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Chepkemoi S, Nyikavaranda P, Semrau M, Archer G, Pantelic M. Resilience resources for mental health among people living with HIV: a mixed-method systematic review. AIDS Care 2024; 36:849-863. [PMID: 38319898 DOI: 10.1080/09540121.2024.2303613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 12/18/2023] [Indexed: 02/08/2024]
Abstract
People living with HIV (PLWH) experience a disproportionate burden of mental health problems compared to people living without HIV. This systematic review aims to depict the spectrum of resilience resources that may promote the mental health of PLWH at the individual, interpersonal, organisational, community and policy levels. A systematic literature search was conducted in PsycINFO, Scopus, Medline and advanced Google Scholar. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT). Of the 591 studies identified, fourteen were included representing a total of 5,142 PLWH from China, Ghana, Nepal, Spain, Tanzania and the USA. Resilience resources were identified at the individual level (self-efficacy, self-esteem, acceptance, hope, optimism, religiosity/spirituality, belief in fate, mindfulness, strength and self-responsibility); interpersonal level (social support and parental monitoring); and community level (attending HIV clinic support groups and access to healthcare). All quantitative studies were cross-sectional, limiting inferences about causation or directionality. Future research should focus on resilience resources at the organisational and policy levels and incorporate longitudinal designs.
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Affiliation(s)
- Sharon Chepkemoi
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Patrick Nyikavaranda
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Maya Semrau
- Centre for Global Health Research, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Gemma Archer
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
| | - Marija Pantelic
- Department of Primary Care & Public Health, Brighton & Sussex Medical School, University of Sussex, Brighton, UK
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
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Mebrahtu H, Chimbindi N, Zuma T, Dreyer J, Mthiyane N, Seeley J, Shahmanesh M, Sherr L, Harling G. Incident pregnancy and mental health among adolescent girls and young women in rural KwaZulu-Natal, South Africa: an observational cohort study. INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2024; 29:2371414. [PMID: 39035705 PMCID: PMC11259029 DOI: 10.1080/02673843.2024.2371414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 06/18/2024] [Indexed: 07/23/2024] Open
Abstract
Pregnancy can place adolescent girls and young women (AGYW) at risk of poor mental health. However, evidence linking youth pregnancy to mental health in resource-limited settings is limited, especially where HIV incidence is high. We analysed a population-representative cohort of AGYW aged 13-25 in rural KwaZulu-Natal to assess how adolescent pregnancy predicts subsequent mental health. Among 1851 respondents, incident pregnancy (self-reported past-12-month) rose from 0.7% at age 14 to 22.1% by 18. Probable common mental disorder (CMD; 14-item Shona Symptom Questionnaire) prevalence was 19.1%. In adjusted Poisson regression recent pregnancy was associated with slightly higher probable CMD (adjusted prevalence ratio [aPR] 1.19, 95%CI 0.96-1.49), and stronger association among 13-15 year-olds (aPR 3.25, 95%CI 1.50-7.03), but not with HIV serostatus. These findings suggest a possible incremental mental health impact of being pregnant earlier than peers, pointing to the need for age-appropriate mental health interventions for AGYW in resource-limited settings.
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Affiliation(s)
- Helen Mebrahtu
- Institute for Global Health, University College London, London, UK
| | - Natsayi Chimbindi
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Thembelihle Zuma
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
- Division of Infection and Immunity, University College London, London, UK
| | - Jaco Dreyer
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Nondumiso Mthiyane
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Guy Harling
- Institute for Global Health, University College London, London, UK
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing & Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
- MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, South Africa
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Pantelic M, Coombes Z, Barnard P, Hartshorn J, Caswell G, Sharma A, Whitbread J, Nyikavaranda P, Llewellyn C. "HIV has taught us that you can survive anything": findings from auto-ethnographic video diaries exploring resilience among people living with HIV during the Covid pandemic in five countries. AIDS Care 2024; 36:351-357. [PMID: 37128186 DOI: 10.1080/09540121.2023.2206606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 04/18/2023] [Indexed: 05/03/2023]
Abstract
This study aimed to elucidate the intrinsic and extrinsic resilience resources among people living with HIV (PLWH) during the Covid pandemic. Autoethnographic video diaries from 29 PLWH from Argentina, UK, Philippines, Zimbabwe, and Trinidad and Tobago were included. Data were thematically analysed and validated with community partners and a video was co-produced. PLWH displayed a readiness to adopt healthy behaviours and engage in optimistic and constructive thinking about the future. Hobbies and daily activities, supportive relationships with peers living with HIV, family and friends, opportunities to mobilise and contribute to their communities in meaningful ways, supportive healthcare providers and reliable access to antiretroviral treatment helped foster psychological resilience among PLWH. The extrinsic resilience resources also supported positive physical health outcomes among PLWH through improved medication adherence.
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Affiliation(s)
- Marija Pantelic
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Zara Coombes
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | - Poppy Barnard
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
| | | | - Georgina Caswell
- Global Network of People Living with HIV, Cape Town, South Africa
| | - Aditi Sharma
- Global Network of People Living with HIV, Cape Town, South Africa
| | | | | | - Carrie Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Falmer, UK
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Jordaan JI, Phillips N, Hoare J. Living through a pandemic: depression and anxiety experienced by youth living with HIV in South Africa. AIDS Care 2024; 36:44-52. [PMID: 38029423 DOI: 10.1080/09540121.2023.2282072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 11/06/2023] [Indexed: 12/01/2023]
Abstract
Youth living with HIV (YLHIV) face significant psychosocial challenges and are at increasedrisk of developing depression and anxiety. This study aims to invesBgate symptoms ofdepression, anxiety and associaBons with psychosocial factors in YLHIV during the first andthird waves of the COVID-19 pandemic. This longitudinal study enrolled 135 YLHIV (ages 12-21) in Cape Town, South Africa. Measures administered telephonically included theCoRonavIruS Health Impact Survey (CRISIS quesBonnaire), Center for Epidemiologic StudiesDepression Scale (CES-D), Beck Anxiety Inventory and Beck Youth Inventory. During the firstwave of COVID-19, 7.5% and 8.0% of YLHIV were depressed (<18 and ≥18 years,respecBvely), and 10% and 4% of parBcipants were anxious (<18 and ≥18 years). During thethird wave, 8.9% and 40.6% of YLHIV were depressed (<18 and ≥18 years), and 13.3% and12.5% (<18 and ≥18 years) were anxious. Depression and anxiety were measured using cutoffscores provided by clinical measures. Symptoms of depression and anxiety in YLHIVescalated over the course of the COVID-19 pandemic. Socio-economic factors, substanceuse, disrupted support and stability concerns were associated with depression and anxiety.These data highlight the increasing need of mental health support and social intervenBonsfor YLHIV in post-pandemic South Africa.
