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Boakye DS, Setordzi M, Dzansi G, Adjorlolo S. Mental health burden among females living with HIV and AIDS in sub-Saharan Africa: A systematic review. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002767. [PMID: 38300927 PMCID: PMC10833589 DOI: 10.1371/journal.pgph.0002767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 12/06/2023] [Indexed: 02/03/2024]
Abstract
Mental health problems, particularly depression and anxiety, are common in women and young girls living with HIV/ AIDS particularly in low- and middle-income (LMICs) countries where women's vulnerability to psychiatric symptoms is heightened due to the prevalent intersectional stressors such as stigma and intimate partner violence. However, no synthesized evidence exists on the mental health burden of females living with HIV/AIDS (FLWHA) in Africa. This systematic review aimed to synthesize the current evidence on the mental health burden among FLWHA in sub-Saharan Africa. A systematic literature review of articles published from 2013-2023 was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA). Five electronic databases; PubMed, MEDLINE with full text, Scopus, Academic Search Complete, and Health Source: Nursing Academic Edition were searched for articles published in English. Nineteen articles (15 quantitative, 3 qualitative, and 1 case study) from over 7 African countries met the inclusion criteria. The majority of the studies' quality was determined to be moderate. The prevalence of depression ranged from 5.9 to 61% and anxiety from 28.9 to 61%. Mental health burden was a logical outcome of HIV diagnosis. Predictors of mental health outcomes in the context of HIV/AIDS were identified as intimate partner violence (IPV), stigma, childhood traumas, sexual abuse, poverty, unemployment, and social isolation. Social support and resilience were identified as protective factors against mental illness in FLWHA. Mental illness had a deleterious effect on viral suppression rates among FLWHA, resulting in delayed initiation of antiretroviral therapy treatment and increased mortality but had no impact on immune reconstitution in the face of ART adherence. Given the high prevalence rates of depression and anxiety and their relationship with HIV progression, it is crucial that mental health care services are integrated into routine HIV care.
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Affiliation(s)
- Dorothy Serwaa Boakye
- Department of Health Administration and Education, University of Education, Winneba, Ghana
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Mawuko Setordzi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Department of Nursing, Presbyterian Nursing, and Midwifery Training College, Dormaa Ahenkro, Bono Region, Ghana
| | - Gladys Dzansi
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Samuel Adjorlolo
- School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- Research and Grant Institute of Ghana, Legon, Ghana
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Kathono J, Nyongesa V, Mwaniga S, Obonyo G, Yator O, Wambugu M, Banerjee J, Breuer E, Duffy M, Lai J, Levy M, Njuguna S, Kumar M. Adolescent perspectives on peripartum mental health prevention and promotion from Kenya: Findings from a design thinking approach. PLoS One 2024; 19:e0290868. [PMID: 38165879 PMCID: PMC10760697 DOI: 10.1371/journal.pone.0290868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 08/17/2023] [Indexed: 01/04/2024] Open
Abstract
In Kenya, approximately one in five girls aged 15-19 years old are pregnant or already a mother. Adolescent girls and young women experience significant mental health vulnerabilities during the pregnancy and postpartum periods, leading to poor antenatal and postnatal care attendance and inferior infant and maternal health outcomes. Pregnant adolescents often experience stigma and disenfranchisement due to their pregnancy status and at the same time lack access to mental health support within health settings, schools, religious institutions, and communities. This paper presents the results of qualitative interviews embedded within the human-centered design (HCD) process used to adapt the Helping Adolescents Thrive (HAT) program for Kenyan peripartum adolescents including young fathers. This qualitative study used two phases. First, a HAT advisory group participated in a series of four workshops to help identify and articulate mental health promotion needs and deepened the team's understanding of youth-centered thinking. Second, qualitative interviews were conducted with 39 pregnant and parenting adolescents to understand their perspectives on mental health prevention and promotion. Pregnant and parenting adolescents articulated different needs including poor support, stigma, and psychological disturbances. Parenting adolescents reported disturbed relationships, managing motherhood, poor health, and social empowerment. Participants highlighted sources of stress including economic challenges, fear of delivery, strained relationships, rejection, and stigma. Participants described psychological disturbances such as feeling stressed, worthless, withdrawn, and suicidal. Coping mechanisms reported by participants included engaging in domestic activities, hobbies, and social networking. Peers, family and spirituality were identified as important sources of support, as well as school integration, livelihoods, support groups and mentorships. Findings from this study can be used to strengthen and adapt HAT program, policy and practice for mental health prevention and promotion for pregnant and parenting adolescents.
