Understanding mental health difficulties and associated psychosocial outcomes in adolescents in the HIV clinic at Kenyatta National Hospital, Kenya

Douglas Gaitho, Manasi Kumar, Dalton Wamalwa, Grace Nduku Wambua, Ruth Nduati, Douglas Gaitho, Manasi Kumar, Dalton Wamalwa, Grace Nduku Wambua, Ruth Nduati

Abstract

Background: Globally adolescents continue to have an upward trend in HIV incidence and AIDS-related mortality. The interplay between the rapid physical growth, sexual maturation, and enormous albeit slow-evolving cognitive and psychological changes in adolescence may partly explain this trend. Our main purpose was to highlight key psychosocial characteristics of HIV-infected adolescents and explore if these characteristics are associated with depression symptoms.

Methods: From August to December 2016 after obtaining informed consent, adolescents living with HIV at Kenyatta National Hospital were interviewed using the Home environment, Education and Employment, Activity, Sexuality, Suicide and depression traits (HEADSS) tool combined with the Patient Health Questionnaire (PHQ-9) to elucidate which key symptoms of depression and link with psychosocial characteristics mapped on HEADSS. In order to determine which psychosocial characteristics were linked with risk of depression, the traits of adolescents who were symptomatic were compared to those who were not using univariate and multivariate regression analysis.

Results: All the 270 adolescents offered participation in the study accepted to enroll. The aged 10-19 years were recruited and mean age was 14.75 and 53.7% (n = 145) were males. Overall, 269 (99.9%) were still in school and 52.6% of the adolescents had symptoms of depression. The independent predictors of depression were being of ages 15-19 years [OR = 2.34 (95% CI 1.36, 4.04) P < 0.02], ever repeating classes [OR = 1.74 (95% CI 1.0-3.05) P = 0.05], ever being sent away from school due to lack of school fees [OR = 1.71 (95% CI 1.0-2.91) P = 0.05], and non-adherence to medication [OR = 1.84 (95% CI 1.08-3.14) P = 0.03. Missing of meals due to food insecurity was associated with an important trend towards increased risk of depression [OR = 2.42 (CI 0.96-6.14) P = 0.06].

Conclusion: One in two of the adolescents interviewed had depression symptoms which were significantly associated with lack of school fees, missing meals, non-adherence to medication, and substance abuse.

Keywords: Adherence; Adolescents; Depression; HIV; Psychosocial characteristics; School performance.

References

    1. UNAIDS. Global report: UNAIDS report on the global AIDS epidemic 2013 [Internet]. Unaids. 2013. p. 198. . Accessed 11 Dec 2017.
    1. UNAIDS/UNICEF. All Into #EndAdolescentAIDS. 2015;95.
    1. National AIDS Control Council. Kenya’ s fast-track plan to end HIV and AIDS among adolescents and young people. 2015;(September):40.
    1. World Health Organization. Global accelerated action for the health of adolescents (AA-HA!). 2017. . Accessed 11 Dec 2017.
    1. Folayan MO, Odetoyinbo M, Harrison A, Brown B, Trinity H, Plaza H, et al. Addressing the socio-development needs of adolescents living with HIV/AIDS in Nigeria: a call for action. Afr J Reprod Health. 2015;18:93–101.
    1. Scorza P, Kanyanganzi F, Smith MC, Sezibera V, Cyamatare F, Beardslee W, et al. HIV and child mental health : a case-control study in Rwanda. Pediatrics. 2014
    1. Louw K, Ipser J, Phillips N, Hoare J. Correlates of emotional and behavioural problems in children with perinatally acquired HIV in Cape Town, South Africa. AIDS Care. 2016
    1. Lowenthal ED, Marukutira TC, Chapman J, Mokete K, Riva K, Tshume O, et al. Psychosocial assessments for HIV+ African adolescents : establishing construct validity and exploring under-appreciated correlates of adherence. PloS ONE. 2014
    1. Mutumba M, Bauermeister A. Psychosocial challenges and strategies for coping with HIV among adolescents in Uganda. AIDS Patient Care STDS. 2015;29(2):86–94. doi: 10.1089/apc.2014.0222.
    1. Souza E, Santos N, Valentini S, Silva G, Falbo A. Long-term follow-up outcomes of perinatally HIV-infected adolescents: infection control but school failure. J Trop Pediatr. 2010;56(56):421–426. doi: 10.1093/tropej/fmq008.
    1. Enimil A, Nugent N, Amoah C, Norman B, Ocran J, Kwara A, et al. Quality of life among Ghanaian adolescents living with perinatally acquired HIV : a mixed methods study. AIDS Care. 2015
    1. Dow DE, Turner EL, Shayo AM, Mmbaga B, Cunningham CK, Donnell KO, et al. Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania. AIDS Care. 2016
    1. Nabukeera-barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, Namusoke E, et al. Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis. 2015
    1. Kim MH, Mazenga AC, Yu X, Devandra A, Nguyen C, Ahmed S, et al. Factors associated with depression among adolescents living with HIV in Malawi. BMC Psychiatry. 2015;15:264. . Accessed 11 Dec 2017.
    1. Mbalinda SN, Kiwanuka N, Eriksson LE, Wanyenze RK, Kaye DK. Correlates of ever had sex among perinatally HIV-infected adolescents in Uganda. Reprod Health. 2015
    1. Cappelli AM, Gray C. The HEADS-ED: a rapid mental health screening tool for pediatric patients in the emergency department. Pediatrics. 2012
    1. Ministry of Health. Guidelines on use of antiretroviral drugs for treating and preventing HIV infection in Kenya. 2016.
    1. National Adolescent Sexual and Reproductive Health Policy, Ministry of Health, Kenya 2015; . Accessed 11 Dec 2017.
    1. Kenya Vision 2030. A globally competitive and prosperous Kenya. 2007. .
    1. Shavisa T, Ndiku J, Musasia M. The role of student characteristics in dropout cases among secondary school students in Vihiga county, Kenya. 2016. p. 85–100.
    1. Our future: a lancet commission on adolescent health and wellbeing: the lancet, 2013 . Accessed 11 Dec 2017.
    1. Kenya Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) investment framework; Ministry of Health Government of Kenya January 31, 2016.
    1. Vreeman RC, Nyandiko WM, Liu H, Tu W, Scanlon ML, Slaven JE, et al. Measuring adherence to antiretroviral therapy in children and adolescents in western Kenya. J Int AIDS Soc. 2014;1–10:19227. doi: 10.7448/IAS.17.1.19227.
    1. Dolezal C, Mckay M, Wiznia A. Mental health and family influences. 2011.
    1. Montalto G, Sawe F, Miruka A, et al. Diagnosis disclosure to adolescents living with HIV in rural Kenya improves antiretroviral therapy adherence and immunologic outcomes: a retrospective cohort study. PloS ONE. 2017
    1. Kenya National Bureau of Statistics (KNBS) and ICF Macro . Kenya demographic and health survey 2008–09. Calverton: KNBS and ICF Macro; 2010.
    1. Toska E, Cluver LD, Hodes R, Kidia KK. Sex and secrecy: how HIV-status disclosure affects safe sex among HIV-positive adolescents. AIDS Care. 2015;27:47–58. doi: 10.1080/09540121.2015.1071775.

Source: PubMed

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