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Affiliation(s)
- Jeannere I Jordaan
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Mugo C, Njuguna IN, Beima-Sofie K, Mburu CW, Onyango A, Itindi J, Richardson BA, Oyiengo L, John-Stewart G, Wamalwa DC. Adolescent experiences, perceptions, and preferences for the process of HIV status disclosure in Kenya. Front Public Health 2023; 11:1165557. [PMID: 38106888 PMCID: PMC10725248 DOI: 10.3389/fpubh.2023.1165557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Disclosure of HIV status to adolescents living with HIV has been associated with improved treatment outcomes. However, there are limited data regarding the experiences of, perceptions of, and preferences for the process of disclosure of HIV status among adolescents and young adults living with HIV (AYLH), especially in sub-Saharan Africa. Methods Young adults living with HIV from 20 HIV clinics in Kenya who participated in a clinical trial evaluating the effectiveness of a disclosure and transition package completed an anonymous survey in 2019. We described their experiences and preferences using counts and proportions and assessed factors associated with satisfaction with the disclosure process using linear regression, reporting age-adjusted mean differences (aMD), and 95% confidence intervals (95%CIs). Results Of the 375 enrolled AYLH, 265 (71%) had perinatally acquired HIV, of whom 162 (61%) were female. The median age of the enrolled AYLH was 16 years (IQR: 14-19 years), and all of them were on antiretroviral therapy (ART). For over half (55%) of the participants, caregivers disclosed their HIV status, and 57% preferred that their caregivers disclose the status to them. Most (78%) of the participants preferred full disclosure by 12 years of age. The majority (69%) believed the disclosure was planned, and 11% suspected being HIV positive before the disclosure. Overall, 198 (75%) AYLH reported that they were ready for disclosure when it happened, and 86% were satisfied with the process. During both pre-disclosure (67 and 70%, respectively) and post-disclosure (>75% for each), AYLH felt supported by the clinic and caregivers. Factors associated with higher satisfaction with the disclosure process were pre-disclosure clinic support (aMD: 0.19 [95%CI: 0.05-0.33]) and pre-disclosure (aMD: 0.19 [0.06-0.31]) and post-disclosure (aMD: 0.17 [0.03-0.31]) caregiver support. AYLH who suspected they were HIV positive before they were disclosed to tended to have lower satisfaction when compared to those who never suspected (aMD: -0.37 [-0.74-(-0.01)]). Overall, they reported that disclosure positively influenced their ART adherence (78%), clinic attendance (45%), and communication with caregivers (20%), and 40% reported being happier after disclosure. Conclusion Young adults living with HIV advocated for an appropriately timed disclosure process with the involvement of caregivers and healthcare workers (HCWs). Support from caregivers and HCWs before and during disclosure is key to improving their disclosure experience.
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Affiliation(s)
- Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Irene N. Njuguna
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Kristin Beima-Sofie
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Caren W. Mburu
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Alvin Onyango
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | | | - Barbra A. Richardson
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Biostatistics, University of Washington, Seattle, WA, United States
| | - Laura Oyiengo
- National AIDS and STI Control Program, Ministry of Health, Kenya, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Global Health, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Dalton C. Wamalwa
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya
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Harrison A, Mtukushe B, Kuo C, Wilson-Barthes M, Davidson B, Sher R, Galárraga O, Hoare J. Better Together: acceptability, feasibility and preliminary impact of chronic illness peer support groups for South African adolescents and young adults. J Int AIDS Soc 2023; 26 Suppl 4:e26148. [PMID: 37909178 PMCID: PMC10618872 DOI: 10.1002/jia2.26148] [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: 02/16/2023] [Accepted: 08/14/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Peer support can help navigate the isolation and psychological strain frequently experienced by youth living with chronic illness. Yet, data are lacking on the impact of providing support for youth living with mixed chronic conditions. We assessed the acceptability, feasibility and preliminary mental health impacts of a clinic-based peer support group for South African youth living with chronic illnesses, including HIV. METHODS This mixed-methods pilot study (September 2021-June 2022) enrolled 58 young patients, ages 13-24, at an urban hospital in Cape Town, South Africa. In-depth interviews elicited the perspectives of 20 young people in relation to their participation in the Better Together programme, a recurring clinic-based peer support group for patients with mixed chronic illnesses. Self-reported resilience, attitudes towards illness, stigma and mental health were captured via established measures. T-tests and multivariate analysis of variance compared psychosocial outcomes for 20 group participants and 38 control patients, controlling for socio-demographic characteristics at enrolment. Logistic regression analyses estimated the predicted probability of a positive depression or anxiety screening given peer group participation. RESULTS All interviewees valued being able to compare treatment regimens and disease management habits with peers living with different conditions. Adolescents living with HIV stated that understanding the hardships faced by those with other conditions helped them accept their own illness and lessened feelings of isolation. Compared to patients who did not participate in Better Together, those who attended ≥5 groups had statistically significantly higher individual-level resilience, a more positive attitude towards their illness(es), lower internalised stigma and a more positive self-concept. The probability of being screened positive for depression was 23.4 percentage points lower (95% CI: 1.5, 45.3) for Better Together participants compared to controls; the probability of a positive anxiety screening was 45.8 percentage points lower (95% CI: 18.1, 73.6). CONCLUSIONS Recurring, clinic-based peer support groups that integrate youth living with HIV and other chronic diseases are novel. Group sustainability will depend on the commitment of experienced peer leaders and providers, routine scheduling and transportation support. A fully powered randomised trial is needed to test the optimal implementation and causal mental health effects of the Better Together model.
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Affiliation(s)
- Abigail Harrison
- International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Bulelwa Mtukushe
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Caroline Kuo
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
- Department of Health Studies, American University, Washington, DC, USA
| | - Marta Wilson-Barthes
- International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Bianca Davidson
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Rebecca Sher
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Omar Galárraga
- International Health Institute, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Jacqueline Hoare
- Division of Psychiatry & Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Bernays S, Lariat J, Cowan F, Senzanje B, Willis N, Nenguke ZM. "They test my blood to know how much blood is in my body": the untapped potential of promoting viral load literacy to support adherence and viral suppression among adolescents living with HIV. J Int AIDS Soc 2023; 26:e26153. [PMID: 37880186 PMCID: PMC10600064 DOI: 10.1002/jia2.26153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 08/16/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Achieving sustained HIV viral suppression is a key strategy to optimize the health and wellbeing of those living with HIV. Sub-optimal adherence to antiretroviral therapy (ART) in adolescents and young people living with HIV (AYPLHIV) in Southern Africa, due to a range of social and contextual factors, including poor mental health, has presented a substantial challenge to meeting targets aimed towards improving treatment outcomes and reducing transmission. With the increasing availability of viral load (VL) testing in Southern Africa, there is an opportunity to better understand the relationship between VL literacy, wellbeing and adherence among adolescents. METHODS We conducted qualitative interviews with 45 AYPLHIV aged 10-24 years in three districts (urban, peri-urban and rural) in Zimbabwe between March and August 2021. The sample was purposively selected to represent a range of experiences related to HIV status disclosure, gender, marital status and treatment experience. Separate workshops were conducted with 18 healthcare workers (HCWs) and 20 caregivers to better understand existing support mechanisms to AYPLHIV accessing ART. We used thematic analysis to examine adolescent VL literacy, treatment support networks, experiences of clinic interactions, VL testing procedures and barriers to adherence. RESULTS VL literacy was consistently under-developed among participants. Comprehension of phrases commonly heard during clinic visits, such as TND (target not detected) and "high" and "low" VL, were better understood by older participants. VL testing was predominantly understood as a clinical procedure that enables HCWs to monitor treatment adherence. Absent throughout the interviews were descriptions of how viral suppression improves health and quality of life, likely fosters wellbeing and enhances self-esteem, enables participation in education and social activities, and eliminates the risk of onward transmission. CONCLUSIONS It is imperative that we reconsider how routine VL monitoring is communicated to and understood by AYPLHIV. Reframing ART, including VL test results, in terms of the psychosocial benefits that viral suppression can generate is likely to be crucial to motivating AYPLHIV to maintain optimal treatment engagement and develop self-management approaches as they move into adulthood. Access to accurate information tailored to individual concerns and circumstances can support AYPLHIV to achieve wellbeing.