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Affiliation(s)
| | | | | | | | - Obadia Yator
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | | | | | - Erica Breuer
- University of Newcastle, Newcastle, New South Wales, Australia
| | - Malia Duffy
- St Ambrose University, Davenport, Iowa, United States of America
- Health Across Humanity, LLC, Boston, Massachusetts, United States of America
| | - Joanna Lai
- UNICEF Headquarters, New York, NY, United States of America
| | - Marcy Levy
- UNICEF Headquarters, New York, NY, United States of America
| | - Simon Njuguna
- Division of Mental Health, Ministry of Health, Nairobi, Kenya
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
- Institute for Excellence in Health Equity, New York University Grossman School of Medicine, New York, NY, United States of America
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Mohamed S, Chipeta MG, Kamninga T, Nthakomwa L, Chifungo C, Mzembe T, Vellemu R, Chikwapulo V, Peterson M, Abdullahi L, Musau K, Wazny K, Zulu E, Madise N. Interventions to prevent unintended pregnancies among adolescents: a rapid overview of systematic reviews. Syst Rev 2023; 12:198. [PMID: 37858208 PMCID: PMC10585784 DOI: 10.1186/s13643-023-02361-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 09/25/2023] [Indexed: 10/21/2023] Open
Abstract
Risks associated with unintended pregnancy include unsafe abortions, poor maternal health-seeking behaviour, poor mental health, and potentially, maternal and infant deaths. Adolescent girls with unintended pregnancies are particularly vulnerable as they are at higher risk of eclampsia, premature onset of labour, and increased neonatal morbidity and mortality. Unintended pregnancy, with the right combination of interventions, can be avoided. Evidence-based decision-making and the need for a robust appraisal of the evidence have resulted in many systematic reviews. This review of systematic reviews focuses on adolescent pregnancy prevention and will seek to facilitate evidence-based decision-making. Two review authors independently extracted data and assessed the methodological quality of each review according to the AMSTAR 2 criteria. We identified three systematic reviews from low- and middle-income countries and high-income counties and included all socioeconomic groups. We used vote counting and individual narrative review summaries to present the results. Overall, skill-building, peer-led and abstinence programmes were generally effective. Interventions focused on information only, counselling and interactive sessions provided mixed results.In contrast, exposure to parenting and delaying sexual debut interventions were generally ineffective. Adolescent pregnancy prevention interventions that deploy school-based primary prevention strategies, i.e. strategies that prevent unintended pregnancies in the first place, may effectively reduce teenage pregnancy rates, improve contraceptive use, attitudes and knowledge, and delay sexual debut. However, the included studies have methodological issues, and our ability to generalise the result is limited.
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Affiliation(s)
- Sahra Mohamed
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Michael G Chipeta
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi.
| | | | - Lomuthando Nthakomwa
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Chimwemwe Chifungo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Themba Mzembe
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Ruth Vellemu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Victor Chikwapulo
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Maame Peterson
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Leyla Abdullahi
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Kelvin Musau
- The Children's Investment Fund Foundation, Nairobi, Kenya
| | - Kerri Wazny
- The Children's Investment Fund Foundation, London, UK
| | - Eliya Zulu
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
| | - Nyovani Madise
- African Institute for Development Policy (AFIDEP), 13/41 Presidential Way, Public Service Pension Fund Building, P.O Box 31024, Lilongwe, Malawi
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Ajayi AI, Athero S, Muga W, Kabiru CW. Lived experiences of pregnant and parenting adolescents in Africa: A scoping review. Reprod Health 2023; 20:113. [PMID: 37537592 PMCID: PMC10401816 DOI: 10.1186/s12978-023-01654-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/26/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Previous studies have not synthesized existing literature on the lived experiences of pregnant and parenting adolescents (aged 10-19) in Africa. Such evidence synthesis is needed to inform policies, programs, and future research to improve the well-being of the millions of pregnant or parenting adolescents in the region. Our study fills this gap by reviewing the literature on pregnant and parenting adolescents in Africa. We mapped existing research in terms of their substantive focus, and geographical distribution. We synthesized these studies based on thematic focus and identified gaps for future research. METHODS We used a three-step search strategy to find articles, theses, and technical reports reporting primary research published in English between January 2000 and June 2021 in PubMed, Jstor, AJOL, EBSCO Host, and Google Scholar. Three researchers screened all articles, including titles, abstracts, and full text, for eligibility. Relevant data were extracted using a template designed for the study. Overall, 116 studies met the inclusion criteria and were included in the study. Data were analyzed using descriptive and thematic analyses. RESULTS Research on pregnant and parenting adolescents is limited in volume and skewed to a few countries, with two-fifths of papers focusing on South Africa (41.4%). Most of the studies were African-led (81.9%), received no funding (60.3%), adopted qualitative designs (58.6%), and were published between 2016 and 2021 (48.3%). The studies highlighted how pregnancy initiates a cycle of social exclusion of girls with grave implications for their physical and mental health and social and economic well-being. Only 4.3% of the studies described an intervention. None of these studies employed a robust research design (e.g., randomized controlled trial) to assess the intervention's effectiveness. Adolescent mothers' experiences (26.7%) and their education (36.2%) were the most studied topics, while repeat pregnancy received the least research attention. CONCLUSION Research on issues affecting pregnant and parenting adolescents is still limited in scope and skewed geographically despite the large burden of adolescent childbearing in many African countries. While studies have documented how early pregnancy could result in girls' social and educational exclusion, few interventions to support pregnant and parenting adolescents exist. Further research to address these gaps is warranted.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya.
| | - Sherine Athero
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Winstoun Muga
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-Born, Child, and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Nairobi, Kenya
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Fauk NK, Gesesew HA, Mwanri L, Hawke K, Merry MS, Asa GA, Ward PR. Understanding coping strategies of mothers living with HIV who care for children living with HIV: a qualitative study in Indonesia. BMC Womens Health 2023; 23:172. [PMID: 37041572 PMCID: PMC10091524 DOI: 10.1186/s12905-023-02299-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 03/22/2023] [Indexed: 04/13/2023] Open
Abstract
HIV infection and its sequelae continue to be a significant challenge among women and their families in developing countries despite the progress that has been made in the prevention and treatment of HIV. This paper describes the strategies employed by mothers with HIV to cope with the various challenges experienced following their own and their children's HIV diagnosis. This paper uses previously unpublished data collected for a study that sought to explore the mental health challenges and coping strategies of mothers living with HIV (MLHIV) (n = 23) who have children living with HIV (CLHIV). Data collection was conducted using in-depth interviews, and participants were recruited using the snowball sampling technique. The concept of meaning-making was used to guide the conceptualisation, analysis, and discussion of the findings. Our analysis showed that meaning-making such as the awareness of how important mothers were to their children/CLHIV and families and religious meaning were used by participants to cope with HIV-related and mental health challenges they faced. The meaning of mother-child relationship which was supported and maintained through the provision of time, attention and fulfillment of CLHIV's needs were also coping strategies employed by these women. Additional coping strategies used were to link their CLHIV to groups and activities of CLHIV. The connections made through these links enabled their children to know other CLHIV, build relationships, and share experiences. These findings are useful evidence that can inform policies and practices and indicate the need for the development of intervention programs that address the needs of MLHIV and their families to cope with HIV-related challenges of their children. Future large-scale studies involving MLHIV who have CLHIV are recommended to have a comprehensive understanding of strategies they employ to cope with HIV-related challenging circumstances and mental health issues that they continue to face.
