0.002 and O.R. = 0.332, p = <0.001 respectively. The psychometric properties were excellent with Kappa and Alpha values of > 0.9 each, sensitivity and specificity of > 90% each, with positive and negative predictive values of > 91% each. Conclusions: Depression affects one out of every five HIV+ subjects and the BDI – II is a valid instrument for the detection of depression in this group. We therefore recommend the routine screening of depression among adults on HAART with vulnerability factors using this instrument.