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Affiliation(s)
- Sarah Bernays
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
- Department of Global Health and Development London School of Hygiene & Tropical MedicineLondonUK
| | - Joni Lariat
- School of Public HealthUniversity of SydneySydneyNew South WalesAustralia
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Abimiku A, Ramadhani HO, Moloney M, Stafford KA, Chang JCW, Patel HK, Domaoal RA, Okoye M, Jelpe T, Bronson M, Ibrahim D, Swaminathan M, Gambo A, Charurat M. Factors associated with viral suppression among adults living with HIV on antiretroviral therapy in Nigeria: Analysis of a population-based survey, 2018. HIV Med 2023; 24:827-837. [PMID: 36945183 PMCID: PMC11195444 DOI: 10.1111/hiv.13485] [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: 08/09/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Viral load suppression (VLS) is critical in reducing morbidity and mortality associated with HIV as well as minimizing the likelihood of HIV transmission to uninfected persons. The objective of this study was to identify factors associated with VLS among people living with HIV (PLWH) on antiretroviral (ARV) therapy to inform HIV programme strategies in Nigeria. METHODS Adult participants, aged 15-64 years, from the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS), who self-reported to be a PLWH or had detectable ARVs, were analysed to examine factors associated with VLS defined as HIV RNA <1000 copies/mL. NAIIS measured HIV prevalence, viral load, ARV and hepatitis B in PLWH. Logistic regression models were used and reported weighted prevalence. RESULTS Of 1322 participants, 949 (68.25%) were women and 1287 (96.82%) had detectable ARVs. The median age was 39.31 [interquartile range (IQR): 31.47-47.63] years. Prevalence of VLS was 80.88%. Compared with participants with detectable ARVs, those with undetectable ARVs in their blood specimens had lower odds of VLS [adjusted odds ratio (aOR) = 0.24, 95% confidence interval (CI): 0.08-0.64). Coinfection with hepatitis B and nonnucleoside reverse transcriptase inhibitor metabolites were also associated with lower odds of VLS. Older people (45-54 vs 15-24 years) had increased odds of VLS (aOR = 2.81, 95% CI: 1.14-6.90). CONCLUSION Young people and those with undetectable ARVs had lower odds of virological suppression. Targeted interventions focusing on young people and adherence to medication are needed to achieve the UNAIDS 95-95-95 goals for HIV epidemic control.
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Affiliation(s)
- Alash’le Abimiku
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Habib O. Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Mirna Moloney
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Kristen A. Stafford
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Joy Chih-Wei Chang
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Hetal K. Patel
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Robert A. Domaoal
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - McPaul Okoye
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Tapidiyel Jelpe
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Megan Bronson
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Dalhatu Ibrahim
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Mahesh Swaminathan
- Division of Global HIV & TB, Center for Global Health, Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Aliyu Gambo
- National Agency for the Control of AIDS, Abuja, Federal Capital Territory, Nigeria
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, United States
- Center for International Health, Education, and Biosecurity, University of Maryland School of Medicine, Baltimore, MD, United States
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, United States
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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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Gamassa E, Steven E, Mtei R, Kaaya S. Prevalence of Depression and Suicidal Ideation and Associated Risk Factors in Adolescents Receiving Care and Treatment for Hiv/Aids at a Tertiary Health Facility in Kilimanjaro Region, Tanzania. RESEARCH SQUARE 2023:rs.3.rs-2534893. [PMID: 36909487 PMCID: PMC10002847 DOI: 10.21203/rs.3.rs-2534893/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Background The HIV/AIDS pandemic is a significant health concern worldwide since the first case emerged in the early 1980's. Most of the HIV disease burden is in Sub Saharan Africa (SSA). Depression and suicidal ideation have been found to be higher among people living with HIV/AIDS (PLWHA) than persons not infected with HIV. Adolescents living with HIV/AIDS (ALWH) are more at risk of suffering from depression and suicidal ideation than their unaffected peers. Factors such as social demographics, poor social support and HIV related stigma have been found to be significantly associated with depression and suicidal ideation among adolescents living with HIV/AIDS. Moreover, depression and suicidal ideation may lead to poor ART adherence, lower viral load suppression and development of opportunistic infections. Few studies have evaluated the mental health of ALWH in SSA. However, these studies do not provide information on the magnitude of suicidality among this population subgroup despite them being at high risk. Objective The aim of the study is to determine the prevalence of depression and suicidal ideation and explore associated risk factors in adolescents receiving care and treatment for HIV/AIDS at a tertiary health facility in Kilimanjaro Region, Tanzania. Materials and methods A hospital-based cross-sectional analytical study using quantitative approach was conducted. Adolescents receiving care and treatment for HIV/AIDS in a youth clinic at Kilimanjaro Christian Medical Centre (KCMC) were sampled. Data collection on depression was assessed using Patient Health Questionnaire for Adolescents (PHQ-A). A semi-structured questionnaire captured the socio-demographic and clinical information characteristics of the participants, also included a short version of the HIV Stigma Scale measured HIV-related stigma, a social support measure (Multidimensional Perceived Social Support Scale (MSPSS)) and a locally developed Hope Scale assessed hopefulness. Captured data were analyzed using SPSS version 23; Frequency distributions described the participants' sociodemographic characteristics. Chi-Square test established the univariate association between the independent and the dependent variables. While analysis to identify independent risk factors of suicidality and depression was used a multivariate logistic regression model. Associated risk factors and the strengths of association are summarized using odds ratios (ORs) and 95% confidence intervals. Ethical clearance was obtained from MUHAS Senate Research and Publications Committeeand permission sought from the administration of KCMC. Results A total 170 adolescents were studied, 96 (56.5%) were females while 74 (43.5%) were males. Mean age (standard deviation) of participants was 15 (2.2) years. The prevalence of depression was 15.9% and that of suicidal ideation was 31.2%. Based on univariate analysis relatively high levels of HIV-related stigma and lower levels of hope were significantly associated with depression and suicidal ideation. From multivariable analyses adolescents with low levels of hope were 9.2 times more likely to develop depression compared to those with high levels of hope (OR, 9.21, 95% CI: 2.16-39.32).Participants who experienced high levels of HIV-related stigma were 2.7 times more likely to have suicidal ideation compared to those with lower levels (OR, 2.7, 95% CI: 1.01-7.37). Furthermore, participants with low levels of hope were also 3.8 times more likely to have suicidal ideation compared to those with high levels (OR, 3.84, 95% CI: 1.50-9.84). Conclusion and recommendation This study reveals depression and suicidal ideation among adolescents living with HIV to be 16% and 31% respectively. High levels of stigma and low hope were identified as risk factors.Further studies need to be done to evaluate the mental health of adolescents living with HIV and integration of mental health services in the clinic providing services for these adolescents.
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Affiliation(s)
| | - Ester Steven
- Muhimbili University of Health and Allied Sciences
| | - Rachel Mtei
- Muhimbili University of Health and Allied Sciences
| | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences
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Orth Z, Van Wyk B. Asking the Experts: Using Cognitive Interview Techniques to Explore the Face Validity of the Mental Wellness Measure for Adolescents Living with HIV. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4061. [PMID: 36901066 PMCID: PMC10001944 DOI: 10.3390/ijerph20054061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
There has been an increased focus on the mental health of adolescents living with HIV (ALHIV), because evidence shows that poor mental health outcomes are associated with lower rates of adherence and retention in HIV care. However, the research to date has predominantly focused on addressing mental health problems and reducing symptoms of mental illness rather than strengthening mental wellness [positive mental health]. Consequently, little is known about the critical mental wellness indicators that should be targeted in services for ALHIV. There is a need for valid and appropriate measures of mental wellness to drive research and provide evidence on the mental wellness needs of ALHIV that would inform service delivery as well as the monitoring and evaluation of treatment outcomes. To this end, we developed the Mental Wellness Measure for Adolescents Living with HIV (MWM-ALHIV) for ALHIV in the South African context. In this paper, we report on the findings from a cognitive interview study with nine ALHIV aged 15-19 years receiving treatment at a public healthcare facility in the Cape Metropole, South Africa. Through interviews, participants identified key issues related to the wording, relevance and understanding of the items and provided suggestions to improve the instrument's overall face validity.
