Depression Among Hiv-positive Individuals Attending the Antiretroviral Treatment Clinics of Wolaita Zone, Southern Ethiopia,2021

Depression Among Hiv-positive Individuals Attending the Antiretroviral Treatment Clinics of Wolaita Zone, Southern Ethiopia,2021 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Depression Among Hiv-positive Individuals Attending the Antiretroviral Treatment Clinics of Wolaita Zone, Southern Ethiopia,2021 Aseb Arba, Nefsu Awoke, Mistire Teshome, Tsegaye Lolaso, Kebreab Paulos, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4254185/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: People who are infected with HIV are more likely to develop depression than the general population. It is one of the causes of poor adherence to Anti-retroviral therapy and worsens the patient’s condition and leads to death. Most studies conducted in the area addressed a single setting whereas this study was multi-central. So, it is important to assess the prevalence of depression and its determinants among HIV-positive individuals attending ART clinics of Wolaita Zone. Objective This study aimed to assess the prevalence and determinants of depression among HIV-positive individuals attending ART clinics in Wolaita Zone, Ethiopia. Methods and Materials: Institution-based cross-sectional study was conducted among HIV-positive individuals attending ART clinics of Wolaita Zone. Data was collected from 596 participants. Health facilities were clustered based on the number of patients attending to ART clinics. Then, facilities were selected randomly from the respective clusters. Data was collected through the face-to-face interview. Epi data for data entry and analyzed using SPSS’s version 20. The presence and strength of association were declared when p-value < 0.05 and using AOR in multivariate analysis respectively. Result The prevalence of depression among HIV-positive individuals in the Wolaita Zone is 32.6% at 95% CI [29%, 36%]. Marital status, educational status, living with families, family history of depression, place of medical follow-up, presence of Tuberculosis co-infection, and presence of sleep problems are significantly associated with depression among study participants. Conclusion and recommendation : The prevalence of depression among HIV-positive individuals in the Wolaita Zone is high. Being single, living far away from family members, having a family history of depression, the presence of sleep problems and TB co-infection, and making medical follow up at governmental facilities are determined to be factors associated with the occurrence of depression among HIV-positive individuals attending ART clinics of Wolaita Zone. Therefore, psychological support with differential counseling of patients on ART based on their specific needs is essential to minimize the occurrence of depression. In addition, early screening and treatment of TB co-infection, and depression are very important. depression depressive disorders HIV patients patients on ART Figures Figure 1 Figure 2 Background The hallmarks of depression, a common mental condition, include dark mood, lack of interest or pleasure, diminished energy, guilt or feelings of feeling worthless, sleep disruptions or food, and troubles concentration ( 1 ). Everyone can be unhappy and depressed, but when such adverse feelings continue to rule daily life and lead to bodily and mental decline, they are known to as depressive disorders ( 2 ). Human immune deficiency virus, HIV/AIDS, is a cause of death and disability, especially in low- and middle-income countries ( 3 ). Over 25.5 million people suffer with the virus in Sub-Saharan Africa, making this part of Africa the most impacted in the world ( 4 ). Data from Ethiopian Federal HIV/AIDS Prevention and Control Office (EFHAPCO) indicates that there are over 718,550 people (a little over 1.18% of the population) living with HIV in Ethiopia alone ( 5 ). People living with HIV (PLWHA) now have greater access to highly effective antiretroviral therapy (ART), which has lengthened survival and slowed the advancement of the HIV disease, bringing issues with quality of life, particularly their mental wellbeing, at the forefront ( 6 , 7 ). Depending on the local context, people with chronic health conditions may be placed at a significantly higher risk of experiencing mental health problems ( 8 ). Depression is the most common neuropsychiatric complication of HIV/AIDS disease ( 9 ). People who are infected with HIV are more likely than the general population to develop depression ( 10 – 14 ). Depression affects a person’s ability to follow treatment for HIV/AIDS ( 15 ). Depression associated with poor adherence to ART leading to immunological failure and may independently increase HIV progression ( 16 ). Stress, difficult situations in life, drugs side effects, or the impact of HIV on the brain could all contribute to depression in PLWHA. Depression may also hasten the progression of HIV to AIDS ( 10 ). Studies indicate that in patients with HIV disease, severity of depression correlates with rapidity of decline in CD4 count, suggesting that failure to treat depression may accelerate HIV disease progression and impact on survival ( 17 ). When recent affective losses (death or rejection of any kind), the rate of hospitalizations, a faster progression of opportunistic infections, or physical deterioration occur, there may be a greater chance of depression in HIV/AIDS patients ( 18 ). Depressive symptom among HIV-positive clients is associated with low income, widowed, being female, non-adherence of ART, having frequent of schedule for clinical visit in a month, low educational status, being female, age category ( 40 – 49 ), and having stage III and Stage IV HIV-related symptom ( 11 , 12 , 19 – 22 ). Being mentally impaired has been linked with an impaired adherence to ART and poor treatment outcome, decrease in CD4 count and increase in viral load ( 23 ). In addition, depression has been associated with high risk behaviors like engaging in unsafe sex ( 24 ). Early identification of depressive symptoms among HIV-positive individuals is critical to improving health outcomes in this vulnerable population. In HIV care, treating depressed symptoms may improve quality of life and lower the effect of depression on HIV clinical advancement. Although studies on depression and HIV are numerous, research is limited on the factors that contribute to depression among HIV-positive individuals. However, little is known about how depression affects one's socioeconomic status and physical health after receiving antiretroviral therapy (ART). Thus, the aim of this study was to identify the magnitude of depression among HIV positive individuals attending ART clinics of Wolaita Zone, South Ethiopia. This study finding will give direction for further interventions and provision of comprehensive care and bases for further study. OBJECTIVES To assess the prevalence of depression among HIV-positive individuals attending ART clinics of Wolaita Zone To identify determinants of depression among HIV-positive individuals attending ART clinics of Wolaita Zone METHODS AND MATERIALS Study area and period The study was conducted in hospitals and health centers providing ART clinics in Wolaita Zone, Southern regional state, located 387 Km from Addis Ababa. Regarding public health facilities in Zone, there is 1 teaching and referral hospital, 4 primary hospitals and 68 health centers. This study was conducted among HIV positive individuals attending ART clinics of Wolaita Zone from Dec- Jan, 2021. Study design A health facility-based cross-sectional study design was used Population Source population All HIV-positive individuals attending ART clinics in Wolaita Zone Study population All HIV-positive individuals attending selected ART clinics of Wolaita Zone Inclusion and Exclusion Criteria Inclusion criteria All HIV-positive individuals attending ART clinic for at least the past 6 months with CD4 counts measured within the last 6 months were included in the study. Exclusion criteria Individuals who are critically sick and unable to hear, with known psychiatric diagnosis, and are on ART for less than 6 months were excluded. Sample Size Calculation The sample size was calculated using single population formula taking the prevalence of depression in the study conducted in Hawassa, South Ethiopia, which is 48.6%, at a confidence level of 95%, with a 5% margin of error (Bereket et al., 2018). n = ( Z α/2) 2 p (1-p) d 2 Where, n = the minimum sample size, Z = the desired level of confidence interval 95% (1.96), sample size was 384; by adding 10% non-response rate and multiplying by 1.5 design effect final sample size was 634. Sampling Procedure To get adequate and well representing sample from HIV positive individuals attending ART clinic, institutions was clustered based on their level and proportional allocation was made based on case number in each ART clinics of Wolaita Zone. Participants was selected using systematic random sampling techniques. Every sixth patients were selected (Fig. 1). Data Collection Methods & Tools Data collection tools Structured questionnaire was used to collect data. Questionnaire was designed in English and was translated to both Amharic and Wolaita language include patient’s Socio-demographic characteristics, personal behaviors, economic factors, life events, drug related