Prevalence of Depression and Generalized Anxiety Disorder and their Contributing Factors among Older People Receiving HIV Treatment in Homa Bay County, Kenya.

Mental health disorders have increased substantially over the past two decades and are a major contributor to the global burden of disease. Despite advances in HIV diagnosis, treatment, and management, older people living with HIV remain vulnerable to mental health conditions, particularly depression and generalized anxiety disorder (GAD). This study examined the prevalence of depression and generalized anxiety disorder among older people receiving HIV treatment in Homa Bay Township Sub-County, Homa Bay County, Kenya. The study adopted a descriptive cross-sectional research design guided by the Biopsychosocial Model. The target population comprised 4,288 older people receiving HIV treatment, from whom a sample of 372 participants was selected using systematic random sampling. Data were collected using a structured questionnaire. Face and content validity were established through expert review, and data were analysed using descriptive statistics (frequencies, percentages, means, and standard deviations). Qualitative responses were analysed thematically. A total of 355 participants aged 50 years and above were included in the analysis, representing a response rate of 95.4%. Overall, 47.6% of the participants had moderate to severe depressive symptoms (PHQ-9 score ≥10), while 43.4% had moderate to severe generalized anxiety symptoms (GAD-7 score ≥10). Loss of a loved one HIV-related inflammation, sleeplessness stigma and discrimination and opportunistic infections were the most highly perceived factors contributing to depression and anxiety. Participants recommended strengthening counselling and psychological support, integrating routine mental health screening into HIV care, establishing peer support groups among others to improve mental health outcomes. The study concludes that depression and generalized anxiety disorder are common among older people receiving HIV treatment in Homa Bay Township Sub-County.

Depression, Mental disorder, prevalence

1. Abayomi, O., Adelufosi, A., Adebayo, P., Ighoroje, M., Ajogbon, D., Oqunwale, A. (2013). HIV Risk Behavior in Persons with Severe Mental Disorders in A Psychiatric Hospital in Ogun, Nigeria. Ann Med Health Sci Res 2013; 3:380–384. [Google Scholar] [Crossref]

2. Abdilahi, Y. (2020). Anxiety and Depression Among Women Living with HIV: Prevalence and Correlations College of Medicine and Health Sciences, Jijiga University, Jijiga, Ethiopia [Google Scholar] [Crossref]

3. Acuda, S.W., Sebit M.B., (1996). Serostatus surveillance testing of HIV-I infection among Zimbabwean psychiatric inpatients, in Zimbabwe. Cent Afr J Med 42:254–257. [Google Scholar] [Crossref]

4. Adeoti, A.O., Dada, M.U., Fadare, J.O. (2018). Prevalence of Depression and Anxiety Disorders in People Living with HIV/AIDS in a Tertiary Hospital in South Western Nigeria. Med Rep Case Stud 3: 150. doi:10.4172/2572-5130.1000150 [Google Scholar] [Crossref]

5. Algarin AB, Zhou Z, Cook CL, Cook RL, Ibañez GE (2019). Age, sex, race, ethnicity, sexual orientation: intersectionality of marginalized-group identities and enacted HIV related stigma among people living with HIV in Florida. AIDS Behav 23 (11):2992–3001. doi: 10.1007/s10461-019-02629-y [Google Scholar] [Crossref]

6. Alonso, J., Liu, Z., Evans-Lacko. S., (2018). Treatment gap for anxiety disorders is global: results of the world mental health surveys in 21 countries. Depress Anxiety. 35 (3):195–208. Doi:10.1002/Da.22711. [Google Scholar] [Crossref]

7. American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders Washington, DC: American Psychiatric Association; [Google Scholar] [Crossref]

8. Antelman, G., Kaaya, S., Wei, R., Mbwambo, J., Msamanga, G.I., Fawzi, W.W, et al (2007). Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. Acquired Immune Deficiency Syndrome 44:470–477. [Google Scholar] [Crossref]

9. Autenrieth, C.S., Beck, E.J, Stelzle D, et al. (2020) Global and regional trends of people living with HIV aged 50 and over: estimates and projections for 2000-2020. PLo [Google Scholar] [Crossref]

