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AIDS Behav. 2019 Jul 4. doi: 10.1007/s10461-019-02583-9. [Epub ahead of print]

A Dyadic Investigation of Relationship Dynamics and Depressive Symptoms in HIV-Affected Couples in Malawi.

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Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.
Division of Prevention Sciences, Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, CA, USA.
Invest in Knowledge, Zomba, Malawi.


Depression is the leading cause of disability worldwide with health implications for people living with HIV. Primary partnerships like marriage could be protective against depression but may worsen depression depending on the relationship quality. We examined depression and its association with relationship dynamics in a cross-sectional sample of 211 HIV-affected married couples in Malawi. We fit multivariable multilevel linear regression models for depressive symptoms. Men and women reported similar levels of depressive symptoms; 28% had a score indicative of probable depression. Almost half of couples had at least one partner with probable depression. In the adjusted models, equality (B = - 0.22; p < 0.01) and unity (B = - 0.94; p < 0.05) were associated with fewer depressive symptoms while individuals with more experiences of physical (B = 0.81; p < 0.01), sexual (B = 0.87; p < 0.01), and emotional violence (B = 1.52; p < 0.001) had higher levels of depressive symptoms. Couples-based interventions aiming to improve relationships may address depression, especially in settings with inadequate mental health services.


Depression; HIV; Heterosexual couples; Relationship dynamics; Sub-Saharan Africa


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