factors, health related factors, family or social support related factors, adherence of treatment assessed using the Eight-Item Morisky Medication Adherence Scale. These questionnaire items was developed based on literature, the dependent variable assessed using PHQ-9. Data collectors Nurses with bachelor degree was recruited to collect data in each clinic. Prior to that actual data collection, data collectors were trained about tools, data collection procedure. Two MSc nurses were recruited for supervision. Data collection procedure Data was collected through direct interview to get quantitative data. First informed voluntary written consent was obtained from each study participant after explaining purpose of study. Structured questionnaire was used to collect data from HIV positive individuals through interview on different variables after they get service they want in ART clinics. The interview was conducted in private place. Variables Dependent/outcome variable Depression among HIV positive individuals Independent variables Socio-demographic characteristics Personal behaviors Economic factors Life events Drug related factors Health related factors Family or social support related factors Operational definitions Depression: Those with a PHQ-9 score greater than 9 ( 25 ). Adherence; Total score of Morisky: With a sum of scores 8 = high, 6 to < 8 = medium and < 6 = low adherence to therapy ( 26 ). Data Quality Control Data quality was controlled through training of data collectors on questionnaire, ways of conducting interview. Data collectors were supervised by 2 supervisors and principal investigator was received report on daily basis. Before actual data collection, pretest was conducted two health center/hospital. After pretest any ambiguity, confusions, difficult words and differences in understanding was revised based on pretest experience. Completeness and consistency of questionnaire and checklist was checked before and immediately after interview by each data collector and supervisor. Simple frequencies and cross tabulation was done for identifying missing data, and inconsistency. Data processing and Analysis First data was coded, completeness and consistencies of questionnaires was checked and double data entry was made using Epi data 3.02 software. Then the data was exported to the SPSS statistical package version 20 for further analysis. Before analysis, data was further cleaned for possible errors. Data was presented in frequency, proportions and summary statistics to describe the study variables. Bivariate analysis was carried out to identify candidates for multivariate analysis. Variables whose p value less than 0.25 in bivariate analysis was included in multivariable logistic regression. Then multivariate logistic regression analysis was performed to identify independent predictors by controlling for possible confounders. AOR at 95% CI with p-value < 0.05 was estimated to identify the associated factors on multivariate logistic regression. Variables was interpreted as having statistically significant association when p < 0.05 in multivariate logistic regression. RESULTS Socio-demographic Characteristics This study was conducted on 596 participants, making the response rate 94%. More than half of the respondents were females. The mean age of the respondents was 35.39 years with standard deviation of 11.41. Married participants and those from urban area were taking more than half proportion of the respondents. Mothers share the highest proportion in family responsibility, the respondents are the main sources of income in majority of respondents, and majority are not happy by their monthly income. Those who own the living house takes higher share (56.9%) among the study participants as described in the Table 1 below. Table 1 Socio-demographic characteristics of the participants in ART clinics of Wolaita Zone, South Ethiopia, 2021 Variables Category Frequency Percent Sex Male 268 44.8 Female 330 55.2 Age ≤ 25 91 15.2 26–35 235 39.3 ≥ 36 272 45.5 Marital status Single 78 13 Married 308 51.5 Divorced 102 17.1 Widowed 110 18.1 Place of residence Urban 416 69.6 Rural 182 30.4 Educational status Unable to read & write 183 30.6 Able to read & write 157 26.3 Primary education 152 25.4 Secondary and above 106 17.7 Responsibility in family Father 220 36.8 Mother 288 48.2 Child 74 12.4 Relative 16 2.7 Occupation Farmer 73 12.2 Private business 300 50.2 Employee 83 13.9 Student 25 4.2 Housewife 100 16.7 Others 17 2.8 Monthly income (Eth. Birr) ≤ 500 179 29.9 501–1500 202 34.1 1501–2500 77 12.9 ≥ 2501 138 23.1 Source of income Respondent 384 64.2 Others 214 35.8 Satisfaction with income Yes 138 23.1 No 460 76.9 House ownership Private 340 56.9 Rented 258 43.1 Personal and clinical characteristics The respondents were asked for their personal and clinical characteristics which are the main independent variables. More than three-fourths of the respondents had no history of depression in their lifetime and also in their family members and live with their nuclear family members and had good relations with their family members. Nearly all were making regular follow-ups of their health status, comply with the prescribed regimen properly, and are in stage I of HIV infection. Tuberculosis co-infection was reported in 213 (35.6%) participants and 226 (37.8%) faced the sleep problems as shown in Table 2 in detail. Table 2 Personal and clinical characteristics of the respondents attending ART clinics of Wolaita Zone, 2021 Variables Category Frequency Percent History of depression Yes 145 24.2 No 453 75.8 With whom the respondent lives Nuclear family 457 76.4 Relatives 48 8 Others 93 15.6 Substance use Yes 38 6.4 No 560 93.6 Relationship with family members Good 519 86.8 Poor 79 13.2 Support from friends Yes 271 45.3 No 327 54.7 Discrimination Yes 248 41.5 No 350 58.5 Family history of Depression Yes 124 20.7 No 474 79.3 Regular medical check-up Yes 577 96.5 No 21 3.5 HIV infection staging Stage I 523 87.5 Stage II 29 4.8 Stage III 32 5.4 Stage IV 14 2.3 TB co-infection Yes 213 35.6 No 385 64.4 Taking medications Properly Yes 552 92.3 No 46 7.7 Ever faced sleep problem Yes 226 37.8 No 372 62.2 Presence of severe side effects Yes 58 9.7 No 540 90.3 Recent loss of family Member Yes 120 20.1 No 478 79.9 Prevalence of depression The depression was computed from 10 questions of the tool. The maximum score of the tool was 30 and the minimum was 0. In the current study, the prevalence of depression among HIV-positive individuals attending ART clinics in the Wolaita zone was found to be 32.6% at 95% CI [29%, 36%] (Fig. 2). Bivariate and multivariate analysis results In the multivariate analysis, marital status, sleep problems, living with nuclear families, having tuberculosis co-infection, family history of depression, and place of medical follow-up were variables found to be associated with depression among HIV-positive individuals attending ART clinics of Wolaita Zone. Among marital status, being single [AOR = 0.205, CI [0.047, 0.90]] was found to be preventive from the occurrence of depression. Living out of a nuclear family, specifically living with relatives [AOR = 6.79, 95 CI [1.92, 24.1]] found to be associated with the occurrence of depression. Table Bivariate and multivariate analysis results of variables associated with depression among HIV-positive individuals attending ART units of Wolaita Zone, 2021 Variables Category Depression COR (95%CI) AOR (95%CI) P-value Yes No Income (Eth. Birr) ≤ 500 73 106 2.28[1.39, 3.74]* 1.43[0.74,2.78] 501–1500 69 133 1.72[1.05, 2.81]* 0.57[0.20,1.57] 1501–2500 20 57 1.16[0.61,2.22] 1.12[0.45,2.77] ≥ 2500 32 106 1 1 Marital status Single 20 58 0.49[0.26,0.93]* 0.205[0.047,0.90] 0.036 Married 79 228 0.49[0.31,0.78] 1.04[0.49, 2.19] Divorced 50 52 1.37[0.79,2.36] 1.6 [0.66, 3.91] Widowed 45 64 1 1 Educational status Unable to write and read 80 102 2.19[1.30, 3.68] 2.04[0.77,5.42] Able to write and read 62 95 1.82 [1.06,3.11] 0.65[0.25,1.71] Primary Education 24 127 0.53[0.29, 0.97] 0.68[0.25,1.88] Secondary education and above 28 78 1 1 Family responsibility Father 73 145 0.229[0.077, 0.68] 1.18[0.57,2.45] Mother 93 195 0.217[0.073, 0.64] 0.82[0.22,3.02] Child 17 57 0.14[0.04,0.45] 3.65[0.51,26.3] Relative 11 5 1 1 Satisfaction with income Yes 20 118 1 1 No 174 284 3.62 [2.17, 6.02] 1.67[0.81,3.44] Source of income Respondent 142 240 1.84[1.27, 2.68] 1.13[0.61,2.01] Other 52 162 1 1 Homeownership Private 93 245 1 1 Rental 101 157 1.70 [1.20, 2.40] 0.99[0.55,1.82] History of Depression Yes 106 39 11.21 [7.26, 17.3] 1.65[0.78,3.50] No 88 363 1 1 Living with Nuclear Family 126 330 1 1 Relatives 39 9 11.35[5.34,24.1] 6.79[1.92, 24.1]* 0.03 Others 29 63 1.21[0.74,1.96] 0.97[0.48,1.95] Relation with Family Good 159 358 1 1 Poor 35 44 1.79 [1.11, 2.90] 1.18[0.53,2.64] Support from Friends Yes 107 163 0.555[.392, .784] 0.76[0.42,1.38] No 87 239 1 1 Experienced Discrimination Yes 142 106 7.63[5.18, 11.23] 1.83[0.97,3.42] No 52 296 1 1 Family history of depression Yes 104 20 22.1[12.98,37.53] 5.06[2.02,12.63] 0.000 No 90 382 1 1 Place of follow-up Government facility 190 318 12.55 [4.53,34.76] 7.67[1.98,29.74] 0.003 Private facility 4 84 1 1 TB co-infection Yes 126 86 6.81 [4.66, 9.95] 2.3[1.28, 4.21] 0.006 No 68 316 1 1 Sleep problem Yes 138 88 1 2.1[1.16, 3.72] 0.013 No 56 314 0.114 [0.77, 0.168] 1 Severe side-effects Yes 39 19 5.07 [2.84, 9.05] 1.49[0.58,3.87] No 