10. Badiee, J., Moore, D. J., Atkinson, J. H., Vaida, F., Gerard, M., Duarte, N. A., . . . Grant, I. (2012). Lifetime suicidal ideation and attempt are common among HIV+ individuals. J Affect Disord, 136(3), 993-999. doi:10.1016/j.jad.2011.06.044 [Google Scholar] [Crossref]

11. Bavinton, B.R., Pinto A.N., Phanuphak, N., Grinsztejn, B., Prestage, G.P., Zablotska-Manos, I.B, (2018). Viral suppression and HIV transmission in sero discordant male couples: an international, prospective, observational, cohort study. Lancet HIV; 5:e438–e447. [Google Scholar] [Crossref]

12. Beckerman, N.L, & Auerbach, C. (2010). Posttraumatic stress disorder and HIV a snapshot of co-occurrence. Soc Work Health c; 49:687–702] . [Google Scholar] [Crossref]

13. Berhe, B. G. (2018) Depression among adult HIV/AIDS patients attending art clinics at Aksum town, Aksum, Ethiopia: a cross-sectional study. College of Health Sciences, Aksum University, Aksum, Ethiopia [Google Scholar] [Crossref]

14. Bernard, C., Dabis, F., de Rekeneire, N. (2017). Prevalence and factors associated with depression in people living with HIV in sub-Saharan Africa: a systematic review and meta-analysis’ PLoS One. 2017;12(8) doi: 10.1371/journal.pone.0181960. e0181960–e0181960. [Google Scholar] [Crossref]

15. Bhatia, M.S., & Munjal, S. (2014). Prevalence of depression in people living with hiv/aids undergoing art and factors associated with it. J Clin Diagn Res 8:Wc01–Wc04. [Google Scholar] [Crossref]

16. Bing, E.G., Burnam, M.A., Longshore, D., Fleishman, J.A., Sherbourne, C.D., London, A.S. (2001). psychiatric disorders and drug use among human immunodeficiency virus-infected adults in The United States. Arch Gen Psychiatry 58:721–728. [Google Scholar] [Crossref]

17. Bird, S.T., Bogart, L.M. (2001) Perceived race-based and socioeconomic status (ses)-based discrimination in interactions with healthcare providers. Ethn Dis; 11:554–563. [Google Scholar] [Crossref]

18. Bogart, L.M., Wagner, G.J., Galvan, F.H, Landrine, H., Klein, D.J., Sticklor, L.A. (2011). Perceived discrimination and mental health symptoms among black men with HIV. Cult Divers Ethn Minor Psychol; 17:295–302. [Google Scholar] [Crossref]

19. Bonfils, K.A., Firmin, R.L., Salyers, M.P., Wright, E.R. (2015) Sexuality and intimacy among people living with serious mental illnesses: factors contributing to sexual activity. Psychiatr Rehabil J; 38:249–255. [Google Scholar] [Crossref]

20. Chibanda, D. (2017). Reducing the treatment gap for mental, neurological and substance use disorders in Africa: lessons from the friendship bench in Zimbabwe. Epidemiol Psychiatr Sci; 26:342–347. [Google Scholar] [Crossref]

21. Chibanda, D., Mesu, P., Kajawu, L., Cowan, F., Araya, R., Abas, M. (2011). Problem-solving therapy for depression and common mental disorders in Zimbabwe: piloting a task-shifting primary mental health care intervention in a population with a high prevalence of people living with HIV. BMC Public Health 11(1): 828. [Google Scholar] [Crossref]

22. Creswell, J.W (2014) Research Design: Qualitative, Quantitative and Mixed Methods Approach (4th ed,). Thousand Oaks: CA Sage [Google Scholar] [Crossref]

23. Curry, A., Latkin, C., Davey-Rothwell, M. (2008). Pathways to depression: the impact of neighbourhood violent crime on inner-city residents in Baltimore, Maryland, USA. Soc Sci Med; 67:23–30. [Google Scholar] [Crossref]

24. Dale, S.K., Bogart, L.M., Galvan, F.H., Wagner, G.J., Pantalone, D.W., Klein, D.J., (2016). Discrimination and hate crimes in the context of neighbourhood poverty and stressors among HIV-positive African American men who have sex with men. J Commun Health; 41:574–583. [Google Scholar] [Crossref]

