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

## TL;DR

This study in Benin finds that poor sleep quality is strongly linked to depression and anxiety in people living with HIV on antiretroviral therapy.

## Contribution

The study highlights the previously overlooked role of sleep quality in mental health outcomes among HIV patients in Benin.

## Key findings

- Depression and anxiety were present in 20.8% and 12.8% of participants, respectively.
- Poor sleep quality was independently associated with higher odds of depression and anxiety.
- Good sleep quality was protective against both mental health disorders.

## Abstract

Depression and anxiety are common comorbidities among people living with HIV (PLHIV) and may be influenced by sleep quality; evidence from Benin remains limited. We assessed the prevalence of depression and anxiety among PLHIV on antiretroviral therapy (ART) and evaluated their association with sleep quality.

We conducted a hospital-based cross-sectional study at Benin’s National Teaching Hospital from December 2023 to February 2024. Adults on ART ≥ 6 months were randomly sampled from the clinic registry. Validated tools were used: Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7, moderate-or-worse threshold ≥ 10; Pittsburgh Sleep Quality Index, poor sleep > 5. Multivariable logistic regression identified factors independently associated with depression and anxiety.

Among 312 participants (68.3% female; mean age 44.3 ± 12.3 years), the prevalence of depression and anxiety was 20.8% (n/N = 65/312) and 12.8% (n/N = 40/312), respectively; poor sleep quality was common (57.1%, n/N = 178/312). Good sleep quality was independently protective for both depression with adjusted odds ratio (aOR) = 0.3, 95% confidence interval (CI) = 0.2–0.6 and anxiety (aOR = 0.4; 95% CI = 0.2–0.9). Age ≥ 44 years was associated with higher odds of anxiety (aOR = 2.1; 95% CI = 1.0–4.5), while other sociodemographic and clinical covariates were not independently associated.

Moderate-or-worse depressive and anxiety symptoms are frequent among PLHIV in this setting, and sleep quality shows a robust independent association with both outcomes. Integrating routine mental-health and sleep screening with clear referral pathways within ART services is warranted; longitudinal and interventional studies should test whether improving sleep reduces symptoms and enhances ART outcomes.