155 383 1 1 Recent family Loss Yes 87 33 9.1 [5.77, 14.33] 1.63[0.65,2.84] No 107 369 1 1 CD4 count 501 103 238 1 1 Duration on ART (months) 120 65 117 1.12 [0.74,1.69] 1.20[0.62,2.29] Discussion This study presents significant information regarding depression experienced by individuals with HIV who attending HAART treatment in the study's contexts. The study found that the prevalence of depression among participants was about one third (32.6%). The factors of depression included those with sleep problem, co-infection with tuberculosis, a family history of depression, place of medical follow-up and living with relatives (outside of a nuclear family). On the other hand, being single was found to be preventive from the occurrence of depression. Findings from this study is higher when compared to the rate of depression among general population in Ethiopia 17.5%, ( 11 ). The stigma linked to HIV among these communities may increase their risk of developing depression that could be responsible for it. The results of this study is comparable with previous study conducted among HIV positive individuals in Jimma 30.2% ( 27 ), Addis Ababa 35.5% ( 28 ), Gurage Zone 37.5% ( 29 ), Hawassa 32.0%( 30 ), Somalia 3.5% ( 31 ), Kenya 35.6% ( 32 ), and pooled prevalence in Sub-Saharan Africa which ranged between 9% and 32% ( 33 ). On other hand, similar study showed lower prevalence of depression among individuals with HIV such as Aksum 14.6% ( 10 ), Mecha district, Northwest Ethiopia 13.3% ( 34 ), National Health Survey of Ethiopia 9.1% ( 34 ), and Kenya 13.8% ( 35 ), However, this result lower when compared with study conducted in different parts of Ethiopia Gimbi 41.7% ( 36 ), Bahir Dar 57.9% ( 37 ), Bale 44.9% ( 38 ), West Hararghe 52.4% ( 20 ), Harar 45.8% ( 39 ), and also Nigeria 39.6% ( 40 ), Sudan 63.1%( 41 ), and Uganda 46% ( 42 ). The differences is may be due to the different measurement tools, sample size variations, different locations of the study, sociocultural features participants, and different study setting. In this study, sleep problem is associated with depression among individuals with HIV in which those with sleep difficulty two times more likely to report sleep problem than those did not report sleep problem. This supported by evidence from Hawassa University hospital southern Ethiopia, Mettu Karl hospital southwest Ethiopia, Dessie town northeast Ethiopia in which the prevalence of poor quality of sleep found to be 57.6% ( 43 ), 57.1% ( 44 ), 36% ( 45 ) respectively. This might be explained by bidirectional relationship between depression and sleep problem and the effect of HIV positive on both neuropsychiatric complications. Co-infection with tuberculosis is also important factor linked with depression in this study. Individuals with positive TB status 6 times more likely to develop depression when compared with those with negative TB status. This finding could be supported by the evidence from the Oromia region in which tuberculosis and HIV co-infected patients had significantly greater risk of common mental disorders (63.7%) ( 46 ), and study from the Kenya depression accounts 31% ( 22 ), among those who has positive clinical status of both TB and HIV. There is also another evidence which suggests prevalence of depression among TB patients was found to be 45.19% ( 47 ), and having comorbid with TB and HIV might increase the severity of depression. TB and HIV can contribute to depression through their direct and complex interplay with each other, and it is important for healthcare providers to recognize and address the mental health needs of individuals dealing with TB and HIV. Family history of depression is another factor associated with depression in this study. Those with history of depression with in their family more likely to report depression when compared with their counterparty. Studies have found that individuals with a family history of depression are more likely to experience depressive symptoms( 48 ), and be diagnosed with major depressive disorder (MDD) than those without a family history. This association has been observed in both HIV-positive and HIV-negative populations. One potential explanation for this association is the role of genetics. In the context of HIV, family history of depression may be particularly relevant due to the added stressors associated with the illness. Place of follow up is another important factor which associated with depression in this study. Individuals who follow their treatment at government health facility more likely to report depression than those who follow their treatment at private health facilities. This might be due to the patient preference to private health care providers ( 49 ), with the possible reasons of better and more flexible access, shorter waiting, greater confidentiality ( 50 ), which might differ quality of care in further and result in different rate of depressive symptoms in the same group of population. The finding of this study that living outside of a nuclear family is associated with depression among HIV-positive individuals is consistent with previous research on the relationship between social support and mental health outcomes ( 51 ). This finding also consistent with systematic review report of HIV-positive individuals who live outside of a nuclear family may be at higher risk of depression due to the lack of social support and increased isolation ( 52 ). In this study, being single is preventive factor as contrary to general assumption of risk factor for depression. However, this finding also supported by the evidence which reports being single or being divorced/widowed were associated with depressive symptoms at every age in men but for women turn, being single was associated with depressive symptoms ( 53 ). Married women suffer more depression than unmarried ones( 54 ). This could be explained by the majority of participants in this study are women. Limitation The following potential limitations should be taken into consideration when considering the study's conclusions. Firstly, this study only included individuals who attend the antiretroviral treatment clinic, which may limit the generalizability of the findings to those who do not attend such clinics. Also, those who attend the clinic may be more likely to have depression compared to those who do not attend, leading to potential self-selection bias. Participants may not be truthful about their depression symptoms due to social desirability bias. Secondly, this study may not be able to establish causality as it is based on a cross-sectional design. Third, the study depend on self-reported data which may not be accurate due to recall bias or social desirability bias. And finally, the study only focuses on depression among HIV-positive individuals and does not explore other mental health conditions or factors that may contribute to depression. Conclusion Depression is a prevalent mental health issue among the participants, with approximately one third of them experiencing symptoms of depression. The study identified several factors that were associated with depression, including sleep problems, living outside of a nuclear family, co-infection with tuberculosis, a family history of depression, and place of medical follow-up. Being single was found to be a protective factor against the occurrence of depression. These findings suggest that healthcare professionals should be aware of the risk factors for depression, particularly in patients with sleep problems, co-infection with tuberculosis, and a family history of depression. Additionally, the findings indicate that social support, such as living in a nuclear family, may be beneficial in preventing depression. However, the protective effect of being single against depression should be interpreted with caution, as social isolation can also contribute to poor mental health outcomes. Recommendation Healthcare professionals should screen patients for depression, particularly those with sleep problems, co-infection with tuberculosis, and a family history of depression. Early identification and treatment of depression can prevent it from worsening and improve outcomes for patients. Family support should be promoted to prevent depression. Social support should be provided to patients who are at risk of depression. Support groups, community engagement activities, and counseling services can help patients build social connections and reduce feelings of isolation. Further research is needed to better understand the relationship between social factors and depression. Declarations Ethical Consideration This study was approved by the Institutional Health Research Ethical Review Committee of Wolaita Sodo University College of Health and Medical Sciences (reference number 08/01/13) with the project code CHSM/ERC/1. The letter was written from the college to each hospital and health center. Data were collected after obtaining informed written voluntary consent from each participating patient after informing about study. Depression is linked to social support centers or psychiatric units. Availability of data and materials The data and materials supporting the findings of this study are available from the corresponding author upon reasonable request. Competing interests Authors has no conflict of interest to declare. Funding The authors didn’t receive fund for this study. Authors' Contributions AA, YY, MT, and BK conceived and designed the study. SS and TL analyzed and interpreted the data. YY drafted the manuscript. 