Psychological impact and psychiatric morbidity associated with HIV infection have received considerable attention in the last decade due to their effect on an individual’s personal, sexual, occupational and social life [1] . Depression is the commonest psychiatric condition reported in studies among HIV infected individuals [2] -[4] . The prevalence of major depression in HIV-positive population is nearly two times higher compared to that in healthy people representing the community [5] . A study from India has reported depression in 40% HIV infected individuals soon after being tested for HIV [6] . Some studies have reported that depression was one of the significant factors for non adherence to antiretroviral treatment [7] [8] . The prevalence and nature of depression in HIV infected individuals have been mentioned in various studies but there is limited literature addressing depression among HIV uninfected caregivers [9] -[15] . To the best of our knowledge, no studies have reported depressive symptoms in HIV uninfected caregivers in India.

Our experience from HIV sero-discordant couple studies [data unpublished] in Pune, India, indicate that majority of the spouses of HIV infected individuals continue to provide support to their partners. The physical and emotional burden faced by the uninfected spouses while supporting their infected partners was likely to lead to some level of psychiatric morbidity, especially depression among them.

The majority of studies evaluating HIV negative caregivers’ emotional status have been conducted in western cultures, and there is a scarcity of data on mental health among HIV uninfected caregiver spouses in Indian context.

The Beck Depression Inventory (BDI) is a diagnostic tool that measures depressive symptoms in a variety of settings. Studies have been conducted in developed and developing countries using BDI in adolescents, postpartum women, relatives of critically ill patients and HIV infected individuals [7] [8] [16] -[19] . In this paper, we report the level of depression as measured by BDI-II in HIV uninfected spouses of HIV infected individuals and compared their scores with those of demographically similar HIV uninfected individuals from the general community.

Despite its prevalence and importance, depression remains substantially under-recognized in medical settings

^*Mann-Whitney U Test.

[22] and it has been reported that in the primary care setting depression does not get diagnosed in about 50% patients [23] [24] . This scenario largely reflects clinic attendees and is expected to be equally low or lower for the caregivers of patients. This is because they are struggling with different kinds of stresses resulting from managing the chronic disease of their partners, stigma and discrimination and financial difficulties faced by the family [9] -[15] . It has been reported that the patients’ illness symptoms, negative mood, and need for emotional support or physical assistance are often taxing to close family members [25] . It has also been reported that the patients’ close family members may experience poorer psychological well-being, relationship issues with the patient, care giving burden, and poorer physical health [26] . The majority of studies evaluating depressive symptoms in caregivers of HIV seropositive spouses have been conducted in western countries, and to the best of our knowledge, this is the first study focused on the caregivers’ emotional status in India.

In this study, we report symptoms related to depression in HIV uninfected caregiver spouses by comparing them with another group of HIV uninfected individuals with similar age, gender, occupation and education background from the general community.

The total score on BDI-II was higher in the HIV uninfected caregiver spouses as compared to the others. This is suggestive of the depressive psychological state of the caregiver spouses of HIV infected individuals. In majority items on subscale of BDI-II, though the caregiver spouses have scored higher than the comparison group, the differences in scores are statistically significant only with respect to three items, namely sadness, punishment feelings and crying. The first five ranked concerns by the caregiver spouses were sadness, loss of interest in sex, loss of pleasure, pessimism and irritability. These findings highlight and emphasize the need to address depression among the caregivers. Of note, three individuals in the caregiver group endorsed mild suicidal ideation (“I have thoughts of killing myself, but I would not carry them out”) suggesting that clinicians should be cognizant of such issues. In general, the overall depressive symptoms reported by caregivers of HIV infected spouses were low.

The analysis has a limitation. The number of participants is less and hence the findings are not generalizable. The implication of study findings is that the clinicians should evaluate the caregiver spouses of HIV infected individuals for evidence of depression, as they play key role in providing care and support to the infected individuals. Designing and implementing appropriate interventions to provide counseling to spouses may help them to prevent occurrence of depression or develop coping skills to manage it. This may help them in taking better care of their HIV infected partners.

This research was supported by NIMH R01 MH78748 NeuroAIDS in India (Dr. Marcotte, P.I.) and P30 MH62512 HIV Neurobehavioral Research Center (Dr. Grant, P.I.).