Depression to me means…”

Abstract

Addressing the burden of depression requires an improved understanding of anti-retroviral therapy (ART) patients’ and providers’ views toward depression. In-depth interviews were conducted with providers (n=10), ART patients (n=11), clinic leadership (n=3), and a policy maker at two public facilities in Lilongwe, Malawi. Knowledge about the manifestations, causes, treatments, and effects of depression varied widely. Participants described depression as “thinking too much,” a result of being unprepared or in denial. Depression and its clinical treatment were intricately intertwined with HIV. Participants described depression as resulting from HIV diagnoses, equated depression treatment with encouraging HIV status acceptance and ART adherence, and believed that depression would negatively affect HIV care engagement and outcomes. While antidepressants and depression counselling appear to be acceptable depression treatment options, social engagement, support and encouragement may also be important. There are important subtleties in how depression is understood and manifests in Malawi. Capacity-building programs for providers should highlight that depression is a disorder distinct from HIV, requiring its own medical management. Programs should also reinforce that ART adherence counselling may be insufficient to ameliorate depressive symptoms.