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Abdu Z, Dule A. Poor Quality of Sleep Among HIV-Positive Persons in Ethiopia. HIVAIDS - Res Palliat Care. 2020;12:621–8. GebreEyesus FA, Degu FS, Yohanes YB, Azagew AW. Sleep quality and associated factors among adult people living with HIV on follow-up at Dessie Town Governmental Health Facilities Antiretroviral Therapy Clinics, Northeast, Ethiopia, 2020, a multicenter cross-sectional study. BMC Psychiatry. 2023;23(1):132. Deribew A, Tesfaye M, Hailmichael Y, Apers L, Abebe G, Duchateau L et al. Common Research article mental disorders in TB/HIV co-infected patients in Ethiopia. 2010. Duko B, Bedaso A, Ayano G. The prevalence of depression among patients with tuberculosis: a systematic review and meta-analysis. Ann Gen Psychiatry. 2020;19(1):30. Monroe SM, Slavich GM, Gotlib IH. Life stress and family history for depression: The moderating role of past depressive episodes. J Psychiatr Res. 2014;49:90–5. McCombie SC. Treatment seeking for malaria: a review of recent research. Soc Sci Med 1982. 1996;43(6):933–45. ALJUNID S. The role of private medical practitioners and their interactions with public health services in Asian countries. Health Policy Plan. 1995;10(4):333–49. Shao B, Song B, Feng S, Lin Y, Du J, Shao H, et al. The relationship of social support, mental health, and health-related quality of life in human immunodeficiency virus-positive men who have sex with men: From the analysis of canonical correlation and structural equation model A cross-sectional study. Med (Baltim). 2018;97(30):e11652. Weldesenbet AB, Kebede SA, Tusa BS. The Effect of Poor Social Support on Depression among HIV/AIDS Patients in Ethiopia: A Systematic Review and Meta-Analysis. Depress Res Treat. 2020;2020:6633686. Grundström J, Konttinen H, Berg N, Kiviruusu O. Associations between relationship status and mental well-being in different life phases from young to middle adulthood. SSM - Popul Health. 2021;14:100774. Wu X, DeMaris A. Gender and marital status differences in depression: The effects of chronic strains. Sex Roles. 1996;34(5–6):299–319. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4254185","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":314367091,"identity":"2636c00b-3d66-4e3a-8229-6e141d4f8ce9","order_by":0,"name":"Aseb Arba","email":"","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":false,"prefix":"","firstName":"Aseb","middleName":"","lastName":"Arba","suffix":""},{"id":314367093,"identity":"3d1db275-a27b-4123-b5b1-60dc0887d335","order_by":1,"name":"Nefsu Awoke","email":"","orcid":"","institution":"Wolaita Sodo 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19:44:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4254185/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4254185/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60199895,"identity":"1be40373-b36a-4adc-b3fd-e285d42ca2f1","added_by":"auto","created_at":"2024-07-13 02:30:52","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":257289,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure1ofmanuscriptofdepressionpage00011.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4254185/v1/ad2a874e8b9796c4768638d0.jpg"},{"id":60199894,"identity":"34d585c1-4a19-4232-b4e6-d290ab45c102","added_by":"auto","created_at":"2024-07-13 02:30:52","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":121410,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e","description":"","filename":"Figure2ofmanuscriptofdepressionpage00011.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4254185/v1/8023dc6123ea33fd7caa592d.jpg"},{"id":60201500,"identity":"d71b7801-2891-47b5-9d9d-f529d906fb9e","added_by":"auto","created_at":"2024-07-13 02:46:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1299947,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4254185/v1/c2cff495-c7aa-421e-99bb-bfd998494e0e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eDepression Among Hiv-positive Individuals Attending the Antiretroviral Treatment Clinics of Wolaita Zone, Southern Ethiopia,2021\u003c/p\u003e","fulltext":[{"header":"Background","content":"\u003cp\u003eThe hallmarks of depression, a common mental condition, include dark mood, lack of interest or pleasure, diminished energy, guilt or feelings of feeling worthless, sleep disruptions or food, and troubles concentration (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Everyone can be unhappy and depressed, but when such adverse feelings continue to rule daily life and lead to bodily and mental decline, they are known to as depressive disorders (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHuman immune deficiency virus, HIV/AIDS, is a cause of death and disability, especially in low- and middle-income countries (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Over 25.5\u0026nbsp;million people suffer with the virus in Sub-Saharan Africa, making this part of Africa the most impacted in the world (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Data from Ethiopian Federal HIV/AIDS Prevention and Control Office (EFHAPCO) indicates that there are over 718,550 people (a little over 1.18% of the population) living with HIV in Ethiopia alone (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). People living with HIV (PLWHA) now have greater access to highly effective antiretroviral therapy (ART), which has lengthened survival and slowed the advancement of the HIV disease, bringing issues with quality of life, particularly their mental wellbeing, at the forefront (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDepending on the local context, people with chronic health conditions may be placed at a significantly higher risk of experiencing mental health problems (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Depression is the most common neuropsychiatric complication of HIV/AIDS disease (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). People who are infected with HIV are more likely than the general population to develop depression (\u003cspan additionalcitationids=\"CR11 CR12 CR13\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Depression affects a person\u0026rsquo;s ability to follow treatment for HIV/AIDS (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Depression associated with poor adherence to ART leading to immunological failure and may independently increase HIV progression (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStress, difficult situations in life, drugs side effects, or the impact of HIV on the brain could all contribute to depression in PLWHA. Depression may also hasten the progression of HIV to AIDS (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Studies indicate that in patients with HIV disease, severity of depression correlates with rapidity of decline in CD4 count, suggesting that failure to treat depression may accelerate HIV disease progression and impact on survival (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). When recent affective losses (death or rejection of any kind), the rate of hospitalizations, a faster progression of opportunistic infections, or physical deterioration occur, there may be a greater chance of depression in HIV/AIDS patients (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDepressive symptom among HIV-positive clients is associated with low income, widowed, being female, non-adherence of ART, having frequent of schedule for clinical visit in a month, low educational status, being female, age category (\u003cspan additionalcitationids=\"CR41 CR42 CR43 CR44 CR45 CR46 CR47 CR48\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), and having stage III and Stage IV HIV-related symptom (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20 CR21\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Being mentally impaired has been linked with an impaired adherence to ART and poor treatment outcome, decrease in CD4 count and increase in viral load (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). In addition, depression has been associated with high risk behaviors like engaging in unsafe sex (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eEarly identification of depressive symptoms among HIV-positive individuals is critical to improving health outcomes in this vulnerable population. In HIV care, treating depressed symptoms may improve quality of life and lower the effect of depression on HIV clinical advancement. Although studies on depression and HIV are numerous, research is limited on the factors that contribute to depression among HIV-positive individuals. However, little is known about how depression affects one's socioeconomic status and physical health after receiving antiretroviral therapy (ART).\u003c/p\u003e \u003cp\u003eThus, the aim of this study was to identify the magnitude of depression among HIV positive individuals attending ART clinics of Wolaita Zone, South Ethiopia. This study finding will give direction for further interventions and provision of comprehensive care and bases for further study.