Depression, Anxiety and Stress Among People Living With HIV: A Cross‑Sectional Study From Antiretroviral Therapy (ART) Centres in Western Rajasthan, India

Depression, anxiety and stress occur at disproportionately higher rates among people living with HIV (PLWH) compared to the general population. Although antiretroviral therapy (ART) has extended survival, these psychological morbidities remain a critical public health concern. This study aims to estimate the prevalence of depression, anxiety, and stress among PLWH in Western Rajasthan, India, and to identify key sociodemographic and clinical predictors influencing their mental health status. A cross-sectional study was conducted among 551 PLWH attending two government ART centres between March 2024 and March 2025, using consecutive sampling. Mental health status was assessed through face-to-face administration of the validated Hindi version of the Depression Anxiety and Stress Scale-21 (DASS-21) by trained interviewers. Binary logistic regression was applied to calculate odds ratios (OR) with 95% confidence intervals (CIs), followed by multivariable adjusted analyses. The prevalence of depression, anxiety, and stress was 11.6%, 19.6%, and 9.6%, respectively. Depression was significantly associated with rural residence (AOR=2.47, 95% CI: 1.02-5.96, p=0.04), absence of spouse (AOR=2.27, 95% CI: 1.03-5.06, p=0.04), and malnutrition (BMI ≤18.5 kg/m²; AOR=3.63, 95% CI: 1.26-10.46, p=0.02). Anxiety was linked to malnutrition (AOR=1.80, p=0.04) and low CD4 count (≤200 cells/mm³; AOR=0.20, p=0.02). Stress was strongly associated with ART nonadherence (≤95%) (AOR=3.77, 95% CI: 1.46-9.72, p<0.01). These findings underscore the substantial burden of psychological morbidities among PLWH in Western Rajasthan and highlight the need for integrated mental health screening, counselling, and referral mechanisms within HIV care programmes to improve overall health outcomes.