# Probable Depression Is Associated with Lower BMI Among Women on ART in Kinshasa, the Democratic Republic of Congo: A Cross-Sectional Study

## TL;DR

Women with HIV in Kinshasa who experience depression tend to have lower BMI, despite widespread food insecurity and poor diets.

## Contribution

This study identifies probable depression as an independent factor associated with lower BMI among women on ART in a low-income urban setting.

## Key findings

- Probable depression was independently linked to a lower follow-up BMI after adjusting for baseline values and other factors.
- Household food insecurity and inadequate dietary diversity were common but not directly associated with BMI in adjusted models.
- Time since ART initiation showed a slight positive association with BMI.

## Abstract

Background: Women living with HIV (WLHIV) in low-income urban settings face multiple intersecting nutritional risks from food insecurity, poor dietary quality, and mental health problems. We evaluated the prevalence of household food insecurity and inadequate dietary diversity, examining their associations with depressive symptoms, antiretroviral therapy (ART)-related factors, and body mass index (BMI) among WLHIV attending routine ART clinics in Kinshasa, The Democratic Republic of Congo. This study addresses critical gaps in understanding the interplay between mental health and nutrition in the context of HIV care, with significant implications for improving health outcomes among vulnerable populations. Methods: In this clinic-based cross-sectional study (February–April 2024), we enrolled 571 women on ART in Masina 2, Kinshasa. Household food insecurity was measured using the Household Food Insecurity Access Scale (HFIAS), dietary diversity was assessed using the Minimum Dietary Diversity for Women (MDD_W; inadequate ≤ 5 food groups in 24 h), and probable depression was assessed using the Hopkins Symptom Checklist-10 (HSCL-10), which is a validated screening tool. We obtained baseline BMIs from clinic records at ART induction, which we measured again upon survey completion. We used analysis of covariance (ANCOVA) to model follow-up BMI, adjusting for baseline values, age, ART duration, self-reported adherence, household food insecurity, dietary diversity, and probable depression. Sensitivity analyses included change-score and mixed-effects models. Results: The prevalence of any household food insecurity was high (75%; 95% CI:71.5–78.6), with 57.6% (95% CI:53.5–61.6) of the participants experiencing inadequate dietary diversity (MDD_W < 5). Furthermore, forty-two per cent (95% CI:38.4–46.5) experienced depressive symptoms and sixty-eight percent (95% CI: 64.4–72.0) adhered to antiretroviral therapy (ART). The mean MDD_W was 4.3, with a low consumption rate of animal-source foods. Baseline BMI was associated with follow-up values (adjusted βunstandardized, 0.48 kg/m2 per 1 kg/m2 baseline, 95% CI 0.38–0.59; p < 0.001). Probable depression was independently associated with a lower follow-up BMI (adjusted βunstandardized, −0.99 kg/m2; 95% CI −1.72 to −0.26; p = 0.008). Time since ART initiation showed a slight positive association with BMI (adjusted βunstandardized, 0.10 kg/m2 per year). Self-reported ART adherence, household food insecurity, and dietary diversity were not independently associated with follow-up BMI in fully adjusted models. The interaction between age and probable depression did not suggest heterogeneity between age groups (p = 0.503). Conclusions: In our cohort, food insecurity and poor dietary diversity were widespread but did not significantly correlate with BMI, while probable depression, a potentially modifiable factor, was independently associated with lower BMI after accounting for baseline nutritional status. These findings highlight the need for HIV care programs integrating mental health screening and services with nutrition-sensitive interventions to support recovery and long-term health among WLHIV.