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003eOBJECTIVES\u003c/h2\u003e \u003cp\u003eTo assess the prevalence of depression among HIV-positive individuals attending ART clinics of Wolaita Zone\u003c/p\u003e \u003cp\u003eTo identify determinants of depression among HIV-positive individuals attending ART clinics of Wolaita Zone\u003c/p\u003e \u003c/div\u003e"},{"header":"METHODS AND MATERIALS","content":"\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and period\u003c/h2\u003e \u003cp\u003e The study was conducted in hospitals and health centers providing ART clinics in Wolaita Zone, Southern regional state, located 387 Km from Addis Ababa. Regarding public health facilities in Zone, there is 1 teaching and referral hospital, 4 primary hospitals and 68 health centers. This study was conducted among HIV positive individuals attending ART clinics of Wolaita Zone from Dec- Jan, 2021.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA health facility-based cross-sectional study design was used\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eSource population\u003c/strong\u003e \u003cp\u003eAll HIV-positive individuals attending ART clinics in Wolaita Zone\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy population\u003c/strong\u003e \u003cp\u003eAll HIV-positive individuals attending selected ART clinics of Wolaita Zone\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and Exclusion Criteria\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eAll HIV-positive individuals attending ART clinic for at least the past 6 months with CD4 counts measured within the last 6 months were included in the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eIndividuals who are critically sick and unable to hear, with known psychiatric diagnosis, and are on ART for less than 6 months were excluded.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eSample Size Calculation\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using single population formula taking the prevalence of depression in the study conducted in Hawassa, South Ethiopia, which is 48.6%, at a confidence level of 95%, with a 5% margin of error (Bereket et al., 2018).\u003c/p\u003e \u003cp\u003en = (\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eZ α/2)\u003c/span\u003e \u003csup\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003e2\u003c/span\u003e\u003c/sup\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ep (1-p)\u003c/span\u003e\u003c/p\u003e \u003cp\u003ed\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eWhere, n\u0026thinsp;=\u0026thinsp;the minimum sample size, Z\u0026thinsp;=\u0026thinsp;the desired level of confidence interval 95% (1.96), sample size was 384; by adding 10% non-response rate and multiplying by 1.5 design effect final sample size was 634.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSampling Procedure\u003c/h2\u003e \u003cp\u003eTo get adequate and well representing sample from HIV positive individuals attending ART clinic, institutions was clustered based on their level and proportional allocation was made based on case number in each ART clinics of Wolaita Zone. Participants was selected using systematic random sampling techniques. Every sixth patients were selected (Fig.\u0026nbsp;1).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Methods \u0026amp; Tools\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eData collection tools\u003c/h2\u003e \u003cp\u003eStructured questionnaire was used to collect data. Questionnaire was designed in English and was translated to both Amharic and Wolaita language include patient\u0026rsquo;s Socio-demographic characteristics, personal behaviors, economic factors, life events, drug related factors, health related factors, family or social support related factors, adherence of treatment assessed using the Eight-Item Morisky Medication Adherence Scale. These questionnaire items was developed based on literature, the dependent variable assessed using PHQ-9.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eData collectors\u003c/h2\u003e \u003cp\u003eNurses with bachelor degree was recruited to collect data in each clinic. Prior to that actual data collection, data collectors were trained about tools, data collection procedure. Two MSc nurses were recruited for supervision.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eData was collected through direct interview to get quantitative data. First informed voluntary written consent was obtained from each study participant after explaining purpose of study. Structured questionnaire was used to collect data from HIV positive individuals through interview on different variables after they get service they want in ART clinics. The interview was conducted in private place.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec17\" class=\"Section3\"\u003e \u003ch2\u003eDependent/outcome variable\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDepression among HIV positive individuals\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eIndependent variables\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSocio-demographic characteristics\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePersonal behaviors\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eEconomic factors\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLife events\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDrug related factors\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHealth related factors\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eFamily or social support related factors\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eOperational definitions\u003c/h2\u003e \u003cp\u003eDepression: Those with a PHQ-9 score greater than 9 (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdherence; Total score of Morisky: With a sum of scores 8\u0026thinsp;=\u0026thinsp;high, 6 to \u0026lt;\u0026thinsp;8\u0026thinsp;=\u0026thinsp;medium and \u0026lt;\u0026thinsp;6\u0026thinsp;=\u0026thinsp;low adherence to therapy (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eData Quality Control\u003c/h2\u003e \u003cp\u003eData quality was controlled through training of data collectors on questionnaire, ways of conducting interview. Data collectors were supervised by 2 supervisors and principal investigator was received report on daily basis. Before actual data collection, pretest was conducted two health center/hospital. After pretest any ambiguity, confusions, difficult words and differences in understanding was revised based on pretest experience. Completeness and consistency of questionnaire and checklist was checked before and immediately after interview by each data collector and supervisor. Simple frequencies and cross tabulation was done for identifying missing data, and inconsistency.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eData processing and Analysis\u003c/h2\u003e \u003cp\u003eFirst data was coded, completeness and consistencies of questionnaires was checked and double data entry was made using Epi data 3.02 software. Then the data was exported to the SPSS statistical package version 20 for further analysis. Before analysis, data was further cleaned for possible errors. Data was presented in frequency, proportions and summary statistics to describe the study variables.\u003c/p\u003e \u003cp\u003eBivariate analysis was carried out to identify candidates for multivariate analysis. Variables whose p value less than 0.25 in bivariate analysis was included in multivariable logistic regression. Then multivariate logistic regression analysis was performed to identify independent predictors by controlling for possible confounders. AOR at 95% CI with p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was estimated to identify the associated factors on multivariate logistic regression. Variables was interpreted as having statistically significant association when p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in multivariate logistic regression.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic Characteristics\u003c/h2\u003e \u003cp\u003eThis study was conducted on 596 participants, making the response rate 94%. More than half of the respondents were females. The mean age of the respondents was 35.39 years with standard deviation of 11.41. Married participants and those from urban area were taking more than half proportion of the respondents. Mothers share the highest proportion in family responsibility, the respondents are the main sources of income in majority of respondents, and majority are not happy by their monthly income. Those who own the living house takes higher share (56.9%) among the study participants as described in the Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of the participants in ART clinics of Wolaita Zone, South Ethiopia, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e268\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e308\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of residence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e416\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e69.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAble to read \u0026amp; write\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e152\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eResponsibility in family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate business\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHousewife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e16.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003cp\u003e(Eth. Birr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e29.