1
|
Verma A, Kota KK, Bangar S, Rahane G, Yenbhar N, Sahay S. Emotional distress among adolescents living with perinatal HIV in India: examining predictors and their mediating and moderating effects. Child Adolesc Psychiatry Ment Health 2023; 17:40. [PMID: 36922846 PMCID: PMC10018828 DOI: 10.1186/s13034-023-00587-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 03/05/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Development of emotional distress (ED) among adolescents living with perinatally acquired HIV (ALPHIV) affects their adherence behaviour and social and psychological functioning. Data on stressors among ALPHIV demonstrates the gap on the predictors of ED experienced by 'perinatally infected ALHIV' in the Indian socio-cultural milieu. This study aimed to identify the predictors of ED and examine their mediating and moderating role in the development of ED among Indian ALPHIV. METHODS Utilizing the sequential exploratory mixed-methods design, 43 qualitative interviews were conducted with ALPHIV, parents/guardians, and health care providers, followed by the cross-sectional survey among 100 ALPHIV (10-19 years). The distress subscale of the Weinberger Adjustment Inventory was used to measure ED. Qualitative data, analyzed using grounded theory were utilized to develop a survey tool. Bivariate and regression analyses were conducted to identify predictors of ED. Mediation and moderation models were tested to examine underlying mechanisms associated with ED. The study was approved by the institutional ethics committee. RESULTS Strong parental control, compulsive asexuality, perceived negatively different from peers, and anger toward parents were the major themes emerging from the qualitative component which eventually led to survey tool domains viz., HIV awareness, parental control, hypervigilance, adolescent-parent relationship, adolescent-parent communication, body image and perceived negatively different from peers (PNDP). Quantitative analysis indicated high ED among ALPHIV and ED was significantly associated with PNDP, anger, body image, and hypervigilance. The relationship between PNDP and ED was significantly mediated by anger, and moderated by body image and hypervigilance. CONCLUSIONS The study stresses the need for early mental health interventions for Indian ALPHIV before an ALPHIV develops ED. Focused counseling on anger assessment, body image issues, and self-perception is critical for leading a 'normal' life by ALPHIV. Besides, skill building of primary caregivers is recommended to draw a line between protection and overprotection.
Collapse
Affiliation(s)
- Archana Verma
- Division of Social and Behavioral Research Sciences, ICMR-National AIDS Research Institute, 73, G-Block, MIDC, BIE, Pune, 411026, India.,Department of Anthropology, Savitribai Phule Pune University, Ganeshkhind, Pune, India.,ICMR fellow, Division of Social and Behavioral Sciences, ICMR-National AIDS Research Institute, Pune, India
| | - Krishna Kiran Kota
- Department of Health Promotion & Behavior, School of Public Health, Georgia State University, Atlanta, USA.,Division of Social and Behavioral Sciences, ICMR-NARI, Pune, India
| | - Sampada Bangar
- Division of Epidemiology, ICMR-National AIDS Research Institute, Pune, India
| | - Girish Rahane
- Division of Social and Behavioral Research Sciences, ICMR-National AIDS Research Institute, 73, G-Block, MIDC, BIE, Pune, 411026, India
| | - Nayana Yenbhar
- Division of Social and Behavioral Research Sciences, ICMR-National AIDS Research Institute, 73, G-Block, MIDC, BIE, Pune, 411026, India
| | - Seema Sahay
- Division of Social and Behavioral Research Sciences, ICMR-National AIDS Research Institute, 73, G-Block, MIDC, BIE, Pune, 411026, India. .,Department of Anthropology, Savitribai Phule Pune University, Ganeshkhind, Pune, India.