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12
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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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13
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Byansi W, Ssewamala FM, Neilands TB, Bahar OS, Nabunya P, Namuwonge F, McKay MM. The Short-Term Impact of a Combination Intervention on Depressive Symptoms Among School-Going Adolescent Girls in Southwestern Uganda: The Suubi4Her Cluster Randomized Trial. J Adolesc Health 2022; 71:301-307. [PMID: 35660128 PMCID: PMC9771640 DOI: 10.1016/j.jadohealth.2022.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aims to examine the short-term impact of a combined intervention consisting of evidence-based family economic empowerment (FEE) and multiple family group (MFG) interventions on depressive symptoms among school-going adolescent girls in southwestern Uganda. METHODS We analyzed longitudinal data from a cluster randomized trial. The sample consisted of 1,260 adolescent girls (aged 14-17 years at enrollment) recruited from senior one and senior two classes across 47 secondary schools in the southwestern region of Uganda. Participants were randomized at the school level to either the control condition receiving bolstered standard of care or one of the two treatment conditions-the treatment one condition receiving the FEE intervention or the treatment two conditions receiving both the FEE plus MFG interventions. Descriptive statistics and a three-level mixed-effects model were conducted to examine the effect of a combination intervention on depressive symptoms. RESULTS At baseline, there were no significant differences between the control condition and both treatment conditions. While all three groups experienced a substantial reduction in depressive symptoms from baseline to 12 months, the reductions were stronger for the two intervention groups. However, FEE + MFG was not significantly different from FEE at 12 months. DISCUSSION Results imply that the FEE intervention may be a promising tool in addressing depressive symptoms among adolescent girls. Therefore, to reduce the long-term implications of adverse psychosocial health during adolescence, policymakers and program implementers should explore scaling up economic empowerment interventions in similar settings to bridge the mental health treatment gap for adolescent girls.
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Affiliation(s)
- William Byansi
- Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Fred M. Ssewamala
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Torsten B. Neilands
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Ozge Sensoy Bahar
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Proscovia Nabunya
- Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development Field Office, Masaka, Uganda
| | - Mary M. McKay
- Brown School, Washington University in St. Louis, St. Louis, Missouri
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14
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Sevenoaks T, Fouche JP, Phillips N, Heany S, Myer L, Zar HJ, Stein DJ, Hoare J. Childhood Trauma and Mental Health in the Cape Town Adolescent Antiretroviral Cohort. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:353-363. [PMID: 35600517 PMCID: PMC9120333 DOI: 10.1007/s40653-021-00362-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 06/03/2023]
Abstract
This study aimed to assess the association of childhood trauma, stressful life events and HIV stigma with mental health in South African adolescents from the Cape Town Adolescent Antiretroviral Cohort (CTAAC). The Childhood Trauma Questionnaire, Life Events Questionnaire and the HIV Stigma Scale for South African Adolescents Living with HIV was used to assess childhood trauma, stressful life events and stigma in adolescents living with perinatally acquired HIV and healthy controls enrolled in the CTAAC. These measures were associated with mental health outcomes including the Beck-Youth Inventories, Child Behaviour Checklist, Columbian Impairment Scale, Childrens Motivation Scale, Conners Scale for Attention Deficit Hyperactivity Disorder using Pearson correlations and self-reported alcohol use, using Spearman-rank correlation. 63.7% of adolescents reported at least one childhood trauma on the CTQ. Significant associations were reported between CTQ measures and Beck-Youth Inventories. Emotional abuse was associated with anxiety, anger, depression and disruptive behaviour. Emotional neglect was associated with poor self-concept and disruptive behaviour. LEQ total score was significantly associated with Beck-Youth Inventories including anxiety, depression, anger and disruptive behaviour scales. HIV stigma was significantly associated with Beck-Youth Inventories including depression, anger and disruptive behaviour. Childhood trauma, stressful life events and HIV stigma in South African adolescents are associated with anxiety, depression, anger, disruptive-behaviour and poor self-concept. This study highlights the importance of enquiring about exposure to a variety of traumas, particularly those commonly experienced by South African adolescents. In addition, it is important to understand the impact of trauma exposure on each individuals mental health and functioning.
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Affiliation(s)
- Tatum Sevenoaks
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouche
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Nicole Phillips
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Sarah Heany
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa
- SA MRC Unit on Child and Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Outpatient Building, H-Floor Research Offices, Circle Groote Schuur Hospital, Observatory, Cape Town, 7925 South Africa
- Neuroscience Institute, University of Cape Town, Cape Town, South Africa
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15
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Association Between ART Adherence and Mental Health: Results from a National HIV Sero-Behavioural Survey in South Africa. AIDS Behav 2022; 26:1517-1529. [PMID: 34686946 DOI: 10.1007/s10461-021-03505-4] [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: 10/13/2021] [Indexed: 10/20/2022]
Abstract
This paper assesses the levels of antiretroviral treatment (ART) adherence and mental health distress among study participants in a national behavioural HIV-sero prevalence study South Africa. The study was a cross-sectional population-based multi-stage stratified cluster random survey, (SABSSM V, 2017). Structured questionnaires were used to collect information on socio-demographics, HIV knowledge, perceptions, HIV testing and HIV treatment history. Study participants were tested for HIV infection, antiretroviral use, viral suppression, and ART drug resistance. A total of 2155 PLHIV aged 15 years or older who were on ART were included in the study. Incidence of either moderate or severe mental health distress was 19.7%. Self-reported ART adherence among study participants with no, mild, moderate, or severe mental distress was 82%, 83%, 86% and 78%, respectively. The adjusted odds ratio for ART non-adherence was 0.58 (95% CI 0.24; 1.40) for mild mental distress, 0.82 (95% CI 0.35; 1.91) for moderate mental distress and 2.19 (95% CI 1.14; 4.19) for severe mental distress groups compared to the no mental health distress group. The other factors that were associated with ART non-adherence in adjusted models included education level, alcohol use and province/region of residence. The study revealed that mental health remains a challenge to ART adherence in South Africa. To improve ART adherence, HIV continuum of care programs should include screening for mental health among people living with HIV.
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16
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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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17
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van Staden Q, Laurenzi CA, Toska E. Two years after lockdown: reviewing the effects of COVID-19 on health services and support for adolescents living with HIV in South Africa. J Int AIDS Soc 2022; 25:e25904. [PMID: 35475319 PMCID: PMC9042673 DOI: 10.1002/jia2.25904] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/23/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION South Africa's progress towards the 95-95-95 goals has been significantly slower among adolescents living with HIV (ALHIV), among whom antiretroviral therapy (ART) adherence, retention in care and viral suppression remain a concern. After 2 years of living with COVID-19, it is important to examine the direct and indirect effects of the pandemic on healthcare resources, access to HIV services and availability of support structures, to assess their impact on HIV care for ALHIV. DISCUSSION The COVID-19 response in South Africa has shifted healthcare resources towards combatting COVID-19, affecting the quality and availability of HIV services-especially for vulnerable populations, such as ALHIV. The healthcare system's response to COVID-19 has threatened to diminish fragile gains in engaging ALHIV with HIV services, especially as this group relies on overburdened public health facilities for their HIV care. Reallocation of limited health resources utilized by ALHIV disrupted healthcare workers' capacity to form and maintain therapeutic relationships with ALHIV and monitor ALHIV for ART-related side effects, treatment difficulties and mental health conditions, affecting their ability to retain ALHIV in HIV care. Prevailing declines in HIV surveillance meant missed opportunities to identify and manage opportunistic infections and HIV disease progression in adolescents. "Lockdown" restrictions have limited access to healthcare facilities and healthcare workers for ALHIV by reducing clinic appointments and limiting individual movement. ALHIV have had restricted access to social, psychological and educational support structures, including national feeding schemes. This limited access, coupled with reduced opportunities for routine maternal and sexual and reproductive health services, may place adolescent girls at greater risk of transactional sex, child marriages, unintended pregnancy and mother-to-child HIV transmission. CONCLUSIONS Adolescent HIV care in South Africa is often overlooked; however, ART adherence among ALHIV in South Africa is particularly susceptible to the consequences of a world transformed by COVID-19. The current structures in place to support HIV testing, ART initiation and adherence have been reshaped by disruptions to health structures, new barriers to access health services and the limited available education and psychosocial support systems. Reflecting on these limitations can drive considerations for minimizing these barriers and retaining ALHIV in HIV care.
