The Factor Structure and Presentation of Depression Among HIV-Positive Adults in Uganda

Christina Psaros, Jessica E. Haberer, Yap Boum, Alexander C. Tsai, Jeffrey N. Martin, Peter W. Hunt, David R. Bangsberg, Steven A. Safren

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


Depression is one of the most prevalent psychiatric comorbidities of HIV and one of the greatest barriers to HIV self-care and adherence. Despite this, little consensus exists on how to best measure depression among people living with HIV/AIDS (PLWHA) in African settings. Measurement of depression among PLWHA may be confounded by somatic symptoms. Some research recommends excluding these items to enhance measurement validity; sensitivity may be lost with this approach. We sought to characterize depression among a cohort (N = 453) of PLWHA initiating antiretroviral therapy in Uganda via factor analysis of a widely used measure of depression, the Hopkins Symptom Checklist (HSCLD). Common factor analysis was performed, associations between HSCLD and the Mental Health subscale of the Medical Outcomes Study HIV (MOS-HIV) estimated, and a Cronbach’s alpha calculated to examine validity. Factor analysis yielded two factors: (1) somatic-cognitive symptoms and (2) behavioral disengagement. Persons with more versus less advanced disease (CD4 cell count of ≤200 cells/mm3) showed no statistically significant differences in depression scores (1.7 vs. 1.7, P ≥ 0.5). Both factors were significantly associated with the MOS-HIV (P < .01). Factor one was highly reliable (α = .81); factor two had only modest reliability (α = .65). Somatic-cognitive symptoms of depression and disengagement from life’s activities appear to be distinct components of depression in this sample. Consideration of somatic items may be valuable in identifying depression in this setting.

Original languageEnglish (US)
Pages (from-to)27-33
Number of pages7
JournalAIDS and Behavior
Issue number1
StatePublished - Jan 2014
Externally publishedYes


  • Assessment
  • Depression
  • Validity

ASJC Scopus subject areas

  • Social Psychology
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


Dive into the research topics of 'The Factor Structure and Presentation of Depression Among HIV-Positive Adults in Uganda'. Together they form a unique fingerprint.

Cite this