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e501\u0026ndash;1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1501\u0026ndash;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSource of income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSatisfaction with income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e460\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHouse ownership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e56.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRented\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e258\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003ePersonal and clinical characteristics\u003c/h2\u003e \u003cp\u003eThe respondents were asked for their personal and clinical characteristics which are the main independent variables. More than three-fourths of the respondents had no history of depression in their lifetime and also in their family members and live with their nuclear family members and had good relations with their family members. Nearly all were making regular follow-ups of their health status, comply with the prescribed regimen properly, and are in stage I of HIV infection. Tuberculosis co-infection was reported in 213 (35.6%) participants and 226 (37.8%) faced the sleep problems as shown in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e in detail.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePersonal and clinical characteristics of the respondents attending ART clinics of Wolaita Zone, 2021\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e453\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eWith whom the\u003c/p\u003e \u003cp\u003erespondent lives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e457\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e76.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSubstance use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e560\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelationship with\u003c/p\u003e \u003cp\u003efamily members\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSupport from friends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiscrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e350\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of\u003c/p\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e474\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRegular medical check-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eHIV infection staging\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage I\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage II\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage III\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStage IV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTB co-infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e385\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTaking medications\u003c/p\u003e \u003cp\u003eProperly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e552\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEver faced sleep problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e372\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePresence of severe\u003c/p\u003e \u003cp\u003eside effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecent loss of family\u003c/p\u003e \u003cp\u003eMember\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e478\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e79.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003ePrevalence of depression\u003c/h2\u003e \u003cp\u003eThe depression was computed from 10 questions of the tool. The maximum score of the tool was 30 and the minimum was 0. In the current study, the prevalence of depression among HIV-positive individuals attending ART clinics in the Wolaita zone was found to be 32.6% at 95% CI [29%, 36%] (Fig.\u0026nbsp;2).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eBivariate and multivariate analysis results\u003c/h2\u003e \u003cp\u003eIn the multivariate analysis, marital status, sleep problems, living with nuclear families, having tuberculosis co-infection, family history of depression, and place of medical follow-up were variables found to be associated with depression among HIV-positive individuals attending ART clinics of Wolaita Zone. Among marital status, being single [AOR\u0026thinsp;=\u0026thinsp;0.205, CI [0.047, 0.90]] was found to be preventive from the occurrence of depression. Living out of a nuclear family, specifically living with relatives [AOR\u0026thinsp;=\u0026thinsp;6.79, 95 CI [1.92, 24.1]] found to be associated with the occurrence of depression.\u003c/p\u003e \u003cp\u003eTable Bivariate and multivariate analysis results of variables associated with depression among HIV-positive individuals attending ART units of Wolaita Zone, 2021\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCOR\u003c/p\u003e \u003cp\u003e(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003cp\u003e(95%CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eIncome (Eth. Birr)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.28[1.39, 3.74]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.43[0.74,2.78]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e501\u0026ndash;1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.72[1.05, 2.81]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.57[0.20,1.57]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1501\u0026ndash;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.16[0.61,2.22]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.12[0.45,2.77]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49[0.26,0.93]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.205[0.047,0.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.036\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e228\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.49[0.31,0.78]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.04[0.49, 2.19]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.37[0.79,2.36]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.6 [0.66, 3.91]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducational status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnable to write\u003c/p\u003e \u003cp\u003eand read\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.19[1.30, 3.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.04[0.77,5.42]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAble to write\u003c/p\u003e \u003cp\u003eand read\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.82 [1.06,3.11]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.65[0.25,1.71]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.53[0.29, 0.97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.68[0.25,1.88]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary education\u003c/p\u003e \u003cp\u003eand above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eFamily responsibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.229[0.077, 0.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.18[0.57,2.45]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.217[0.073, 0.64]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.82[0.22,3.02]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eChild\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.14[0.04,0.45]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.65[0.51,26.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSatisfaction with income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.62 [2.17, 6.02]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.67[0.81,3.44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSource of income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRespondent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.84[1.27, 2.68]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.13[0.61,2.01]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHomeownership\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRental\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.70 [1.20, 2.40]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.99[0.55,1.82]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of\u003c/p\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.21 [7.26, 17.3]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.65[0.78,3.50]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLiving with\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNuclear Family\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRelatives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.35[5.34,24.1]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.79[1.92, 24.1]*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.21[0.74,1.96]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.97[0.48,1.