Mental health disorders among people living with human immunodeficiency virus on antiretroviral therapy in Benin: the overlooked role of sleep quality.

The prevalence of depression among people living with HIV on antiretroviral therapy in Benin was 20.8%.

• 65 of 312 participants screened positive for depression (n/N = 65/312)
• Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) with a moderate-or-worse threshold of ≥10
• Study population was 68.3% female with a mean age of 44.3 ± 12.3 years
• Hospital-based cross-sectional study conducted at Benin's National Teaching Hospital from December 2023 to February 2024

The prevalence of anxiety among people living with HIV on antiretroviral therapy in Benin was 12.8%.

• 40 of 312 participants screened positive for anxiety (n/N = 40/312)
• Anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7) with a moderate-or-worse threshold of ≥10
• 312 adults on ART for ≥6 months were randomly sampled from the clinic registry

Poor sleep quality was highly prevalent among PLHIV on ART, affecting more than half of participants.

• 57.1% of participants had poor sleep quality (n/N = 178/312)
• Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), with poor sleep defined as a score >5
• Poor sleep quality was identified as a key correlate of both depression and anxiety

Good sleep quality was independently protective against depression in multivariable logistic regression analysis.

• Adjusted odds ratio (aOR) = 0.3 (95% CI = 0.2–0.6) for the association between good sleep quality and depression
• This association remained significant after adjustment for sociodemographic and clinical covariates
• The direction of association indicates that good sleep quality was associated with lower odds of depression

Good sleep quality was independently protective against anxiety in multivariable logistic regression analysis.

• Adjusted odds ratio (aOR) = 0.4 (95% CI = 0.2–0.9) for the association between good sleep quality and anxiety
• This association remained significant after adjustment for sociodemographic and clinical covariates
• The association was described as 'robust' and 'independent'

Age ≥44 years was independently associated with higher odds of anxiety.

• aOR = 2.1 (95% CI = 1.0–4.5) for age ≥44 years and anxiety
• The median/mean age of the study population was 44.3 ± 12.3 years
• Age ≥44 years was the only sociodemographic variable independently associated with anxiety in multivariable analysis
• Other sociodemographic and clinical covariates were not independently associated with depression or anxiety

Other sociodemographic and clinical covariates were not independently associated with depression or anxiety in multivariable analysis.

• Multivariable logistic regression was used to identify factors independently associated with depression and anxiety
• Sleep quality and age ≥44 years (for anxiety only) emerged as the primary independent predictors
• Commonly studied clinical HIV-related variables did not show independent associations after adjustment

The authors recommend integrating routine mental-health and sleep screening with clear referral pathways within ART services.

• Recommendation is based on the high prevalence of poor sleep (57.1%), depression (20.8%), and anxiety (12.8%) found in this population
• The authors call for 'longitudinal and interventional studies' to test whether improving sleep reduces symptoms and enhances ART outcomes
• The paper characterizes sleep quality as an 'overlooked' factor in mental health among PLHIV