Depression is often co-morbid with chronic conditions, and when combined with HIV it can increase progression and reduce survival. A brief and accurate screening tool for depression among children living with HIV is necessary to increase access to mental health care and improve HIV-related outcomes in the long-term.
A validation study was conducted, comparing the Children’s Depression Inventory (CDI) with a structured clinical assessment as the gold standard among children living with HIV ages 7-14 years in Rwanda. The response rate was 87 % and the analysis was performed among 100 study participants.
Twenty-five percent of children had a diagnosis of depression based on the clinical interview. Sensitivity of the CDI ranged from 44 to 76 % and specificity was 92 to 100 % for cut-off scores from 5 to 9. The area under the curve (AUC) for receiver operating characteristic analysis, an estimate of overall accuracy, was 0.87 (95 % confidence interval: 0.77 – 0.97).
The significant prevalence of depression among children living with HIV in Rwanda reflects a critical need to advance mental health care in this population. Although overall accuracy of the CDI is reasonable in this context, further research needs to be done to develop a more sensitive measure of depression in this vulnerable population. Development of a highly sensitive screening measure will be a fundamental step towards improving access to mental health care among children living with HIV, potentially improving health outcomes and quality of life in the long-term as this vulnerable population transitions into adulthood.
Binagwaho, Agnes; Smith Fawzi, Mary C.; Agbonyitor, Mawuena; Nsanzimana, Sabin; Karema, Corine; Remera, Eric; Mutabazi, Vincent; Shyirambere, Cyprien; Cyamatare, Patrick; Nutt, Cameron; Wagner, Claire; Condo, Jeanine; Misago, Nancy; and Kayiteshonga, Yvonne, "Validating the Children’s Depression Inventory in the Context of Rwanda" (2016). Open Dartmouth: Faculty Open Access Articles. 3531.