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Affiliation(s)
- Nelsensius Klau Fauk
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
- Institute of Resource Governance and Social Change, Kupang, Indonesia
| | - Hailay Abrha Gesesew
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia.
- College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia.
| | - Lillian Mwanri
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Karen Hawke
- Women and Kids theme, Aboriginal Health, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Maria Silvia Merry
- Medicine Faculty, Duta Wacana Christian University, Yogyakarta, Indonesia
| | - Gregorius Abanit Asa
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
| | - Paul Russell Ward
- Research Centre for Public Health, Equity and Human Flourishing, Torrens University Australia, Adelaide, South Australia, Australia
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Ajayi AI, Chamdimba E, Sawadogo N, Gitahi N, Tarnagda AM, Ilboudo AK, Munthali A, Thakwalakwa C, Otukpa EO, Ushie BA, Kabiru CW. Socio-ecological factors associated with probable depression among pregnant and parenting adolescent girls: findings from a cross-sectional study in Burkina Faso and Malawi. Reprod Health 2023; 20:38. [PMID: 36882850 PMCID: PMC9990966 DOI: 10.1186/s12978-023-01588-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 02/23/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Pregnant and parenting adolescent girls are at risk of poor mental health because of stigma and social exclusion. Despite one in four girls starting childbearing by the age of 19 in Africa, no study, to the best of our knowledge, has examined the multi-layered factors (individual, family, friends, and neighborhood-related factors) associated with depressive symptoms among pregnant and parenting girls in Africa. Our study contributes to addressing this gap by examining the socio-ecological factors associated with depression symptoms among pregnant and parenting adolescent girls. METHODS Our study adopted a cross-sectional design. Between March and September 2021, we interviewed 980 pregnant and parenting adolescent girls in Ouagadougou, Burkina Faso, and 669 in Blantyre, Malawi. We recruited pregnant and parenting adolescent girls in randomly selected urban and rural enumeration areas in Burkina Faso (n = 71) and Malawi (n = 66). We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9), which generated an overall score of 27. We considered a score of 10 or more as probable depression. We also obtained information on individual, family, friends, and neighborhood characteristics. We employed logistic regression models to examine the significant factors associated with probable depression among pregnant and parenting adolescent girls. RESULTS The prevalence of probable depression was 18.8% and 14.5% in Burkina Faso and Malawi, respectively. At the individual level, having secondary education was significantly associated with a lower likelihood of probable depression in Malawi (AOR: 0.47; 95% CI 0.27-0.82) but not in Burkina Faso. At the family level, denying paternity (AOR: 3.14; 95% CI 1.34-7.11 in Malawi) and no parental support (AOR: 2.08; 95% CI 1.22-3.55 in Burkina Faso) were associated with higher odds of probable depression. At the community level, perceived neighborhood safety was associated with a lower likelihood of probable depression in Malawi (AOR: 0.74; 95% CI 0.61-0.89) and Burkina Faso (AOR: 0.81; 95% CI 0.73-0.90). Having a safety net within the community was associated with lower odds of probable depression in Burkina Faso (AOR: 0.87; 95% CI 0.78-0.96) but not in Malawi. CONCLUSION Depressive symptoms are common among pregnant and parenting adolescents, suggesting the need to screen them regularly for depression during antenatal and postnatal visits. Factors associated with depression among pregnant and parenting girls operate at multiple levels suggesting a need for multilevel interventions that address all areas of vulnerabilities.
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Affiliation(s)
- Anthony Idowu Ajayi
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya.
| | - Elita Chamdimba
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | - Nathalie Sawadogo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Nyawira Gitahi
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
| | - Abdoul Moumini Tarnagda
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Abdoul Kader Ilboudo
- Institut Supérieur des Sciences de La Population, Université Joseph Ki-Zerbo, B.P. 7118, Ouagadougou 03, Burkina Faso
| | - Alister Munthali
- Centre for Social Research, University of Malawi, P. O. Box 280, Zomba, Malawi
| | | | - Emmanuel Oloche Otukpa
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Boniface Ayanbekongshie Ushie
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
| | - Caroline W Kabiru
- Sexual, Reproductive, Maternal, New-born, Child and Adolescent Health (SRMNCAH) Unit, African Population and Health Research Center, Manga Close, Nairobi, Kenya
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Mental Health Problems Across the HIV Care Continuum for Adolescents Living with HIV in Sub-Saharan Africa: A Scoping Review. AIDS Behav 2023:10.1007/s10461-023-03981-w. [PMID: 36650389 PMCID: PMC10350473 DOI: 10.1007/s10461-023-03981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 01/18/2023]
Abstract
Mental health problems (e.g., anxiety, depression) are frequently experienced by adolescents living with HIV (ALWH) and can worsen HIV-related outcomes. This scoping review synthesizes the existing research on ALWHs' mental health problems at multiple steps along the HIV care continuum in sub-Saharan Africa. Searching PubMed, CINAHL, EMBASE, and PsycINFO identified 34 peer-reviewed studies that met inclusion criteria. Most studies assessed ALWHs' mental health problems at the "Engaged or Retained in Care" continuum step, are cross-sectional, focus on depression and anxiety, and used measures developed in high-income countries. Studies identify mental health problems among ALWH as prevalent and barriers to care. Significant gaps remain in understanding how mental health problems and their relationships with HIV-related health outcomes shift across the continuum. Additional attention is needed, especially at the HIV testing and viral suppression steps, to generate a more comprehensive understanding of mental health needs and priority timepoints for intervention for ALWH.