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Affiliation(s)
- Quintin van Staden
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Universitas HospitalBloemfonteinSouth Africa
| | - Christina A. Laurenzi
- Institute for Life Course Health ResearchDepartment of Global HealthFaculty of Medicine and Health SciencesStellenbosch UniversityTygerbergSouth Africa
| | - Elona Toska
- Department of SociologyUniversity of Cape TownCape TownSouth Africa
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- Department of Social Policy and InterventionUniversity of OxfordOxfordUK
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18
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Theron L, Rothmann S, Makhnach A, Ungar M. Adolescent Mental Health Resilience and Combinations of Caregiver Monitoring and Warmth: A Person-centred Perspective. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:2860-2870. [PMID: 36254162 PMCID: PMC9560922 DOI: 10.1007/s10826-022-02287-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/27/2022] [Indexed: 05/22/2023]
Abstract
Caregiver monitoring and warmth have protective mental health effects for adolescents, including vulnerable adolescents. However, combinations of the aforesaid parenting behaviours and their relationship with adolescent mental health are underexplored, especially among younger and older South African (SA) adolescents challenged by structural disadvantage. Hence, the purpose of this study was to investigate unique profiles of caregiver monitoring and warmth and their associations with depression and conduct problems as reported by younger and older adolescents from disadvantaged SA communities. Latent profile and linear regression analyses were used to examine cross-sectional survey data generated by 891 adolescents from two disadvantaged SA communities (62.2% aged 13-17 [average age: 16.13]; 37.5% aged 18-24 [average age: 20.62]). Two profiles emerged. The first, i.e. substantial caregiver warmth and some monitoring, was associated with younger and older adolescent reports of statistically significantly fewer symptoms of depression and conduct problems. The second, i.e. caregiver monitoring without much warmth, was associated with significantly more symptoms of depression or conduct problems among younger and older adolescents. Traditional gender effects (i.e. higher depression symptoms among girls; higher conduct problem symptoms among boys) were amplified when caregiver monitoring was combined with low warmth. In short, protecting the mental health of younger and older adolescents from disadvantaged communities requires higher levels of caregiver warmth combined with moderate levels of caregiver supervision. Because stressors associated with disadvantaged communities jeopardise warm parenting, supporting caregiver resilience to those stressors is integral to supporting adolescent mental health.
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Affiliation(s)
- Linda Theron
- Department of Educational Psychology, University of Pretoria, Pretoria, South Africa
| | | | - Alexander Makhnach
- Institute of Psychology of the Russian Academy of Sciences, Moscow, Russia
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, Halifax, NS Canada
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19
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Chen-Charles J, Rudgard WE, Doyle AM, Toska DE, Cluver PL. What do adolescents value most and is this affected by HIV status? Aspirations and self-perceptions from a large cohort study in South Africa. PSYCHOL HEALTH MED 2022; 27:97-106. [PMID: 36036247 DOI: 10.1080/13548506.2022.2116059] [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] [Indexed: 12/13/2022]
Abstract
Hundreds of millions of adolescents across Africa face challenges in many areas of their lives, including elevated risk of HIV exposure and acquisition. Understanding the aspirations and self-perceptions of adolescents could play an important role in better targeting effective investments to break the cycle of adversity for adolescents and into their adulthood. Aiming to understand what adolescents value most for themselves and their future, we analysed and summarised cross-sectional data on the aspirations and self-perceptions of 1519 adolescents living in South Africa, overall and by HIV status. Outcomes were coded from participant responses to two open-ended questions: 'What job do you want to do when you grow up?' and 'What are you most proud of about yourself?'. Associations with HIV status were then evaluated using multivariable logistic regression adjusting for six sociodemographic factors measured from the same cohort. The sample had a mean age of 14 years, 55% were female, and 70% were living with HIV. The five most common job aspirations were: 'Health and Medical Science Professionals' (28%), 'Law Enforcement and Public Safety Professionals' (14%), 'Social Work Associate Professionals' (12%), 'Legal Professionals' (9%), and 'Education Institutions Teaching Professionals' (6%). The top five themes for what adolescents were most proud of about themselves were 'School performance' (22%), 'Outward appearance' (15%), 'Sports skills' (12%), 'Personality' (11%), and 'Behaviour at home/with elders' (7%). Adjusted analysis showed no evidence that HIV status was associated with important differences in aspirations or self-perceptions. In conclusion, adolescents facing high levels of adversity in South Africa hold high value for their education and aspirations for their futures. Policies and initiatives should focus on meeting these aspirations as vehicles for development, independent of their HIV status. Therefore, more needs to be done to not just help adolescents survive but thrive into adulthood.
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Affiliation(s)
- Jenny Chen-Charles
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - William E Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Aoife M Doyle
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Dr Elona Toska
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Sociology, University of Cape Town, Cape Town, South Africa
| | - Professor Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.,Department of Mental Health and Psychiatry, University of Cape Town, Rondebosch, South Africa
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20
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Orth Z, van Wyk B. Measuring mental wellness among adolescents living with a physical chronic condition: a systematic review of the mental health and mental well-being instruments. BMC Psychol 2021; 9:176. [PMID: 34749818 PMCID: PMC8576887 DOI: 10.1186/s40359-021-00680-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022] Open
Abstract
Background Globally, promoting mental health and well-being among adolescents has become a public health priority, especially for adolescents living with a physical chronic condition (CC), as research suggests they may be more at risk of developing mental health co-morbidities. Valid and reliable instruments are needed to measure and better understand mental health and mental well-being among adolescents living with a CC. To this end, we reviewed studies reporting on mental health and well-being instruments used in adolescent populations living with a chronic physical condition/disease globally. Methods We used a systematic review method guided by PRISMA to identify assess mental health and mental well-being instruments used in adolescents living with a CC. In this instance, mental health instruments were defined as those representing negative domains of mental health (i.e. depression and anxiety) while mental well-being instruments included positive aspects of mental health (i.e. self-concept and resilience). Results We identified 22 articles, which included 31 instruments that were used to measure either mental health (n = 8) or mental well-being (n = 15) or both (n = 8) in adolescents living with a CC. Of these, thirteen studies used a Health-Related Quality of Life (HRQoL) scale to measure mental health and/or mental well-being. The KIDSCREEN questionnaires and the Strengths and Difficulties Questionnaire were identified as being frequently used across the 22 studies. Additionally, 7 out of the 31 instruments were disease specific, with 3 focusing on adolescents with diabetes. All the instruments were developed in high income countries and adapted for use in lower- and middle-income countries (LMICs). Adolescents with Type 1 Diabetes (n = 7) and HIV (n = 4) were researched in 11 out of 22 studies. Only eight studies were conducted in LMIC, of which four were in Africa. Conclusions HRQoL instruments are useful in measuring mental health and well-being in adolescents living with a CC. However, relatively few valid measures of mental health and mental well-being for adolescents living with a CC exist, which accentuates the paucity of research on mental health and mental well-being of adolescents who are living with a CC. Specific measures need to be developed in and for LMICs where cultural contexts affect mental well-being in unique ways. Systematic review registration: PROSPERO CRD42020186707.
