Easwaran Vigneshwaran, Orayj Khalid, Goruntla Narayana, Mekala Jyothi Suchitra, Bommireddy Bhavana Reddy, Mopuri Bhavani, Mantargi Mohammad Jaffar Sadiq, Bhupalam Pradeepkumar, Thammisetty Durga Prasad, Bandaru Vishnuvandana
Department of Clinical Pharmacy, College of Pharmacy, Kingdom of Saudi Arabia, King Khalid University, Abha, 61421, Kingdom of Saudi Arabia.
Department of Clinical Pharmacy and Pharmacy Practice, School of Pharmacy, Kampala International University, Western Campus, Ishaka, Uganda.
BMC Pregnancy Childbirth. 2025 Feb 11;25(1):134. doi: 10.1186/s12884-025-07261-4.
The COVID-19 pandemic has caused an unparalleled increase in psychological distress among everyone and everywhere. Perinatal depression, anxiety, and stress (DAS) are more prominent among HIV-positive pregnant women and are associated with poor maternal and neonatal outcomes. Therefore, this study aimed to assess the prevalence and explore the factors associated with DAS among HIV-positive pregnant women in India.
A multicentric, cross-sectional, analytical study was conducted among all HIV-positive pregnant women, aged more than 18 years, taking antiretroviral therapy, and attending antenatal care visits at two hospitals that are offering HIV care services in Anantapur District, Andhra Pradesh, India. Women who were unable to communicate were mentally ill, and refused to give consent were excluded. The study was conducted for a period of eighteen months from April 2020 to September 2021. A validated and interview-based data collection form was used to capture sociodemographic, obstetric profiles, clinical and support-related profiles, and COVID-19 stressors among study participants. The DASS-21 scale was used to assess depression, anxiety, and stress among study participants. Univariable and multivariable Poisson regression analyses were used to identify factors associated with DAS among study participants.
The prevalence of depression, anxiety, and stress among HIV-positive pregnant women was found to be 50.3% (95% CI 23.6-76.4), 56.2% (95% CI 28.3-80.3), and 42.2% (95% CI 18.5-69.9), respectively. A multivariate Poisson regression analysis showed that participants living in a rural area (adj. PR 1.43,1.08-1.91), primigravidae (adj. PR 1.37, 1.09-1.72), less number of ANC visits (adj. PR 1.41, 1.12-1.76), identified HIV during pregnancy (adj. PR 1.42, 1.13-1.77), non-disclosure of HIV status with one's partner (adj. PR 1.43, 1.11-1.83), no partner support (adj. PR 1.84, 1.31-2.59), and having a negative HIV status sexual partner (adj. PR 1.35, 1.02-1.79) were all significantly associated with depression. Factors such as lack of partner support (adj. PR 1.48, 1.09-1.99) and known HIV status during pregnancy (adj. PR 1.24, 1.01-1.52) were significantly associated with anxiety. Participants who had less ANC visits (adj. PR 1.50, 1.12-2.02), non-disclosure of HIV status with partner (adj. PR 1.47, 1.08-2.02), known HIV status during pregnancy (adj. PR 1.62, 1.23-2.15), negative HIV status of sexual partner (adj. PR 1.44, 1.02-2.02), and no partner's support (adj. PR 1.85, 1.25-2.74) were significantly associated with stress.
The study concludes that about one-third of the HIV-positive pregnant women reported anxiety, and more than half of the women were feeling stressed and depressed during COVID-19. Factors such as residence and primigravidae were linked with antenatal depression. Whereas variables like ANC visits, knowing HIV status during pregnancy, non-disclosure of HIV status, no partner's support, and sexual partner HIV negative status were associated with depression and stress. The anxiety symptoms are very high among women who are HIV positive during pregnancy, and not having a partner's support. Demographic, clinical, and support-related determinants and COVID-19 stressors of DAS provide insights for interventions to reduce the burden of mental health problems among HIV-positive pregnant women.
新冠疫情导致全球各地所有人的心理困扰都出现了前所未有的增加。围产期抑郁、焦虑和压力（DAS）在艾滋病毒呈阳性的孕妇中更为突出，并且与不良的孕产妇和新生儿结局相关。因此，本研究旨在评估印度艾滋病毒呈阳性孕妇中DAS的患病率，并探索与之相关的因素。
对所有年龄超过18岁、正在接受抗逆转录病毒治疗且在印度安得拉邦阿南塔布尔区提供艾滋病毒护理服务的两家医院进行产前检查的艾滋病毒呈阳性孕妇开展了一项多中心、横断面分析研究。无法沟通、患有精神疾病以及拒绝给予同意的女性被排除在外。该研究于2020年4月至2021年9月进行了18个月。使用经过验证的基于访谈的数据收集表来获取研究参与者的社会人口统计学、产科概况、临床和支持相关概况以及新冠压力源。使用DASS - 21量表评估研究参与者的抑郁、焦虑和压力情况。采用单变量和多变量泊松回归分析来确定研究参与者中与DAS相关的因素。
发现艾滋病毒呈阳性孕妇中抑郁、焦虑和压力的患病率分别为50.3%（95%置信区间23.6 - 76.4）、56.2%（95%置信区间28.3 - 80.3）和42.2%（95%置信区间18.5 - 69.9）。多变量泊松回归分析显示，居住在农村地区的参与者（调整后PR 1.43，1.08 - 1.91）、初产妇（调整后PR 1.37，1.09 - 1.72）、产前检查次数较少（调整后PR 1.41，1.12 - 1.76）、孕期确诊感染艾滋病毒（调整后PR 1.42，1.13 - 1.77）、未向伴侣透露艾滋病毒感染状况（调整后PR 1.43，1.11 - 1.83）、没有伴侣支持（调整后PR 1.84，1.31 - 2.59）以及有艾滋病毒检测结果为阴性的性伴侣（调整后PR 1.35，1.02 - 1.79）均与抑郁显著相关。缺乏伴侣支持（调整后PR 1.48，1.09 - 1.99）和孕期已知艾滋病毒感染状况（调整后PR 1.24，1.01 - 1.52）等因素与焦虑显著相关。产前检查次数较少（调整后PR 1.50，1.12 - 2.02）、未向伴侣透露艾滋病毒感染状况（调整后PR 1.47，1.08 - 2.02）、孕期已知艾滋病毒感染状况（调整后PR 1.62，1.23 - 2.15）、性伴侣艾滋病毒检测结果为阴性（调整后PR 1.44，1.02 - 2.02）以及没有伴侣支持（调整后PR 1.85，1.25 - 2.74）的参与者与压力显著相关。
该研究得出结论，约三分之一的艾滋病毒呈阳性孕妇报告有焦虑情绪，在新冠疫情期间，超过一半的女性感到压力大和抑郁。居住地区和初产妇等因素与产前抑郁有关。而诸如产前检查次数、孕期知晓艾滋病毒感染状况、未透露艾滋病毒感染状况、没有伴侣支持以及性伴侣艾滋病毒检测结果为阴性等变量与抑郁和压力相关。孕期艾滋病毒呈阳性且没有伴侣支持的女性焦虑症状非常高。DAS的人口统计学、临床和支持相关决定因素以及新冠压力源为减轻艾滋病毒呈阳性孕妇心理健康问题负担的干预措施提供了见解。
