دانلود رایگان مقاله انگلیسی اثرات کاهش افسردگی بر بهره وری کار و درآمد بیماران اچ آی وی در اوگاندا - اشپرینگر 2017

Abstract

Purpose Depression is common among people living with HIV, and it is associated with impaired work functioning. However, little research has examined whether depression alleviation improves work-related outcomes in this population, which is the focus of this analysis. Method A sample of 1028 depressed HIV clients in Uganda enrolled in a comparative trial of depression care models and were surveyed over 12 months. Serial regression analyses examined whether depression alleviation (measured by the nine-item Patient Health Questionnaire) was associated with change in self-reported weekly amount of hours worked and income earned, and whether these relationships were mediated by change in work-related self-efficacy. Results Among those with major depression, depression alleviation was associated with nearly a doubling of weekly hours worked in bivariate analysis. The relationship between depression alleviation and hours worked was partially mediated by change in work self-efficacy among those with major depression, as well as those with minor depression, in multivariate regression analysis that controlled for demographic and health covariates. Depression alleviation was not significantly associated with change in weekly income. Conclusion These findings suggest that depression alleviation benefits work functioning at least in part through improved confidence to engage in work-related activities. Integration of depression care services into HIV care may be important for improving the economic well-being of people living with HIV.

Discussion

These findings show that alleviation of major depression is associated with better work-related functioning and productivity, as measured by an increase in number of hours worked, but not associated with change in income earned, in people receiving HIV care in Uganda. In bivariate analysis, depression alleviation was associated with nearly a doubling of average weekly hours worked. Work-related self-efficacy partially mediated the relationship between depression alleviation and change in hours worked in those with major depression, suggesting that depression (and alleviated or treated depression) influences work functioning in part through its influence on confidence to engage in and successfully perform work-related activities. Similar findings were observed for alleviation of minor depression.

Depression has been associated with work- and economicrelated outcomes such as work status (i.e., whether or not someone was engaged in work activity) in studies of people living with HIV [11, 29], but few studies have examined the economic associations of depression alleviation in this population. In a prior study of the work-related effects of antidepressant treatment in a small sample of people living with HIV in Uganda, we found that treatment resulted in improved work functioning and self-efficacy [29], but had no effect on engagement in actual work activity; this led us to suggest that supplementary therapeutic strategies (e.g., behavioral activation, problem solving) may be needed to more directly impact work-related behavioral change. However, this larger study now shows that when depression is alleviated, whether as a result of antidepressant treatment (which was the case for most in this study) or not, work activity in the form of hours worked increases significantly among those who have major depression.