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Affiliation(s)
- Zaida Orth
- School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville, 7535, South Africa.
| | - Brian van Wyk
- School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville, 7535, South Africa
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21
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Relationship Between Mental Health and HIV Transmission Knowledge and Prevention Attitudes Among Adolescents Living with HIV: Lessons from Suubi + Adherence Cluster Randomized Study in Southern Uganda. AIDS Behav 2021; 25:3721-3733. [PMID: 33797667 DOI: 10.1007/s10461-021-03243-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 01/29/2023]
Abstract
We assessed the effect of depression, hopelessness, and self-concept on HIV prevention attitudes and knowledge about infection, transmission and sexual risk behavior among adolescents living with HIV in Uganda. Utilizing longitudinal data from 635 adolescents living with HIV, multiple ordinary least square regression was used to evaluate associations between the three indicators of mental health functioning at baseline and HIV knowledge and prevention attitudes at 12-months follow-up. We found that depression (β = - 0.17; 95% CI - 0.31, - 0.04) and hopelessness (β = - 0.16; 95% CI - 0.28, - 0.04) scores at baseline were associated with a 0.17 and 0.16 average reduction in HIV prevention attitudes and HIV knowledge scores, respectively at 12-months follow-up. However, self-concept was not significantly associated with HIV knowledge or prevention attitudes. Adolescents living with HIV with greater levels of hopelessness are at increased risk of having limited HIV knowledge while those with greater symptoms of depression had less favorable HIV prevention attitudes.
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22
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Apondi E, Wachira J, Ayikukwei R, Kafu C, Onyango J, Omollo M, Genberg B, Nyandiko W, Braitstein P. Barriers to ART adherence among school students living with HIV in Kenya. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2021; 20:232-237. [PMID: 34635018 DOI: 10.2989/16085906.2021.1979606] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
HIV has transformed from a serious acute illness with high rates of morbidity and mortality to a fairly easily managed chronic disease. However, children and adolescents living with HIV are yet to achieve similar improvement in their HIV care outcomes compared to adults. There have been a number of studies assessing the reasons for slower improvement in these age categories, mainly focusing on health systems, drug- and family- related barriers to ART adherence in children. We sought to explore school-related barriers to adherence through in-depth interviews with students living with HIV (SLHIV) aged 13-17 years who had fully disclosed their HIV status in western Kenya. Data was analysed using NVivo 8™. The study found that stigmatisation in the form of negative discussions and alienation, fear of unintended disclosure (due to the drug packaging and lack of privacy while taking their pills) were barriers to ART adherence among these SLHIV. Other barriers included challenges with drug storage while in school and the complexity of coordinating school and clinic-related activities and a lack of structured support systems in schools. In addition to hindering their adherence to ART, these barriers resulted in negative emotions (anger, sadness, frustration) and affected school performance. This study found fairly serious barriers to ART adherence among SLHIV, which calls for structured communication and coordinated support between government ministries of health and education in Kenya.
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Affiliation(s)
- Edith Apondi
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Child Health and Paediatrics, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Child Health and Paediatrics, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Rose Ayikukwei
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Catherine Kafu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jael Onyango
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Mark Omollo
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Becky Genberg
- Department of Epidemiology, Johns Hopkins University, Baltimore, USA
| | - Winstone Nyandiko
- Child Health and Paediatrics, College of Health Sciences, Moi University, Eldoret, Kenya
- USAID-AMPTH Partnership, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Epidemiology, University of Toronto, Ontario, Canada
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23
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Rencken CA, Harrison AD, Mtukushe B, Bergam S, Pather A, Sher R, Davidson BJ, Carrihill M, Matiwane M, Kuo C, Galárraga O, Hoare J. "Those People Motivate and Inspire Me to Take My Treatment." Peer Support for Adolescents Living With HIV in Cape Town, South Africa. J Int Assoc Provid AIDS Care 2021; 20:23259582211000525. [PMID: 33691500 PMCID: PMC8743913 DOI: 10.1177/23259582211000525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) and psychosocial support to manage stigma and disclosure is essential for adolescents living with HIV (ALHIV). Peer support groups can help ALHIV and their families live successfully with HIV. This qualitative study aimed to examine adolescent and caregiver perspectives on peer support groups. Three themes emerged: (1) peer support encouraged adherence to ART, (2) serostatus disclosure outside the family was perceived as difficult, and (3) the peer support group fostered fundamental and meaningful peer relationships for ALHIV. Caregivers felt peer support groups increased self-acceptance and adherence for ALHIV across 3 domains: (1) as motivation for families and adolescents, (2) to increase adolescent independence and maturity, and (3) to help adolescents accept their HIV status and live successfully with HIV. These data highlight the importance of psychosocial support groups for ALHIV and caregivers, illustrating the benefits of a safe space with trusted relationships and open communication.
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Affiliation(s)
| | - Abigail D Harrison
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Bulelwa Mtukushe
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Scarlett Bergam
- Brown University School of Public Health, Providence, RI, USA
| | - Ariana Pather
- Brown University School of Public Health, Providence, RI, USA
| | - Rebecca Sher
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | | | - Michelle Carrihill
- Department of Paediatric Endocrinology, University of Cape Town, South Africa
| | - Mluleki Matiwane
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.,Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Omar Galárraga
- Department of Health Services, Brown University School of Public Health, Providence, RI, USA
| | - Jacqueline Hoare
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
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24
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Too EK, Abubakar A, Nasambu C, Koot HM, Cuijpers P, Newton CRJC, Nyongesa MK. Prevalence and factors associated with common mental disorders in young people living with HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc 2021; 24 Suppl 2:e25705. [PMID: 34164931 PMCID: PMC8222842 DOI: 10.1002/jia2.25705] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/20/2021] [Accepted: 03/23/2021] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub-Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA. METHODS We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: "Depression OR Anxiety", "Young people", "HIV infections" and "sub-Saharan Africa". RESULTS AND DISCUSSION Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV-negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV-related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV-positive status, bullying, sexual abuse, HIV-related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms. CONCLUSIONS The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV-negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV-clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth-friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.
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Affiliation(s)
- Ezra K Too
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
| | - Amina Abubakar
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordUK
- Institute for Human DevelopmentAga Khan UniversityNairobiKenya
| | - Carophine Nasambu
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
| | - Hans M Koot
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Pim Cuijpers
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - Charles RJC Newton
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of Public HealthPwani UniversityKilifiKenya
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Moses K Nyongesa
- KEMRI‐Wellcome Trust Research ProgrammeCentre for Geographic Medicine Research (Coast)KilifiKenya
- Department of ClinicalNeuro‐ and Developmental PsychologyAmsterdam Public Health Research InstituteVrije Universiteit AmsterdamAmsterdamThe Netherlands
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25
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Okumu M, Nyoni T, Byansi W. Alleviating psychological distress and promoting mental wellbeing among adolescents living with HIV in sub-Saharan Africa, during and after COVID-19. Glob Public Health 2021; 16:964-973. [PMID: 33843460 DOI: 10.1080/17441692.2021.1912137] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
COVID-19 social control measures (e.g. physical distancing and lockdowns) can have both immediate (social isolation, loneliness, anxiety, stress) and long-term effects (depression, post-traumatic stress disorder) on individuals' mental health. This may be particularly true of adolescents living with HIV (ALHIV) and their caregivers - populations already overburdened by intersecting stressors (e.g. psychosocial, biomedical, familial, economic, social, or environmental). Addressing the adverse mental health sequelae of COVID-19 among ALHIV requires a multi-dimensional approach that at once (a) economically empowers ALHIV and their households and (b) trains, mentors, and supervises community members as lay mental health services providers. Mental health literacy programming can also be implemented to increase mental health knowledge, reduce stigma, and improve service use among ALHIV. Schools and HIV care clinics offer ideal environments for increasing mental health literacy and improving access to mental health services.