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRelation with\u003c/p\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e159\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.79 [1.11, 2.90]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.18[0.53,2.64]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSupport from\u003c/p\u003e \u003cp\u003eFriends\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.555[.392, .784]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.76[0.42,1.38]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExperienced Discrimination\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e142\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7.63[5.18, 11.23]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.83[0.97,3.42]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e296\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e22.1[12.98,37.53]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.06[2.02,12.63]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePlace of follow-up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGovernment facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e12.55 [4.53,34.76]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7.67[1.98,29.74]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrivate facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eTB co-infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e86\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.81 [4.66, 9.95]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.3[1.28, 4.21]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e316\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSleep problem\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.1[1.16, 3.72]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.013\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e314\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.114 [0.77, 0.168]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSevere side-effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.07 [2.84, 9.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.49[0.58,3.87]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRecent family\u003c/p\u003e \u003cp\u003eLoss\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.1 [5.77, 14.33]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.63[0.65,2.84]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e369\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eCD4 count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e164\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.28 [0.98, 1.81]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.64[0.97,2.97]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;501\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e238\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eDuration on ART\u003c/p\u003e \u003cp\u003e(months)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.6 [0.31,1.16]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.77[0.29,2.05]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u0026ndash;119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.54 [0.33,0.88]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.19[0.56,2.52]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.12 [0.74,1.69]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.20[0.62,2.29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study presents significant information regarding depression experienced by individuals with HIV who attending HAART treatment in the study's contexts. The study found that the prevalence of depression among participants was about one third (32.6%). The factors of depression included those with sleep problem, co-infection with tuberculosis, a family history of depression, place of medical follow-up and living with relatives (outside of a nuclear family). On the other hand, being single was found to be preventive from the occurrence of depression.\u003c/p\u003e \u003cp\u003eFindings from this study is higher when compared to the rate of depression among general population in Ethiopia 17.5%, (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The stigma linked to HIV among these communities may increase their risk of developing depression that could be responsible for it. The results of this study is comparable with previous study conducted among HIV positive individuals in Jimma 30.2% (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), Addis Ababa 35.5% (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), Gurage Zone 37.5% (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), Hawassa 32.0%(\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), Somalia 3.5% (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), Kenya 35.6% (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), and pooled prevalence in Sub-Saharan Africa which ranged between 9% and 32% (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). On other hand, similar study showed lower prevalence of depression among individuals with HIV such as Aksum 14.6% (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e), Mecha district, Northwest Ethiopia 13.3% (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), National Health Survey of Ethiopia 9.1% (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), and Kenya 13.8% (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), However, this result lower when compared with study conducted in different parts of Ethiopia Gimbi 41.7% (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e), Bahir Dar 57.9% (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e), Bale 44.9% (\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e), West Hararghe 52.4% (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e), Harar 45.8% (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e), and also Nigeria 39.6% (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e), Sudan 63.1%(\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e), and Uganda 46% (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The differences is may be due to the different measurement tools, sample size variations, different locations of the study, sociocultural features participants, and different study setting.\u003c/p\u003e \u003cp\u003eIn this study, sleep problem is associated with depression among individuals with HIV in which those with sleep difficulty two times more likely to report sleep problem than those did not report sleep problem. This supported by evidence from Hawassa University hospital southern Ethiopia, Mettu Karl hospital southwest Ethiopia, Dessie town northeast Ethiopia in which the prevalence of poor quality of sleep found to be 57.6% (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), 57.1% (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e), 36% (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) respectively. This might be explained by bidirectional relationship between depression and sleep problem and the effect of HIV positive on both neuropsychiatric complications.\u003c/p\u003e \u003cp\u003eCo-infection with tuberculosis is also important factor linked with depression in this study. Individuals with positive TB status 6 times more likely to develop depression when compared with those with negative TB status. This finding could be supported by the evidence from the Oromia region in which tuberculosis and HIV co-infected patients had significantly greater risk of common mental disorders (63.7%) (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e), and study from the Kenya depression accounts 31% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), among those who has positive clinical status of both TB and HIV. There is also another evidence which suggests prevalence of depression among TB patients was found to be 45.19% (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), and having comorbid with TB and HIV might increase the severity of depression. TB and HIV can contribute to depression through their direct and complex interplay with each other, and it is important for healthcare providers to recognize and address the mental health needs of individuals dealing with TB and HIV.\u003c/p\u003e \u003cp\u003eFamily history of depression is another factor associated with depression in this study. Those with history of depression with in their family more likely to report depression when compared with their counterparty. Studies have found that individuals with a family history of depression are more likely to experience depressive symptoms(\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e), and be diagnosed with major depressive disorder (MDD) than those without a family history. This association has been observed in both HIV-positive and HIV-negative populations. One potential explanation for this association is the role of genetics. In the context of HIV, family history of depression may be particularly relevant due to the added stressors associated with the illness.