Findings of the study provide valuable information about depression among HIV/AIDS patients. We found that about nearly half of participants had depression. Participants who had; a lower CD4 cell count, poor drug adherence and poor social support were more likely to suffer from depression. In addition, having HIV related stigma, living alone and being female were also positively associated with depression.
In this study, the prevalence of depression among adult HIV/AIDS patients on ART was 44.3% (95% CI: 39.4% − 49.2%). This figure was in line with studies conducted in Ethiopia Gimbi general Hospital, south west Ethiopia (13), Harar town, eastern Ethiopia (14), Alert Hospital, Addis Ababa (15) and Tigray region (16) with the prevalence of 41.7%, 45.8%,41.2% and 43.9% respectively.
However, the result of this study was lower than what was reported from Brazil (17), India (18) and Sudan (19) and with the prevalence of 53.5%,58.7%and 63.1% % respectively. The difference could be attributed to the socio demographic factors, study setting and sample size differences. Compared to our study, small sample size used for studies conducted in India and Brazil.
In contrast, the finding of this study was higher than what was obtained in previous studies at Cameron (20), Nigeria (21), Uganda (22), East Africa (23) and Debrebirhan Referral Hospital, North Showa, Ethiopia (24) with the prevalence of 26.7%,39.6%, 8.1%, 38.9% and 38% respectively. The discrepancy might be due to variation in socio demographic factors; sample size, study time, study population and study design. Compared to our study, the study population was recruited age of 21 years and above, and large sample size was used for study conducted in Cameron and Uganda respectively. We used cross sectional study design, whereas study reported from East Africa used a systematic review and meta-analysis.
The present study revealed that female respondents were significantly associated with depression. Female conferred twofold increased odds for depression relative to the male which was supported with the studies done at Zimbabwe (AOR = 2.32, 95% CI:1.07–5.05) (25), Entebbe district in Uganda (AOR = 2.04, 95% CI: 1.88, 4.75) (26) and Debirebirhan Referral Hospital in Ethiopia (AOR = 2.07, 95% CI: 1.07, 3.98) (19).The possible gender discrepancy found in this study could be due to the biological, psychological and socio cultural factors.
Our study results also suggest that living condition of the study participants was significantly associated with depression among HIV/AIDS patients on ART. Those respondents who were living alone were 3 times more likely to have depression when compared to those respondents who were living with family which was in agreement with studies conducted at Hawassa University Comprehensive Specialized Hospital and Yirgalem General Hospital, south Ethiopia (AOR = 1.94, 95% CI: 1.06, 3.56) (27).This might be happened that lack of interpersonal relationship between family, friends and other community members with HIV patients can leads to depression.
Concerning the HIV related stigma status of the study participants, that HIV related stigma was significantly associated with depression. The odds of depression among respondents with HIV related stigma about 3 times more likely as compared to the odds of depression among respondents who had no HIV related stigma. This was consistent with studies conducted in Ethiopia at Alert Hospital, Addis Ababa (AOR = 3.60, 95% CI 2.23, 5.80 (20) and at Hawassa University Comprehensive Specialized Hospital, Hawassa (AOR = 2.83, 95% CI 1.78, 4.48) (12).This might be having HIV related stigma might be associated with Self isolation which can increase a sense of depression and complicate relation with family, friend and other community members.
The result of this study also indicated there was a statistically significant association found between social support and depression. This shows that participants who had poor support 2.55 times tend to have depression than those without social support. This result is in agreement with a study conducted in Ethiopia ,at Alert Hospital, Addis Ababa (AOR = 2.02, 95% CI: 1.25, 3.27) (20) and at Hawassa University Comprehensive specialized Hospital, Hawassa (AOR = 2.53, (95% CI 1.70, 9.13) (18). This might be due to worry about telling about their status and some might choose to withdraw due to pressure from the stigma and hopelessness that can limit social support, which in turn leads to depression.
For clinical-related variables in this study, high depression scores were significantly associated with low CD4 count. This finding is supported with studies reported in Cameroon (AOR = 3.70, 95% CI: 1.45–9.09) (28) and in Hawassa University Comprehensive Specialized Hospital, Hawassa, Ethiopia (AOR = 2.317, 95% CI: (1.10, 4.84) (12). This might be due to patients with lower CD4 count are probably having more symptoms of HIV infection and consequently more emotional and physical disability.
Respondents who had poor medication adherence were 2 times more likely to develop depression as compared with those who had good medication adherence. Our finding consistent with studies done in Cameron (AOR = 5.04, 95% CI 2.84–8.97) (20) and in Alert Hospital, Addis Ababa, Ethiopia (AOR = 1.61, 95% CI: 1.02, 2.55) (20). The possible explanation might be poor medication adherence has been brought in emergence of drug resistance strains of HIV, that results in increase in viral load which leads to immune suppression and poor health outcome. This can be explained by the fact that patients with a more severe and progressive illness would be more likely to be depressed.