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Psychiatric disorders in HIV-positive individuals in urban Uganda

King’s College London School of Medicine

Jed Boardman, Senior Lecturer in Social Psychiatry

Health Services Research Department, Institute of Psychiatry, King’s College London, De Crespigny Park, London SE5 8AF, UK, e-mail: jed.boardman{at}scmh.org.uk

Emilio Ovuga, Professor of Psychiatry

Makerere University, Kampala, Uganda

Declaration of interest

None.

AIMS AND METHOD

The study examined the prevalence of psychiatric disorders in people with HIV/AIDS attending the AIDS Support Organisation (TASO) clinic at Mulago Hospital, Kampala, Uganda and the preparedness of AIDS counsellors to deal with mental disorders. Forty-six patients were interviewed using the Mini International Psychiatric Interview to ascertain DSM-IV diagnoses. All 15 counsellors working at the clinic were interviewed.

RESULTS

The total prevalence of psychiatric disorder was 82.6 (38 out of 46 patients). Depressive and anxiety disorders were common. Non-affective psychoses were present in eight patients (17.4%), bipolar affective disorder in eight (17.4%) and major depression with melancholic features in five (10.9%); 8 (13%) had current suicidal thoughts. None of the people with psychiatric disorders were receiving mental health treatment. The prevalence of disorder as estimated by the counsellors ranged from 0 to 33%. Only one counsellor had received any formal training in mental disorders and only two thought that they could deal with these if they arose. The attitudes of counsellors towards people with mental disorders were mixed, but most believed that they should be trained to provide care.

CLINICAL IMPLICATIONS

There is a need to provide additional mental health services to the TASO clinic through appropriate training of TASO counsellors to improve their awareness of psychiatric disorders, delivery of some psychological therapies and liaison with the psychiatric services at Mulago Hospital, in addition to public mental health education. The psychiatric disorders experienced by those attending the clinic might put them at greater risk of contracting HIV/AIDS.