Effect of Depression on Quality of Life among Women Living with HIV in Gondar Town, Northwest, Ethiopia, Prospective Cohort Study

Abstract

Depression is highly prevalent among women living with HIV (WLHIV) and is linked to poor quality of life (QoL), impaired functioning, and negative treatment outcomes. While studies in high-income settings report strong associations between depression, stigma, social support, and QoL, evidence from low-resource contexts such as Ethiopia remains limited. This study examined the relationship between depression and QoL among 627 WLHIV on stable antiretroviral therapy (ART) for at least six months. Data were collected prospectively at three-month intervals between September 2023 and April 2024 using structured interviews. Validated tools assessed depression (PHQ-9), HIV-related stigma, social support (Oslo scale), and QoL (WHOQOL-HIV BREF-Eth-27). Repeated measures ANOVA and linear mixed-effects models evaluated QoL trajectories and the impact of depression while adjusting for confounders. Depression was significantly associated with lower scores across all QoL domains: general (β = -0.06, p = 0.000), physical (β = -0.22, p = 0.000), psychological (β = -0.25, p=), spiritual (β = -0.08, p = 0.000), independence (β = -0.13, p = 0.000), environmental (β = -0.23, p = 0.000), and social (β = -0.09, p = 0.000). Non-adherence to ART also negatively affected multiple domains, including general (β = -0.28, p = 0.035), physical (β = -0.51, p = 0.031), psychological (β = -0.72, p = 0.003), social (β = -0.50, p = 0.006), and environmental (β = -0.97, p = 0.015). HIV-related stigma reduced QoL in six domains, while greater social support was positively associated with all domains. These findings underscore the urgent need to address depression, stigma, and ART adherence while promoting social support to improve QoL among WLHIV in Ethiopia.