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Affiliation(s)
- Moses Okumu
- School of Social Work, University of North Carolina, Chapel Hill, NC, USA
| | - Thabani Nyoni
- Brown School of Social Work, Washington University, St. Louis, MO, USA
| | - William Byansi
- Brown School of Social Work, Washington University, St. Louis, MO, USA
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26
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Casale M, Cluver L, Boyes M, Toska E, Gulaid L, Armstrong A, Shenderovich Y, Rudgard WE, Zhou S, Langwenya N. Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors. J Acquir Immune Defic Syndr 2021; 86:436-444. [PMID: 33196550 DOI: 10.1097/qai.0000000000002574] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART nonadherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent nonadherence or risk and protective factors that could moderate this relationship. SETTING This study investigates (1) the direct longitudinal relationship between bullying exposure and ART nonadherence, and the indirect relationship via psychological distress, and (2) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public health care facilities in a South African health district. METHODS Survey data were collected at 2 time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach. RESULTS A significant longitudinal relationship was found between bullying victimization and nonadherence, operating indirectly through psychological distress [B = 0.07; 95% confidence interval (CI): (0.03 to 0.13)]. Moderation analyses indicated that older adolescents exposed to bullying are more at risk of nonadherence [B = 0.52; 95% CI: (0.07 to 0.97) P < 0.05], and parental monitoring is a potential protective factor buffering indirect effects of bullying on nonadherence [B = -0.22; 95% CI: (-0.42 to -0.02) P < 0.05]. CONCLUSIONS These findings underscore the importance of interventions that address bullying and psychological distress, and strengthen parental monitoring, particularly among older ALHIV.
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Affiliation(s)
- Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - 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
| | - Mark Boyes
- School of Public Health and School of Psychology, Curtin University, Australia
| | - 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
| | - Laurie Gulaid
- UNICEF Eastern and Southern Africa Regional Office, Kenya; and
| | - Alice Armstrong
- UNICEF Eastern and Southern Africa Regional Office, Kenya; and
| | - Yulia Shenderovich
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - William E Rudgard
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | - Siyanai Zhou
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Nontokozo Langwenya
- Centre for Social Science Research, University of Cape Town, Cape Town, South Africa
- Oxford Research South Africa, East London, South Africa
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27
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Nyongesa MK, Mwangi P, Kinuthia M, Hassan AS, Koot HM, Cuijpers P, Newton CRJC, Abubakar A. Prevalence, risk and protective indicators of common mental disorders among young people living with HIV compared to their uninfected peers from the Kenyan coast: a cross-sectional study. BMC Psychiatry 2021; 21:90. [PMID: 33568115 PMCID: PMC7877112 DOI: 10.1186/s12888-021-03079-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/31/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa, common mental disorders (CMDs) like depression and anxiety are under-investigated amongst young people living with HIV (YLWH). To address the gap, in Kenya we: a) determined the prevalence of CMDs among YLWH compared to their uninfected peers; b) investigated HIV status as an independent predictor of CMDs in young people; c) investigated CMDs risk and protective indicators with more focus on YLWH. METHODS Between November 2018 and September 2019, 819 young people aged 18-24 years (407 HIV-infected) were recruited from two Counties on the Kenyan coast. Locally adapted pre-existing mental health measures, Patient Health Questionnaire (9-item) and Generalized Anxiety Disorder scale (7-item), were administered among other questionnaires via audio computer-assisted self-interview. Logistic regression was used to determine the correlates of CMDs. RESULTS Prevalence of CMDs was significantly elevated among YLWH compared to their uninfected peers i.e. 29% vs. 12%; p < 0.001 for depressive symptoms, 19% vs. 8%; p < 0.001 for anxiety symptoms, and 16% vs. 5%; p < 0.001 for comorbid depressive and anxiety symptoms. HIV status independently predicted depressive symptoms and its co-occurrence with anxiety symptoms. Among YLWH, negative life events, higher perceived HIV-related stigma and low adherence to antiretroviral therapy were the risk indicators for elevated CMDs. Among HIV-uninfected youths, death of both parents was a risk indicator for elevated depressive symptoms. Protective indicators against CMDs among youths with and without HIV included higher social support and health-related quality of life. CONCLUSION At the Kenyan coast, YLWH have significantly higher burden of CMDs compared to their uninfected peers. Being HIV-positive as a youth in this setting is predictive of more depressive symptoms and its comorbidity with anxiety symptoms. YLWH at high risk of CMDs in coastal Kenya can benefit from early detection, referral and treatment if routine screening for CMDs is integrated in their care package. The mental wellbeing of bereaving HIV-unaffected youths could be improved through continued support to help them come to terms with their loss. At the community level, programmes strengthening the social capital or improving the overall quality of life of youths with or without HIV may be beneficial to their mental health.
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Affiliation(s)
- Moses K. Nyongesa
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya ,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Paul Mwangi
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Michael Kinuthia
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Amin S. Hassan
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya
| | - Hans M. Koot
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pim Cuijpers
- Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charles R. J. C. Newton
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK
| | - Amina Abubakar
- grid.33058.3d0000 0001 0155 5938KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya ,grid.449370.d0000 0004 1780 4347Department of Public Health, Pwani University, Kilifi, Kenya ,grid.4991.50000 0004 1936 8948Department of Psychiatry, University of Oxford, Oxford, UK ,grid.470490.eInstitute for Human Development, Aga Khan University, Nairobi, Kenya
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28
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Shenderovich Y, Boyes M, Esposti MD, Casale M, Toska E, Roberts KJ, Cluver L. Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa. BMC Public Health 2021; 21:172. [PMID: 33472607 PMCID: PMC7816135 DOI: 10.1186/s12889-020-10147-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 12/28/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. METHODS The study traced adolescents aged 10-19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. RESULTS Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97-0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98-1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92-0.97, p<.0001) and anxiety (0.91, 95% CI 0.89-0.94, p<.0001) symptoms reported by adolescents. CONCLUSIONS Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.
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Affiliation(s)
- Yulia Shenderovich
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
| | - Mark Boyes
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Michelle Degli Esposti
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Marisa Casale
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Elona Toska
- Centre for Evidence-Based Intervention, 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
| | | | - Lucie Cluver
- Centre for Evidence-Based Intervention, 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
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29
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Boyes ME, Pantelic M, Casale M, Toska E, Newnham E, Cluver LD. Prospective associations between bullying victimisation, internalised stigma, and mental health in South African adolescents living with HIV. J Affect Disord 2020; 276:418-423. [PMID: 32871672 DOI: 10.1016/j.jad.2020.07.101] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/26/2020] [Accepted: 07/05/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescents living with HIV may be at elevated risk of psychological problems, which are correlated with negative health outcomes. In cross-sectional research with HIV-affected adolescents, bullying victimisation and internalised HIV stigma have been associated with poorer psychological health. We extended these findings and tested longitudinal associations between bullying victimisation, internalised stigma, and mental health among adolescents living with HIV. We also tested whether relationships between bullying victimisation and psychological symptoms were mediated by internalised stigma. METHOD Adolescents living with HIV (n = 1060, 10-19 years, 55% female), who had ever initiated HIV treatment in 53 public health facilities in the Eastern Cape, South Africa, were interviewed and followed up 18 months later (n = 995, 94% retention). Participants completed well-validated measures of depression, anxiety, posttraumatic stress, bullying victimisation, and internalised stigma. RESULTS After adjusting for baseline mental health and sociodemographic characteristics, baseline internalised stigma prospectively predicted poorer outcomes on all psychological measures. Bullying victimisation at baseline was not directly associated with any psychological measures at follow up; however, it was indirectly associated with all psychological measures via internalised stigma. LIMITATIONS Reliance on self-report measures and poor reliability of the depression scale. CONCLUSIONS Bullying victimisation is associated with internalised stigma, which in turn predicts psychological symptoms over time. Interventions reducing internalised stigma and associated psychological distress are needed, and these should be integrated into HIV care to ensure optimal HIV management. The implementation of bullying prevention programs may reduce internalised stigma and promote mental health among adolescents living with HIV.
