Depression, anxiety, and psychiatric morbidity in Ethiopian immigrants living with HIV

Abstract

The prevalence of mental health morbidity among Ethiopian immigrants in Israel is higher than in the general population, with diagnosis complicated by differing clinical presentations and unfamiliarity with the concept of depression. Among Ethiopian immigrants living with HIV, mental health challenges may further be exacerbated by HIV related stigma, anti-retroviral treatment, and HIV-associated neurotoxicity.

Aims

Assess the rates of depression and identify risk factors among Ethiopians with HIV living in Israel.

Methods

Two culturally adapted questionnaires in Amharic (SRQ-F and HADS) were administered to HIV + patients of Ethiopian origin in the Hadassah AIDS center between April 2021 and December 2022. Demographic and clinical data were collected and compared to the questionnaire's outcomes. Relationships with questionnaire outcomes were analyzed using chi-square tests, ANOVA, T-tests, and Wilcoxon-rank test.

Results

Ninety patients were recruited to the study, 60% of them were identified by at least one of the questionnaires as suffering from depression, anxiety, or psychopathology, with both questionnaires yielding consistent results. A significant correlation was found between depression or psychopathology and employment status, immigration dates 2000–2009, CD4 at diagnosis, current viral load, and the number of antiretroviral pills taken.

Conclusions

We found a higher-than-expected rate of psychiatric morbidity among Ethiopian immigrants living with HIV in Israel, exceeding global rates reported for PLWH. The strong correlation between mental health issues and social factors (unemployment, immigration year) and HIV-related factors (CD4, pill burden, viral load) underscores the role of social difficulties experienced by this community in the community's well-being. A detectable viral load should alert healthcare providers to the possibility of undiagnosed depression and/or anxiety. As untreated depression and anxiety can lead to poor treatment adherence, there is a pressing need for a structured, culturally adapted program for the detection and treatment of mental illness in this population.