| |
Collapse
|
3
|
Araújo FPD, Ferreira AP, Vianna MB, Oliveira MHBD. Heteronomia no âmbito da saúde do adolescente: uma revisão integrativa da literatura. CIENCIA & SAUDE COLETIVA 2018; 23:2979-2989. [DOI: 10.1590/1413-81232018239.16962018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Accepted: 02/26/2018] [Indexed: 01/23/2023] Open
Abstract
Resumo Os direitos dos adolescentes no âmbito da saúde não se restringem à compreensão de suas demandas, mas ao respeito de si como sujeito autônomo e protagonista do seu cuidado. Entretanto, em face dos direitos dos adolescentes no cotidiano da assistência à saúde sob a ótica da autonomia, a heteronomia, sujeição do indivíduo à vontade de terceiros, apresenta-se em situação precária. Foram buscados artigos nas bases de dados Scopus, PubMed e BVS utilizando o cruzamento com os descritores: “saúde do adolescente”, “responsabilidade civil”, e “responsabilidade parental”. Após a adoção dos critérios de inclusão e exclusão foram analisados 32 estudos. Em geral, foi sinalizado que os adolescentes não são considerados diante da decisão dos pais/responsáveis acerca da assistência de saúde a ser realizada, como também a relação familiar é estabelecida por regras mantidas por punição, cobrança e controle, deixando-os à margem o diálogo. Face a isso, considera-se a necessidade de medidas de proteção e de promoção da autonomia, os debates acadêmicos acerca da relação saúde do adolescente e heteronomia, considerando o campo dos Direitos Humanos e Saúde, requer maiores avaliações com vistas a orientar no âmbito legal o cotidiano da atuação parental na assistência à saúde do adolescente.
Collapse
|
4
|
Tulloch O, Theobald S, Ananworanich J, Chasombat S, Kosalaraksa P, Jirawattanapisal T, Lakonphon S, Lumbiganon P, Taegtmeyer M. From transmission to transition: lessons learnt from the Thai paediatric antiretroviral programme. PLoS One 2014; 9:e99061. [PMID: 24893160 PMCID: PMC4043947 DOI: 10.1371/journal.pone.0099061] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Accepted: 04/28/2014] [Indexed: 12/04/2022] Open
Abstract
Background The Thai HIV programme is a leader in the public health approach to HIV treatment. Starting at transmission of HIV and ending with transition to adult services this paper assesses the paediatric HIV treatment continuum from three perspectives: service-user, provider and policy maker, to understand what works well and why. Methods A qualitative research design was used to assess and triangulate the stakeholder perspectives. Semi-structured interviews were conducted with ART service-users (n = 35), policy actors (n = 20); telephone interviews with prior caregivers of orphans (n = 10); and three focus group discussions with service-providers (hospital staff and volunteers) from a district, provincial and a university hospital. Findings Children accessing HIV care were often orphaned, cared for by elderly relatives and experiencing multiple vulnerabilities. Services were divided into three stages, 1. Diagnosis and linkage: Despite strong policies there were supply and demand-side gaps in the prevention of mother-to-child transmission ‘cascade’ preventing early diagnosis and/or treatment. 2. Maintenance on ART - Children did well on treatment; caregivers took adherence seriously and valued the quality of services. Drug resistance, adherence and psychosocial issues were important concerns from all perspectives. 3. Adolescents and transition: Adolescent service-users faced greater complexity in their physical and emotional lives for which providers lacked skills; transition from the security of paediatric clinic was a daunting prospect. Dedicated healthcare providers felt they struggled to deliver services that met service-users' diverse needs at all stages. Child- and adolescent-specific elements of HIV policy were considered low priority. Conclusions Using the notion of the continuum of care a number of strengths and weaknesses were identified. Features of paediatric services need to evolve alongside the changing needs of service users. Peer-support volunteers have potential to add continuity and support at all stages. It is critical that adolescents receive targeted support, particularly during transition to adult services.
Collapse
Affiliation(s)
- Olivia Tulloch
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
- * E-mail:
| | - Sally Theobald
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| | - Jintanat Ananworanich
- SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sanchai Chasombat
- Bureau of AIDS, Tuberculosis and Sexually Transmitted Infections, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Pope Kosalaraksa
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Thidaporn Jirawattanapisal
- Bureau of AIDS, Tuberculosis and Sexually Transmitted Infections, Department of Disease Control, Ministry of Public Health, Nonthaburi, Thailand
| | - Sudrak Lakonphon
- SEARCH and HIV-NAT, The Thai Red Cross AIDS Research Center, Bangkok, Thailand
| | - Pagakrong Lumbiganon
- Department of Pediatrics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Miriam Taegtmeyer
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
| |
Collapse
|