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Affiliation(s)
- Mark E Boyes
- School of Psychology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Marija Pantelic
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Marisa Casale
- Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom; School of Public Health, University of the Western Cape, 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
| | - Elizabeth Newnham
- School of Psychology, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, Western Australia 6845, Australia; FXB Center for Health and Human Rights, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Lucie D 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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The prevalence of mental health problems in sub-Saharan adolescents living with HIV: a systematic review. Glob Ment Health (Camb) 2020; 7:e29. [PMID: 33489245 PMCID: PMC7786273 DOI: 10.1017/gmh.2020.18] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 08/17/2020] [Accepted: 09/08/2020] [Indexed: 01/10/2023] Open
Abstract
Despite the progress made in HIV treatment and prevention, HIV remains a major cause of adolescent morbidity and mortality in sub-Saharan Africa. As perinatally infected children increasingly survive into adulthood, the quality of life and mental health of this population has increased in importance. This review provides a synthesis of the prevalence of mental health problems in this population and explores associated factors. A systematic database search (Medline, PsycINFO, Scopus) with an additional hand search was conducted. Peer-reviewed studies on adolescents (aged 10-19), published between 2008 and 2019, assessing mental health symptoms or psychiatric disorders, either by standardized questionnaires or by diagnostic interviews, were included. The search identified 1461 articles, of which 301 were eligible for full-text analysis. Fourteen of these, concerning HIV-positive adolescents, met the inclusion criteria and were critically appraised. Mental health problems were highly prevalent among this group, with around 25% scoring positive for any psychiatric disorder and 30-50% showing emotional or behavioral difficulties or significant psychological distress. Associated factors found by regression analysis were older age, not being in school, impaired family functioning, HIV-related stigma and bullying, and poverty. Social support and parental competence were protective factors. Mental health problems among HIV-positive adolescents are highly prevalent and should be addressed as part of regular HIV care.
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Haines C, Loades ME, Coetzee BJ, Higson-Sweeney N. Which HIV-infected youth are at risk of developing depression and what treatments help? A systematic review focusing on Southern Africa. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2019-0037/ijamh-2019-0037.xml. [PMID: 31393831 DOI: 10.1515/ijamh-2019-0037] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 04/16/2019] [Indexed: 01/26/2023]
Abstract
Background Depression is common in people with HIV and is associated with lower quality of life, reduced medication adherence, worse disease progression and higher risk of transmission to others. While the majority of HIV-infected youth live in Southern Africa, research has largely focused on adults from Western countries, with limited generalisability across these populations. This review sought to identify and synthesise research on the risk factors for depression in HIV-infected youth in Southern Africa, and to summarise the available evidence on psychosocial interventions to reduce depression. Method A systematic review was conducted of studies using a validated measure of depression in HIV-infected youth (aged ≤19) in Southern Africa. Eligible studies included either analysis of variables associated with depression, or evaluation of the impact of psychosocial interventions on depression in this population. Results Twelve studies met inclusion criteria for assessing risk factors, based on nine independent samples, constituting 3573 HIV-infected youth (aged 9-19 years). Study quality varied, with heterogeneous methodology limiting comparability and conclusions. There is some evidence that female gender, older age, food insecurity, exposure to abuse and internalised stigma are risk factors for depression, while disclosure of HIV status, satisfaction with relationships and social support are protective. Only one study met inclusion criteria for assessing psychosocial interventions (n = 65; aged 10-13 years). The intervention study did not successfully reduce depression, demonstrating a need for low-cost, large scale interventions to be developed and trialled. Conclusion This review has highlighted the dearth of research into depression in HIV-infected youth in Southern Africa. Disclosing HIV status could be an important protective factor.
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Affiliation(s)
- Cara Haines
- Department of Psychology, University of Bath, Bath, UK
| | - Maria E Loades
- Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK
| | - Bronwynè J Coetzee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
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Niu L, Luo D, Chen X, Wang M, Zhou W, Zhang D, Xiao S. Longitudinal trajectories of emotional problems and unmet mental health needs among people newly diagnosed with HIV in China. J Int AIDS Soc 2019; 22:e25332. [PMID: 31424617 PMCID: PMC6699581 DOI: 10.1002/jia2.25332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Accepted: 06/05/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Concern over mental health morbidity affecting people living with HIV is increasing worldwide. The objective of this study was to describe the longitudinal trajectories of depression and anxiety, and mental health service utilization among people newly diagnosed with HIV. METHODS This was an observational cohort study that enrolled people newly diagnosed with HIV consecutively and followed them for one year in Changsha, China. Socio-demographic, clinical and psychological data were collected at the baseline and at one-year follow-up. Participants were recruited between March 1, 2013 and September 30, 2014. The final follow-up was in September 30, 2015. RESULTS Among 557 people newly diagnosed with HIV enrolled at the baseline, 410 (73.6%) completed the one-year follow-up survey (median (interquartile range) age at follow-up: 29 (25, 39) years; 376 men (91.7%)), and were included in the analysis. 39.3% and 30.2% of the 410 participants were screened with significant symptoms of depression and anxiety at baseline respectively. An overall drop in the prevalence of each condition was found at follow-up, however, 10.5% and 6.1% of participants were found to have persistent depression and anxiety. The results of mixed-effect models showed that bisexuality, homosexual transmission, other clinical symptoms (for example, not on antiretroviral therapy (ART)), non-disclosure, higher levels of HIV/AIDS-related stress, and lack of social support were associated with significant symptoms of depression and anxiety. One year after diagnosis, 8.3% had visited healthcare providers for emotional or psychological problems. CONCLUSIONS Despite the obvious need people newly diagnosed with HIV in China rarely seek professional help. Integrating depression and anxiety screening and referral into HIV care settings is warranted.
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Affiliation(s)
- Lu Niu
- Department of Social Medicine and Health ManagementXiangya School of Public HealthCentral South UniversityChangshaChina
- The Affiliated Brain Hospital of Guangzhou Medical University (Guangzhou Huiai Hospital)GuangzhouChina
| | - Dan Luo
- Department of Social Medicine and Health ManagementXiangya School of Public HealthCentral South UniversityChangshaChina
| | - Xi Chen
- Hunan Provincial Center for Disease Prevention and ControlChangshaChina
| | - Min Wang
- HIV/AIDS Research InstituteThe First Hospital of ChangshaChangshaChina
| | - Wei Zhou
- Hospital Administration InstituteXiangya HospitalCentral South UniversityChangshaChina
| | - Dexing Zhang
- The Jockey Club School of Public Health and Primary CareFaculty of MedicineThe Chinese University of Hong KongHong KongChina
| | - Shuiyuan Xiao
- Department of Social Medicine and Health ManagementXiangya School of Public HealthCentral South UniversityChangshaChina
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