25. Do, A.N., Rosenberg, E.S., Sullivan, P.S., Beer L, Strine, T.W., Schulden, J.D., (2014). Excess burden of depression among HIV-infected persons receiving medical care in the United States: data from the medical monitoring project and the behavioral risk factor surveillance system. PLoS One; 9:e92842. [Google Scholar] [Crossref]

26. Dowdall, N., Ward, C.L., Lund, C. (2017). The association between neighbourhood-level deprivation and depression: evidence from the south African national income dynamics study. BMC Psychiatry; 17:395. [Google Scholar] [Crossref]

27. Effros, R.B., Fletcher, C.V., Gebo, K., Halter, J.B., Hazzard, W.R., Horne, F.M. (2008) Aging and infectious diseases: workshop on HIV infection and aging: what is known and future research directions. Clinical Infectious Diseases. [Google Scholar] [Crossref]

28. Engel, G. L. (1977). The need for a new medical model: a challenge for biomedicine. Science (New York, N.Y.). [Google Scholar] [Crossref]

29. Engel, G. L. (1982). The Biopsychosocial model and medical education. New England Journal of Medicine, 306(13), 802–805. doi: 10.1056/nejm198204013061311 [Google Scholar] [Crossref]

30. Evans, D.L., Charney, D.S., Lewis, L., Golden, R.N., Gorman, J.M., Krishnan, K.R. (2005) Mood disorders in the medically ill: scientific review and recommendations. Biological Psychiatry.Aug;58 (3):175–89. [Google Scholar] [Crossref]

31. Fialho, R., Pereira, M., Rusted, J., Whale, R. (2017). Depression in HIV and HCV co-infected patients: a systematic review and meta-analysis. Psychol Health Med; 22:1089–1104. [Google Scholar] [Crossref]

32. Fonner, V.A., Dalglish, S.L., Kennedy, C.E., Baggaley, R., O’Reilly, K.R., Koechlin, F.M. (2016). Effectiveness and safety of oral HIV preexposure prophylaxis for all populations. AIDS 30:1973–1983. [Google Scholar] [Crossref]

33. Gacau, K.K., Mugendi, G., Kiragu G, Ngayo, M.O., Omosa, G. (2024). Burden and predictors of anxiety disorder among HIV patients on art in Nairobi Kenya. PLOS Ment Health 1(2): e0000072. [Google Scholar] [Crossref]

34. Global Burden of Disease, (2021). Institute of Health Metrics and Evaluation. [Google Scholar] [Crossref]

35. Global HIV and AIDAS Statistics (2023) -Fact sheet Available at: https://www. unaids.org/en/resources/fact-sheet. [Google Scholar] [Crossref]

36. Gonzalez, J.S., Batchelder, A.W., Psaros, C., Safren, S.A. (2011). Depression and HIV/AIDS treatment non-adherence: a review and meta-analysis. Acquired immune deficiency syndrome 19992011; 58:181–187. [Google Scholar] [Crossref]

37. Gutkovich, Z., Rosenthal, R.N., Galynker, I., Muran, C., Batchelder, S., Itskhoki, E. (1999). Depression and demoralization among Russian Jewish immigrants in primary care. Psychosomatics. 1999 Mar-Apr;40(2):117-25. [Google Scholar] [Crossref]

38. He, Q., Hao, C., Pan, D. (2023). Adherence to antiretroviral therapy and its predictive factors among people living with HIV in China: A behavioural theory-based prospective cohort study. Int.J. Behav. Med. 30, 555–565. [Google Scholar] [Crossref]

39. Himelhoch, S., Ehrenreich, M. (2007). Psychotherapy by primary-care providers: results of a national sample. Psychosomatics 48(4): 325–330. [Google Scholar] [Crossref]

40. Himelhoch, S., Medoff, D.R., Oyeniyi, G. (2007) Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis. AIDS Patient Care STDS 21(10): 732–739. [Google Scholar] [Crossref]

41. Hinkin, C. H., Castellon, S. A., Atkinson, J. H., & Goodkin, K. (2001). Neuropsychiatric aspects of HIV infection among older adults. J Clin Epidemiol, 54 Suppl 1, S44. [Google Scholar] [Crossref]

42. Holodniy, M., Nguyen, N. (2008). HIV infection in the elderly. clinical interventions in aging. 2008 Sep; Volume 3 [Google Scholar] [Crossref]