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Malama K, Logie CH, Okumu M, Hakiza R, Mwima S, Kyambadde P. Factors associated with motherhood among urban refugee adolescent girls and young women in informal settlements in Kampala, Uganda. Women Health 2023; 63:51-58. [PMID: 36529708 DOI: 10.1080/03630242.2022.2158411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Adolescent girls and young women (AGYW) in sub-Saharan Africa face a high risk of unintended pregnancy. This risk is compounded in informal settlements, where resources are scarce and access to sexual and reproductive health services is limited. Being a young mother in informal settlements could exacerbate existing experiences of resource scarcity and poor access to sexual and reproductive health services. To explore this, we analyzed the factors associated with motherhood among refugee AGYW in Kampala, Uganda. Between January and March 2018, peer researchers recruited refugee youth aged 15-24 and living in five informal settlements in Kampala to participate in this study. We used a backwards generalized linear model with a log binomial regression to determine if mental health, resource insecurity and sexual and reproductive health variables were associated with motherhood among study participants. Our analysis included 333 AGYW with a mean age of 19.3 years (standard deviation: 2.6). Nearly one-quarter (23 percent; n = 76) of AGYW had children. Having children was associated with greater likelihood of reporting food insecurity (adjusted prevalence ratio [aPR]: 1.96, 95 percent confidence interval [CI]: 1.07-3.61), depressive symptoms (aPR: 2.03, 95 percent CI: 1.09-3.80), and contraception uptake (aPR: 2.37, 95 percent CI: 1.58-3.56) compared to not having children. Mental health and resource insecurity interventions are required for refugee AGYW with children in informal settlements. Sexual and reproductive health services should be promoted to refugee AGYW regardless of motherhood status to prevent unplanned pregnancy.
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Affiliation(s)
- Kalonde Malama
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Moses Okumu
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.,Department of Social Work and Social Administration Uganda Christian University, Mukono, Uganda
| | - Robert Hakiza
- Young African Refugees for Integral Development, Kampala, Uganda
| | - Simon Mwima
- School of Social Work, University of Illinois Urbana-Champaign, Urbana, Illinois, USA.,AIDS Control Program Republic of Uganda Ministry of Health, Kampala, Uganda
| | - Peter Kyambadde
- Most At Risk Population Initiative Mulago Hospital, Kampala, Uganda
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Chingono R, Kasese C, Miles S, Busza J. 'I was in need of somewhere to release my hurt:' Addressing the mental health of vulnerable adolescent mothers in Harare, Zimbabwe, through self-help groups. Glob Health Action 2022; 15:2040151. [PMID: 35322767 PMCID: PMC8956306 DOI: 10.1080/16549716.2022.2040151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Adolescents experiencing multiple vulnerabilities, including poverty, curtailed education, transactional sex and early childbearing, are at risk of poor mental health. In Zimbabwe, girls who are pregnant or new mothers and involved in selling sex struggle to cope with the combined pressures of parenthood, financial insecurity, and social stigma. A pilot intervention brought such girls together into self-help groups to increase peer support, resources and skills. Objective This study aimed to explore whether and how participation in a self-help group intervention affected vulnerable young mothers’ experiences and perceptions of mental health stressors. Methods Self-help groups received 12 participatory sessions over 6 months. Eighteen semi-structured interviews and three focus group discussions were held with participants and drop-outs. Before and after the intervention, participants completed the locally validated 14-item Shona Symptom Questionnaire tool to indicate the probable prevalence of common mental health disorders. Results Adolescent girls described mutually reinforcing stressors in their lives and reported low self-esteem and anxiety. Key themes emerging from qualitative data centred around girls’ struggles with adverse life events, the burden of new motherhood, social isolation related to sex work and self-help groups as a source of hope. Participants joined groups to obtain support and felt their mental well-being improved due to new social networks, feelings of solidarity with peers, and increased confidence for positive action, that is, seeking health services for themselves and their babies. Prior to enrolment 16% showed signs of possible common mental disorders falling to 2% at follow-up. Conclusions Participants believed involvement in interactive self-help groups improved their mental health by strengthening peer support and engendering hope for the future. Although reduced mental distress cannot be attributed to the programme, the pilot intervention offers a low-cost approach that could be rigorously tested and adapted to a wide range of community settings.
