"I Found Out I was Pregnant, and I Started Feeling Stressed": A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Emily L Tuthill, Ann E Maltby, Belinda C Odhiambo, Eliud Akama, Jennifer A Pellowski, Craig R Cohen, Sheri D Weiser, Amy A Conroy, Emily L Tuthill, Ann E Maltby, Belinda C Odhiambo, Eliud Akama, Jennifer A Pellowski, Craig R Cohen, Sheri D Weiser, Amy A Conroy

Abstract

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28-38 weeks pregnant, 6-weeks postpartum and 5-7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Keywords: Exclusive breast feeding; Financial insecurity; Food insecurity; Longitudinal qualitative; Mental health; Perinatal depression; Prevention of mother to child transmission; Women living with HIV.

Conflict of interest statement

The authors declare that they have no conflict of interest to declare.

© 2021. The Author(s).

Figures

Fig. 1
Fig. 1
Depressive symptom scores using the patient health questionnaire 9 (PHQ-9)
Fig. 2
Fig. 2
Conceptual pathway of perinatal mental health among WLWH
https://www.ncbi.nlm.nih.gov/pmc/articles/instance/8602218/bin/10461_2021_3283_Figa_HTML.jpg

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Source: PubMed

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