43. Institute of Health Metrics and Evaluation (2023). global health data exchange (GHDx). https://vizhub.healthdata.org/gbd-results/ (Accessed 4 March 2023). [Google Scholar] [Crossref]

44. a. Journal of Dermatology, 61(3), 261–264. [Google Scholar] [Crossref]

45. Krumme, A.A., Kaigamba ,F., Binagwaho, A., Murray, M.B., Rich, M.L., Franke, M.F. (2015). Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy. J Epidemiol Community Health; 69:284–289. [Google Scholar] [Crossref]

46. Linda, B., Da, Yunfeng, T.E., PhDa, Mabel, P,A., Ha, R. Luke, S, M (2020) medical monitoring project. division of HIV/AIDS prevention, centres for disease control and prevention, 1600 Clifton Rd. NE, MS-E46, Atlanta, GA, US [Google Scholar] [Crossref]

47. Mann, C. J. (2003). Observational research methods: Research design II: Cross- [Google Scholar] [Crossref]

48. Mcmahon, S.B., Koltzenberg, M., Wall and Melzack Textbook of pain. (Elsevier, New York, 2003) [Google Scholar] [Crossref]

49. Milanini, B., Catella, S., Perkovich, B., Esmaeili-Firidouni, P., Wendelken, L., Paul, R., Valcour, V. (2017). Psychiatric symptom burden in older people living with HIV with and without cognitive impairment: the UCSF HIV over 60 cohort study. AIDS Care, 1-8. doi:10.1080/09540121.2017.1281877 [Google Scholar] [Crossref]

50. Motumma, A., Negesa, L., Hunduma, G. (2019). Prevalence and associated factors of common mental disorders among adult patients attending HIV follow up service in Harar town, eastern Ethiopia: a cross-sectional study. BMC Psychol 7, 11. [Google Scholar] [Crossref]

51. Mugavero, M.J., Lin H.Y., Willig, J.H., Westfall, A.O., Ulett, K.B., Routman, J.S. (2009) Missed visits and mortality among patients establishing initial outpatient HIV treatment. Clin Infect Dis; 48:248–256. [Google Scholar] [Crossref]

52. Mwangala, P.N., Wagner, R.G., Newton, C.R., Abubakar, A. (2023) Strategies for improving mental health and wellbeing used by adults ageing with HIV from the Kenyan coast: a qualitative exploration. Welcome Open Res. 2023 Jun 22;7:221. doi: 10.12688/wellcomeopenres.18212.2. PMID: 37415804; PMCID: PMC10320323. [Google Scholar] [Crossref]

53. Nakimuli‐Mpungu, E., Musisi, S., Smith, C.M., Von-Isenburg, M., Akimana, B., Shakarishvili, A.(2021). Mental health interventions for persons living with HIV in low‐ and middle‐income countries: A Systematic Review. Journal of the International AIDS Society. Jun;24 (S2) [Google Scholar] [Crossref]

54. National Institute of Mental Health (2008). "What Is Generalized Anxiety Disorder?". [Google Scholar] [Crossref]

55. O'Brien, K.K., Ibáñez-Carrasco, F., Solomon, P. (2020). Research priorities for rehabilitation and aging with HIV: a framework from the Canada-International HIV and rehabilitation research collaborative (CIHRRC). [Google Scholar] [Crossref]

56. Pence, B.W., Mills, J.C., Bengtson, A.M., Gaynes, B.N., Breger, T.L., Cook, R.L. (2018). Association of increased chronicity of depression with HIV appointment attendance, treatment failure, and mortality among HIV-infected adults in the United States. JAMA Psychiatry; 75:379–385. [Google Scholar] [Crossref]

57. Pence, B.W., O’Donnell, J.K., Gaynes, B.N. (2012). The Depression treatment cascade in primary care: a public health perspective. Curr Psychiatry Rep; 14:328–335. [Google Scholar] [Crossref]

58. Rabkin, J.G. (2008). HIV and depression: review and update. Current HIV/AIDS Rep. 2008 Nov;5(4):163-71. [Google Scholar] [Crossref]

59. Rodger, A.J., Cambiano, V., Bruun, T., Vernazza, P., Collins, S., Van Lunzen, J. (2016). Sexual activity without condoms and risk of HIV transmission in Sero-different couples when the HIV-positive partner is using suppressive antiretroviral therapy. JAMA; 316:171–181 [Google Scholar] [Crossref]