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Affiliation(s)
- Rudo Chingono
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe.,Biomedical Research and Training Institute, Harare, Zimbabwe.,Institute of Global Health, University College London, UK
| | - Constance Kasese
- Centre for Sexual Health and HIV/AIDS Research, Harare, Zimbabwe
| | - Sam Miles
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Busza
- Department of Public Health, Environment & Society, London School of Hygiene and Tropical Medicine, London, UK
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Kumar M, Yator O, Nyongesa V, Kagoya M, Mwaniga S, Kathono J, Gitonga I, Grote N, Verdeli H, Huang KY, McKay M, Swartz HA. Interpersonal Psychotherapy's problem areas as an organizing framework to understand depression and sexual and reproductive health needs of Kenyan pregnant and parenting adolescents: a qualitative study. BMC Pregnancy Childbirth 2022; 22:940. [PMID: 36522716 PMCID: PMC9756635 DOI: 10.1186/s12884-022-05193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 11/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Peripartum adolescents experience significant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents' responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy's (IPT) problem areas as a framework to understand depression. METHOD We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16-18 years (n = 23) with experiences of depression, keeping interpersonal psychotherapy framework of problem areas in mind. We explored the nature of their distress, triggers, antecedents of distress associated with an unplanned pregnancy, quality of their relationships with their partner, parents, and other family members, perceived needs, and sources of support. RESULTS We found that the interpersonal psychotherapy (IPT) framework of interpersonal problems covering grief and loss, role transitions, interpersonal disputes, and social isolation was instrumental in conceptualizing adolescent depression, anxiety, and stress in the perinatal period. CONCLUSION Our interviews deepened understanding of peripartum adolescent mental health focusing on four IPT problem areas. The interpersonal framework yields meaningful information about adolescent depression and could help in identifying strategies for addressing their distress.
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Affiliation(s)
- Manasi Kumar
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya ,grid.470490.eBrain and Mind Institute, Aga Khan University, Nairobi, Kenya
| | - Obadia Yator
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Vincent Nyongesa
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Martha Kagoya
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, 00100 (47074), Nairobi, Kenya
| | - Shillah Mwaniga
- Nairobi Metropolitan Services, Nairobi, Kenya ,grid.12380.380000 0004 1754 9227Vrije University, Amsterdam, Netherlands
| | - Joseph Kathono
- grid.10604.330000 0001 2019 0495Department of Psychiatry, University of Nairobi, Kenya and Nairobi Metropolitan Services, Nairobi, Kenya
| | - Isaiah Gitonga
- grid.95004.380000 0000 9331 9029Department of Psychology, National University of Ireland, Maynooth, Ireland
| | - Nancy Grote
- grid.34477.330000000122986657School of Social Work, University of Washington, Seattle, USA
| | - Helena Verdeli
- grid.21729.3f0000000419368729Global Mental Health Lab, Columbia University, New York, USA
| | - Keng Yen Huang
- grid.137628.90000 0004 1936 8753New York University, New York, USA
| | - Mary McKay
- grid.4367.60000 0001 2355 7002Vice Provost of Interdisciplinary Initiatives, University of Washington, St Louis, USA
| | - Holly A. Swartz
- grid.21925.3d0000 0004 1936 9000Department of Psychiatry, University of Pittsburgh, Pittsburg, USA
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11
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Toska E, Saal W, Chen Charles J, Wittesaele C, Langwenya N, Jochim J, Steventon Roberts KJ, Anquandah J, Banougnin BH, Laurenzi C, Sherr L, Cluver L. Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort. PLoS One 2022; 17:e0278163. [PMID: 36480550 PMCID: PMC9731463 DOI: 10.1371/journal.pone.0278163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 11/11/2022] [Indexed: 12/13/2022] Open
Abstract
The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.
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Affiliation(s)
- Elona Toska
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Wylene Saal
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Jenny Chen Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Camille Wittesaele
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Kathryn J. Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Jason Anquandah
- Department of Statistics, University of Leeds, Leeds, United Kingdom
| | - Boladé Hamed Banougnin
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Christina Laurenzi
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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12
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Steventon Roberts KJ, Smith C, Cluver L, Toska E, Jochim J, Wittesaele C, Marlow M, Sherr L. Adolescent mothers and their children affected by HIV-An exploration of maternal mental health, and child cognitive development. PLoS One 2022; 17:e0275805. [PMID: 36264898 PMCID: PMC9584392 DOI: 10.1371/journal.pone.0275805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 09/24/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development. METHODS Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores. RESULTS The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores. CONCLUSIONS This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.
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Affiliation(s)
- Kathryn J. Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Institute for Global Health, University College London, London, United Kingdom
| | - Colette Smith
- Institute for Global Health, University College London, London, United Kingdom
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | | | | | - Lorraine Sherr
- Institute for Global Health, University College London, London, United Kingdom
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13
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Stanton AM, O'Cleirigh C, Knight L, Davey DLJ, Myer L, Joska JA, Mayer KH, Bekker L, Psaros C. The importance of assessing and addressing mental health barriers to PrEP use during pregnancy and postpartum in sub-Saharan Africa: state of the science and research priorities. J Int AIDS Soc 2022; 25:e26026. [PMID: 36251124 PMCID: PMC9575939 DOI: 10.1002/jia2.26026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
Introduction Pregnant and postpartum women (PPW) in sub‐Saharan Africa are at disproportionately high risk of HIV infection compared to non‐pregnant women. When used consistently, pre‐exposure prophylaxis (PrEP) can prevent HIV acquisition and transmission to the foetus or infant during these critical periods. Recent studies have demonstrated associations between mental health challenges (e.g. depression and traumatic stress associated with intimate partner violence) and decreased PrEP adherence and persistence, particularly among adolescents, younger women and women in the postpartum period. However, mental health is not currently a major focus of PrEP implementation research and programme planning for PPW. Discussion PrEP implementation programmes for PPW need to assess and address mental health barriers to consistent PrEP use to ensure effectiveness and sustainability in routine care. We highlight three key research priorities that will support PrEP adherence and persistence: (1) include mental health screening tools in PrEP implementation research with PPW, both to assess the feasibility of integrating these tools into routine antenatal and postpartum care and to ensure that limited resources are directed towards women whose symptoms may interfere most with PrEP use; (2) identify cross‐cutting, transdiagnostic psychological mechanisms that affect consistent PrEP use during these periods and can realistically be targeted with intervention in resource‐limited settings; and (3) develop/adapt and test interventions that target those underlying mechanisms, leveraging strategies from existing interventions that have successfully mitigated mental health barriers to antiretroviral therapy use among people with HIV. Conclusions For PPW, implementation of PrEP should be guided by a robust understanding of the unique psychological difficulties that may act as barriers to uptake, adherence and persistence (i.e. sustained adherence over time). We strongly encourage PrEP implementation research in PPW to incorporate validated mental health screening tools and ultimately treatment in routine antenatal and postnatal care, and we stress the potential public health benefits of identifying women who face mental health barriers to PrEP use.