\u003c/p\u003e \u003cp\u003ePlace of follow up is another important factor which associated with depression in this study. Individuals who follow their treatment at government health facility more likely to report depression than those who follow their treatment at private health facilities. This might be due to the patient preference to private health care providers (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e), with the possible reasons of better and more flexible access, shorter waiting, greater confidentiality (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e), which might differ quality of care in further and result in different rate of depressive symptoms in the same group of population. The finding of this study that living outside of a nuclear family is associated with depression among HIV-positive individuals is consistent with previous research on the relationship between social support and mental health outcomes (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e). This finding also consistent with systematic review report of HIV-positive individuals who live outside of a nuclear family may be at higher risk of depression due to the lack of social support and increased isolation (\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this study, being single is preventive factor as contrary to general assumption of risk factor for depression. However, this finding also supported by the evidence which reports being single or being divorced/widowed were associated with depressive symptoms at every age in men but for women turn, being single was associated with depressive symptoms (\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Married women suffer more depression than unmarried ones(\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). This could be explained by the majority of participants in this study are women.\u003c/p\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eThe following potential limitations should be taken into consideration when considering the study's conclusions. Firstly, this study only included individuals who attend the antiretroviral treatment clinic, which may limit the generalizability of the findings to those who do not attend such clinics. Also, those who attend the clinic may be more likely to have depression compared to those who do not attend, leading to potential self-selection bias. Participants may not be truthful about their depression symptoms due to social desirability bias. Secondly, this study may not be able to establish causality as it is based on a cross-sectional design. Third, the study depend on self-reported data which may not be accurate due to recall bias or social desirability bias. And finally, the study only focuses on depression among HIV-positive individuals and does not explore other mental health conditions or factors that may contribute to depression.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDepression is a prevalent mental health issue among the participants, with approximately one third of them experiencing symptoms of depression. The study identified several factors that were associated with depression, including sleep problems, living outside of a nuclear family, co-infection with tuberculosis, a family history of depression, and place of medical follow-up. Being single was found to be a protective factor against the occurrence of depression. These findings suggest that healthcare professionals should be aware of the risk factors for depression, particularly in patients with sleep problems, co-infection with tuberculosis, and a family history of depression. Additionally, the findings indicate that social support, such as living in a nuclear family, may be beneficial in preventing depression. However, the protective effect of being single against depression should be interpreted with caution, as social isolation can also contribute to poor mental health outcomes.\u003c/p\u003e\n\u003ch3\u003eRecommendation\u003c/h3\u003e\n\u003cp\u003eHealthcare professionals should screen patients for depression, particularly those with sleep problems, co-infection with tuberculosis, and a family history of depression. Early identification and treatment of depression can prevent it from worsening and improve outcomes for patients. Family support should be promoted to prevent depression. Social support should be provided to patients who are at risk of depression. Support groups, community engagement activities, and counseling services can help patients build social connections and reduce feelings of isolation. Further research is needed to better understand the relationship between social factors and depression.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study\u0026nbsp;was approved by the\u0026nbsp;Institutional Health Research Ethical Review Committee of Wolaita Sodo University College of Health and Medical Sciences (reference number 08/01/13) with the project code\u0026nbsp;CHSM/ERC/1.\u0026nbsp;The\u0026nbsp;letter was written from\u0026nbsp;the college to each\u0026nbsp;hospital and health center. Data were collected after\u0026nbsp;obtaining informed written voluntary consent\u0026nbsp;from each participating patient after informing about study. \u0026nbsp;Depression is linked to social support centers or psychiatric units.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data and materials supporting the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors has no conflict of interest to declare.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors didn\u0026rsquo;t receive fund for this study.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u003cstrong\u003eAuthors\u0026apos; Contributions\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAA, YY, MT, and BK conceived and designed the study. SS and TL analyzed and interpreted the data. YY drafted the manuscript. AA, KP, and NA critically reviewed and revised the manuscript. All authors read and approved the final manuscript.\u003c/em\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAmerican Psychiatric Association, American Psychiatric Association, editors. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013. p. 947.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDiagnostic and Statistical Manual of Mental Disorders. Fifth Edition Text Revision DSM-5-TR\u003csup\u003e\u0026trade;\u003c/sup\u003e.:1377.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShao Y, Williamson C. The HIV-1 Epidemic: Low- to Middle-Income Countries. Cold Spring Harb Perspect Med. 2012;2(3):a007187\u0026ndash;007187.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDel Rio C. 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Sex Roles. 1996;34(5\u0026ndash;6):299\u0026ndash;319.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"depression, depressive disorders, HIV patients, patients on ART","lastPublishedDoi":"10.21203/rs.3.rs-4254185/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4254185/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003ePeople who are infected with HIV are more likely to develop depression than the general population. It is one of the causes of poor adherence to Anti-retroviral therapy and worsens the patient\u0026rsquo;s condition and leads to death. Most studies conducted in the area addressed a single setting whereas this study was multi-central. So, it is important to assess the prevalence of depression and its determinants among HIV-positive individuals attending ART clinics of Wolaita Zone.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to assess the prevalence and determinants of depression among HIV-positive individuals attending ART clinics in Wolaita Zone, Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods and Materials:\u003c/h2\u003e \u003cp\u003eInstitution-based cross-sectional study was conducted among HIV-positive individuals attending ART clinics of Wolaita Zone. Data was collected from 596 participants. Health facilities were clustered based on the number of patients attending to ART clinics. Then, facilities were selected randomly from the respective clusters. Data was collected through the face-to-face interview. Epi data for data entry and analyzed using SPSS\u0026rsquo;s version 20. The presence and strength of association were declared when p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 and using AOR in multivariate analysis respectively.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e \u003cp\u003eThe prevalence of depression among HIV-positive individuals in the Wolaita Zone is 32.6% at 95% CI [29%, 36%]. Marital status, educational status, living with families, family history of depression, place of medical follow-up, presence of Tuberculosis co-infection, and presence of sleep problems are significantly associated with depression among study participants.\u003c/p\u003e\u003ch2\u003eConclusion and recommendation\u003c/h2\u003e \u003cp\u003e: The prevalence of depression among HIV-positive individuals in the Wolaita Zone is high. Being single, living far away from family members, having a family history of depression, the presence of sleep problems and TB co-infection, and making medical follow up at governmental facilities are determined to be factors associated with the occurrence of depression among HIV-positive individuals attending ART clinics of Wolaita Zone. Therefore, psychological support with differential counseling of patients on ART based on their specific needs is essential to minimize the occurrence of depression. In addition, early screening and treatment of TB co-infection, and depression are very important.\u003c/p\u003e","manuscriptTitle":"Depression Among Hiv-positive Individuals Attending the Antiretroviral Treatment Clinics of Wolaita Zone, Southern Ethiopia,2021","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-13 02:30:48","doi":"10.21203/rs.3.rs-4254185/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8ad9eaf9-2ba0-491d-b85f-f1e91d40a19b","owner":[],"postedDate":"July 13th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-13T02:30:50+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-13 02:30:48","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4254185","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4254185","identity":"rs-4254185","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}