60. Sabin, C.A., & Reiss, P. (2017). Epidemiology of ageing with HIV: what can we learn from cohorts? AIDS;31 Suppl 2:S121– [Google Scholar] [Crossref]

61. Salik, I., Marwaha. R. (2022) Electroconvulsive therapy. StatPearls Publishing; Treasure Island (FL). [Google Scholar] [Crossref]

62. Satz, P., Myers, H. F., Maj, M., Fawzy, F., Forney, D. L., Bing, E. G., . . . Janssen, R. (1997). Depression, substance use, and sexual orientation as cofactors in HIV-1-infected men: cross-cultural comparisons. NIDA Res Monogr, 172, 130-155. [Google Scholar] [Crossref]

63. a. sectional, case-control, and cohort studies. Emergency Medicine Journal, [Google Scholar] [Crossref]

64. Setia, M. S. (2016). Methodology series module 3: Cross-sectional studies. Indian [Google Scholar] [Crossref]

65. Shapiro, T., & Emde, R. N. (1991). Introduction: Some empirical approaches to psychoanalysis. Journal of the American Psychoanalytic Association, 39, 1-3 [Google Scholar] [Crossref]

66. Smith Fawzi, M.C., Eustache, E., Oswald, C. (2012) Psychosocial support intervention for HIV-affected families in Haiti: implications for programs and policies for orphans and vulnerable children. Soc Sci Med 74(10): 1494–1503. [Google Scholar] [Crossref]

67. Steves, C.J., Spector, T.D., Jackson, S.H.(2012) Ageing, genes, environment and epigenetics: what twin studies tell us now, and in the future. Age and ageing. 2012 Sep;41(5) :581-6 [Google Scholar] [Crossref]

68. Tan, T., Zhou, C., Lu, R., Chen, C., Bai, C., Li L., Wu, G. (20220.Depression and associated factors among men living with HIV/AIDS aged 50 years and over in Chongqing, China. J Multidiscip Healthc. 2022 Sep 9;15:2033-2040. [Google Scholar] [Crossref]

69. Terlizzi EP, Zablotsky B. (2019). Mental health treatment among adults: United States. NCHS Data Brief, no 380. Hyattsville, MD: National Center for Health Statistics. 2020 [Google Scholar] [Crossref]

70. Trickey, A., Lei., Z., Caroline, A., C., Jonathan, A.C. (2022). Life expectancy of people with HIV on long term antiretroviral therapy in Europe and North America: A cohort study, University of Bristol. [Google Scholar] [Crossref]

71. UNAIDS. (2018) Global HIV & AIDS Statistics – 2018 fact sheet. Geneva, Switzerland: UNAIDS. [Google Scholar] [Crossref]

72. UNAIDS. (2025) Global HIV & AIDS Statistics – 2025 fact sheet. Geneva, Switzerland: UNAIDS. [Google Scholar] [Crossref]

73. United Nations (2019). World population ageing: Highlights, In ST/ESA/SER. A/430. [Google Scholar] [Crossref]

74. United Nations Programme on HIV/AIDS (2021). End Inequalities. End AIDS. Global AIDS Strategy 2021–2026. Geneva. [Google Scholar] [Crossref]

75. World Health Organization (2015). Mental health atlas. Geneva, Switzerland: WHO. [Google Scholar] [Crossref]

76. World Health Organization (2022). HIV Statistics 2022. Geneva, Switzerland: WHO. [Google Scholar] [Crossref]

77. World Health Organization (2025). HIV Statistics 2026. Geneva, Switzerland: WHO. [Google Scholar] [Crossref]

78. World Health Organization. (2014). Global health expenditure database. Geneva, Switzerland: WHO. [Google Scholar] [Crossref]

79. Xiaojie, H. (2018). The Double burdens of mental health among aids patients with fully successful immune restoration: a cross-sectional study of anxiety and depression in China [Google Scholar] [Crossref]

80. Yimer, S., Girma, Z., Mengistu, N., Shumye, S. (2021) Determinants of common mental disorders among people living with HIV/AIDS attending art service in southern Ethiopia. HIV AIDS (Auckl). 2021 Sep 1 [Google Scholar] [Crossref]

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