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Affiliation(s)
- Amelia M. Stanton
- Department of Psychological and Brain SciencesBoston UniversityBostonMassachusettsUSA,Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA
| | - Conall O'Cleirigh
- Massachusetts General HospitalBostonMassachusettsUSA,Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
| | - Lucia Knight
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - Dvora L. Joseph Davey
- School of Public HealthUniversity of Cape TownCape TownSouth Africa,Division of Infectious Diseases, Geffen School of MedicineUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Landon Myer
- School of Public HealthUniversity of Cape TownCape TownSouth Africa
| | - John A. Joska
- HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
| | - Kenneth H. Mayer
- Fenway HealthBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA,HIV Mental Health Research Unit, Division of Neuropsychiatry, Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa,Beth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | | | - Christina Psaros
- Massachusetts General HospitalBostonMassachusettsUSA,Harvard Medical SchoolBostonMassachusettsUSA
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14
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Masiano SP, Yu X, Tembo T, Wetzel E, Mphande M, Khama I, Mkandawire A, Chitani M, Liwimbi O, Udedi M, Mazenga A, Nyasulu P, Abrams E, Ahmed S, Kim MH. The relationship between adverse childhood experiences and common mental disorders among pregnant women living with HIV in Malawi. J Affect Disord 2022; 312:159-168. [PMID: 35752220 PMCID: PMC9892657 DOI: 10.1016/j.jad.2022.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/28/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) have been linked to common mental disorders (CMDs) such as anxiety and depressive thoughts. We examined the prevalence of ACEs and their association with CMDs among pregnant women living with HIV (PWLHIV) in Malawi-an HIV endemic resource-limited setting. METHODS This is a cross-sectional study of 798 PWLHIV enrolled in the VITAL Start trial in Malawi (10/2018 to 06/2021) (NCT03654898). ACE histories were assessed using WHO's Adverse Childhood Experiences International Questionnaire (ACE-IQ) tool. Depressive symptoms (somatic complaints, reduced vital energy, anxiety, and depressive thoughts) were assessed using WHO's Self Reporting Questionnaire 20-Item (SRQ-20) tool. Log-binomial regressions were used to examine the association between cumulative ACEs and each depressive symptom, as well as identify ACEs driving this association. RESULTS The mean age of our sample was 27.5 years. Over 95 % reported having experienced ≥1 ACE. On average, each participant reported four ACEs; 11 % reported sexual abuse. About 52 % and 44 % reported anxiety and depressive thoughts, respectively. In regressions, cumulative ACE scores were significantly associated with depressive symptoms-even after adjusting for multiple testing. This association was primarily driven by reports of sexual abuse. LIMITATIONS Data on maternal ACEs were self-reported and could suffer from measurement error because of recall bias. CONCLUSIONS ACEs are widespread and have a graded relationship with depressive symptoms in motherhood. Sexual abuse was found to be a primary driver of this association. Earlier recognition of ACEs and provision of trauma-informed interventions to improve care in PWLHIV may reduce negative mental health sequelae.
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Affiliation(s)
- Steven P Masiano
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Healthcare Delivery and Implementation Science Center, Cleveland Clinic, Cleveland, OH, USA; Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public Health and Population Health, University of Texas Medical Branch, Galveston, TX, USA
| | - Tapiwa Tembo
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elizabeth Wetzel
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Mtisunge Mphande
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Innocent Khama
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Angella Mkandawire
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Mike Chitani
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Olive Liwimbi
- Ministry of Health, Zomba Mental Hospital, Zomba, Malawi
| | - Michael Udedi
- Ministry of Health, NCDs and Mental Health Unit, Lilongwe, Malawi; University of North Carolina at Chapel Hill, Department of Epidemiology, Chapel Hill, NC, USA
| | - Alick Mazenga
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Phoebe Nyasulu
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi
| | - Elaine Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA; Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Saeed Ahmed
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Maria H Kim
- Baylor College of Medicine Children's Foundation Malawi, Lilongwe, Malawi; Baylor International Pediatric AIDS Initiative at Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
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15
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Roberts KJS. Promoting mental health among pregnant adolescents living with HIV. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:511-513. [PMID: 35750062 DOI: 10.1016/s2352-4642(22)00186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
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16
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Cluver LD, Sherr L, Toska E, Zhou S, Mellins CA, Omigbodun O, Li X, Bojo S, Thurman T, Ameyan W, Desmond C, Willis N, Laurenzi C, Nombewu A, Tomlinson M, Myeketsi N. From surviving to thriving: integrating mental health care into HIV, community, and family services for adolescents living with HIV. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:582-592. [PMID: 35750063 DOI: 10.1016/s2352-4642(22)00101-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/18/2022] [Accepted: 03/23/2022] [Indexed: 01/10/2023]
Abstract
Adolescents are a crucial generation, with the potential to bring future social and economic success for themselves and their countries. More than 90% of adolescents living with HIV reside in sub-Saharan Africa, where their mental health is set against a background of poverty, familial stress, service gaps, and an HIV epidemic that is now intertwined with the COVID-19 pandemic. In this Series paper, we review systematic reviews, randomised trials, and cohort studies of adolescents living with and affected by HIV. We provide a detailed overview of mental health provision and collate evidence for future approaches. We find that the mental health burden for adolescents living with HIV is high, contributing to low quality of life and challenges with adherence to antiretroviral therapy. Mental health provision is scarce, infrastructure and skilled providers are missing, and leadership is needed. Evidence of effective interventions is emerging, including specific provisions for mental health (eg, cognitive behavioural therapy, problem-solving, mindfulness, and parenting programmes) and broader provisions to prevent drivers of poor mental health (eg, social protection and violence prevention). We provide evidence of longitudinal associations between unconditional government grants and improved mental health. Combinations of economic and social interventions (known as cash plus care) could increase mental health benefits. Scalable delivery models include task sharing, primary care integration, strengthening families, and a pyramid of provision that differentiates between levels of need, from prevention to the care of severe disorders. A turning point has now been reached, from which complacency cannot persist. We conclude that there is substantial need, available frameworks, and a growing evidence base for action while infrastructure and skill acquisition is built.
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Affiliation(s)
- Lucie D Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK; Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa; School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude-Ann Mellins
- HIV Center for Clinical and Behavioral Studies, Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Irving Medical Center, New York, NY, USA
| | - Olayinka Omigbodun
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Samuel Bojo
- Agency for Research and Development Initiative, Juba, South Sudan
| | - Tonya Thurman
- Highly Vulnerable Children Research Center, Cape Town, South Africa; Tulane University School of Public Health, New Orleans, LA, USA
| | - Wole Ameyan
- Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, World Health Organization, Geneva, Switzerland
| | - Chris Desmond
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Amahle Nombewu
- Teen Advisory Group, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa; School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Noxolo Myeketsi
- Department of Information Systems, University of the Western Cape, Cape Town, South Africa
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17
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Mental Health Challenges and the Associated Factors in Women Living with HIV Who Have Children Living with HIV in Indonesia: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116879. [PMID: 35682460 PMCID: PMC9180562 DOI: 10.3390/ijerph19116879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/01/2022] [Accepted: 06/03/2022] [Indexed: 11/17/2022]
Abstract
Women living with HIV (WLHIV) are vulnerable to various mental health challenges. However, there is a paucity of studies globally and in the Indonesian context that have specifically explored mental health challenges among mothers living with HIV who also have children living with HIV (CLHIV). This qualitative study explored mental health challenges and the associated factors in mothers living with HIV who have CLHIV in Yogyakarta, Indonesia. In-depth interviews were employed to collect data from the participants (N = 23) who were recruited using the snowball sampling technique. A qualitative data analysis framework was used to guide the analysis of the findings. The findings showed that the mothers experienced a range of mental health issues due to their own, and their child’s diagnoses of stress, depression, anxiety, fear, sadness, and guilt. Lack of knowledge about HIV, fear of death, shame, not knowing whom to talk with and what to do after their own HIV diagnosis, and the HIV diagnosis of their children were factors that challenged their mental health. Difficulties in dealing with daily life or social activities of their CLHIV, dilemmas in addressing questions and complaints of their CLHIV about HIV treatment, and concerns about the health condition of their CLHIV and how their children cope with any potential negative social impacts also impacted the mothers’ mental health. Social factors such as unsympathetic expressions from friends towards them and their CLHIV and negatively worded religious-related advice from parents and relatives also contributed to their poor mental health. Our findings indicate the need for intervention programs that support mothers living with HIV and their CLHIV. Future large-scale studies involving mothers living with HIV who have CLHIV in Indonesia and other settings globally are needed to obtain a comprehensive understanding of mental health challenges and the associated factors they face.
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18
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Roberts KJ, Smith C, Cluver L, Toska E, Zhou S, Boyes M, Sherr L. Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder. AIDS Behav 2022; 26:1197-1210. [PMID: 34570313 PMCID: PMC8940800 DOI: 10.1007/s10461-021-03474-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2021] [Indexed: 01/25/2023]
Abstract
The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher’s exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral.
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Affiliation(s)
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Mark Boyes
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Bentley, Perth, Australia
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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19
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Quarshie ENB, Oppong Asante K. Self-harm and suicidal behaviours among pregnant adolescent girls and young women could be doubly compounded in sub-Saharan Africa: A call for further research. EClinicalMedicine 2022; 45:101339. [PMID: 35295666 PMCID: PMC8919230 DOI: 10.1016/j.eclinm.2022.101339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Affiliation(s)
- Emmanuel Nii-Boye Quarshie
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
- School of Psychology, University of Leeds, Leeds, UK
- Corresponding author at: Department of Psychology, University of Ghana, Legon, Accra, Ghana.
| | - Kwaku Oppong Asante
- Department of Psychology, University of Ghana, Legon, Accra, Ghana
- Department of Psychology, University of the Free State, Bloemfontein, South Africa
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20
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Logie CH, Coelho M, Kohrt B, Tsai AC, Mendenhall E. Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research. Curr Opin HIV AIDS 2022; 17:46-54. [PMID: 35081555 PMCID: PMC11045292 DOI: 10.1097/coh.0000000000000722] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review is to identify themes across articles that aimed to explore HIV-related syndemics in 2020 and 2021 and to discuss their implications for research on syndemics. RECENT FINDINGS We identified 189 articles on syndemics between 2020 and 2021. Key themes across studies included COVID-19; mental health and psychosocial challenges; substance use; socio-structural factors; protective factors; and methodological approaches. COVID-19's implications for HIV syndemic research were discussed. Mental health and substance use research largely examined linkages with sexual practices or reduced HIV care retention. Researchers examined associations between socio-structural variables (e.g. poverty) and elevated HIV exposure, reduced HIV testing and poorer health. Concepts of water insecurity and 'ecosyndemics' were also raised, as was the importance of attending to noncommunicable diseases and comorbidities. Most studies did not assess interactions between health conditions, signalling the need for methodological grounding in the foundational concepts of syndemic theory. SUMMARY Most studies recommended that HIV prevention and care research attend to the interplay between poor mental health, substance use and multidimensional violence. Increased attention to structural factors, particularly exacerbated poverty in the COVID-19 pandemic, is required. Research can identify protective factors to harness to advance HIV prevention and care.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada
- United Nations University Institute for Water, Environment & Health, Hamilton, Canada
| | - Madelaine Coelho
- Ontario Institute for Studies in Education, University of Toronto, Toronto, Ontario, Canada
| | - Brandon Kohrt
- Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, District of Columbia, USA
| | - Alexander C Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Mendenhall
- Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, District of Columbia, USA
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21
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Steventon Roberts K, Smith C, Toska E, Cluver L, Haag K, Wittesaele C, Langwenya N, Jochim J, Saal W, Shenderovich Y, Sherr L. Risk factors for poor mental health among adolescent mothers in South Africa. PSYCHOL HEALTH MED 2022; 27:67-84. [PMID: 36154770 DOI: 10.1080/13548506.2022.2124295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
In South Africa, high rates of adolescent pregnancy and HIV pose prominent public health challenges with potential implications for mental wellbeing. It is important to understand risk factors for mental health difficulties among adolescent mothers affected by HIV. This study aims to identify the prevalence of likely common mental disorder among adolescent mothers (both living with and not living with HIV) and explores hypothesised risk factors for likely common mental disorder. Cross-sectional data from adolescent mothers (10-19 years; n=1002) utilised within these analyses are drawn from a cohort of young mothers residing in the Eastern Cape Province, South Africa. All mothers completed a detailed questionnaire consisting of standardised measures of sociodemographic characteristics, mental health, and hypothesised risk factors. Logistic regression models were utilised to explore associations between hypothesised risk factors and likely common mental disorder. Risk factors were clustered within a hypothesised socioecological framework and entered into models using a stepwise sequential approach. Interaction effects with maternal HIV status were additionally explored. The prevalence of likely common mental disorder among adolescent mothers was 12.6%. Adolescent mothers living with HIV were more likely to report likely common mental disorder compared to adolescent mothers not living with HIV (16.2% vs 11.2%, X2=4.41, p=0.04). Factors associated with likely common mental disorder were any abuse exposure (OR=2.54 [95%CI:1.20-5.40], p=0.01), a lack of perceived social support (OR=4.09 [95%CI:2.48-6.74], p=<0.0001), and community violence exposure (OR=2.09 [95%CI:1.33-3.27], p=0.001). There was limited evidence of interaction effects between risk factors, and maternal HIV status. Violence exposure and a lack of perceived support are major risk factors for poor mental health among adolescent mothers in South Africa. Violence prevention interventions and social support may help to reduce risk. Identified risk factors spanning individual, interpersonal, and community levels have the potential to impact adolescent maternal mental health.
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Affiliation(s)
- Kathryn Steventon Roberts
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Institute for Global Health, University College London, London, UK
| | - Colette Smith
- Institute for Global Health, University College London, London, UK
| | - Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa
- Department of Sociology, University of Cape Town, Rondebosch, South Africa
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
| | | | - Camille Wittesaele
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- London School of Hygiene and Tropical Medicine, London, UK
| | - Nontokozo Langwenya
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Janina Jochim
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Wylene Saal
- Centre for Social Science Research, University of Cape Town, Rondebosch, South Africa
| | - Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Wolfson Centre for Young People's Mental Health, Cardiff University, Cardiff, UK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), Cardiff University, Cardiff, UK
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
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22
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Kumar M, Chu W, Gellatly R, Wambua GN, Becker KD, Chorpita BF. Identified needs of peripartum adolescents in Sub-Saharan Africa from 2013 to 2021: a mapping of domains for strengthening psychosocial interventions. Curr Opin Psychol 2021; 45:101291. [PMID: 35016086 DOI: 10.1016/j.copsyc.2021.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 12/01/2021] [Accepted: 12/06/2021] [Indexed: 11/16/2022]
Abstract
Adolescent pregnancy and early motherhood pose significant socioeconomic and health risks in Sub-Saharan Africa, leading to considerable morbidity and mortality. To learn more about the needs of this population, we reviewed 24 articles featuring 21 samples covering 12,490 adolescents from 14 countries. Our coding revealed that adolescent mothers were studied more (85.7% of samples) than pregnant adolescents (61.9%). We summarized needs as per six categories. Resource needs were most prevalent, reported by 100% of samples, followed by ecology (85.7%), mental health (76.2%), medical (61.9%), other (61.9%), and education (33.3%). The most frequently reported resource needs were low income and unemployment. Low social support, low family functioning, and exposure to negative cultural norms were ecological needs prevalent in most samples. Among mental health concerns, depression was the most commonly reported problem, whereas other problems, such as anxiety, substance use, and suicidality, were reported much less frequently. HIV-positive status was the most frequently reported medical concern. Intervention developers should consider the range of challenges when designing psychosocial services for this population.
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Affiliation(s)
- Manasi Kumar
- Department of Psychiatry, University of Nairobi, Kenya.
| | - Wendy Chu
- Department of Psychology, University of South Carolina, USA
| | - Resham Gellatly
- Department of Psychology, University of California, Los Angeles, USA
| | - Grace Nduku Wambua
- Faculty of Behavioural and Movement Sciences, Clinical Psychology, Vrije Universiteit, Netherlands
| | | | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, USA
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