Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder

Roberts, Kate; Smith, Colette; Cluver, Lucie; Toska, Elona; Zhou, Siyanai; Boyes, Mark; Sherr, Lorraine

doi:10.1007/s10461-021-03474-8

Cited by 21 publications

(24 citation statements)

References 77 publications

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“…Results show high rates of IPV and pregnancy‐related stigma, both independently associated with higher levels of depression and anxiety, coinciding with previous reports from Uganda and elsewhere in Sub‐Saharan Africa (Atuyambe et al, 2009; Choi et al, 2015; Hall et al, 2018; Ochen et al, 2019; Roberts et al, 2021). Frequently, adolescents who become pregnant out of wedlock in this region face severe social consequences, including social isolation, lack of family, and partner support (Apolot et al, 2020), being forced to leave school (Maly et al, 2017), and being forcibly removed from their homes (Osok et al, 2018), possibly contributing to depression and anxiety symptoms.…”

Section: Discussionsupporting

confidence: 89%

Association of pregnancy‐related stigma and intimate partner violence with anxiety and depression among adolescents

Asiimwe

Tseng

Murray

et al. 2022

Journal of Adolescence

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Introduction We explored the association between pregnancy‐related stigma and intimate partner violence (IPV) with depression and anxiety among adolescents in Uganda. Methods We interviewed a convenience sample of 100 adolescents (>18 years) who were pregnant (>3 months) or recently gave birth (<3 months) at Tororo District Hospital, Uganda. Symptoms of depression and anxiety were evaluated using the Hopkins Symptom Checklist (HSCL‐25), physical and sexual IPV were assessed using the WHO violence against women instrument, and pregnancy‐related stigma was captured with a questionnaire. Regression models were used to evaluate associations of pregnancy stigma and IPV with depression and anxiety. Results Mean age was 18 years, 84% were primiparous, 66% were married and 57% had only primary school‐level education. About 48% women had clinically meaningful distress levels; 45% reported sexual IPV, 32% physical IPV, and 86% reported experiencing pregnancy‐related stigma. Adjusted models showed that higher levels of depression and anxiety were associated with higher report of pregnancy‐related stigma (β = .27, p = .03), physical IPV, (β = −.24, p < .01), or sexual IPV (β = −.19, p = .05), compared to those who did not. Unemployment (β = −.24, p = .01) and lower educational level (β = −.21, p = .05) were also independent predictors of depression and anxiety. Conclusion Findings suggest that IPV is common among adolescents in Uganda, as is pregnancy‐related stigma, and both are independent predictors of depression and anxiety. The implications of these findings and the need for clinical interventions for IPV among adolescents are discussed.

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Section: Discussionsupporting

confidence: 89%

Association of pregnancy‐related stigma and intimate partner violence with anxiety and depression among adolescents

Asiimwe

Tseng

Murray

et al. 2022

Journal of Adolescence

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“…This previous study of 723 adolescents undertaken within South Africa identified elevated prevalence of common mental disorder among adolescent mothers living with HIV compared to adolescent non-mothers and adolescent mothers not living with HIV. Results from the current study additionally support some of the nuanced findings of this previous study identifying elevated depressive and suicidality symptomology among adolescent mothers living with HIV [ 21 ]. Potentially reflecting the myriad of challenges, and the ongoing need for support, experienced by adolescent mothers in this setting, particularly those living with HIV [ 21 ].…”

Section: Discussionsupporting

confidence: 86%

“…if a participant scored above the cut-off on any of the four mental health measures within the study (see below) they were classified as experiencing poor mental health and, 2) Any likely mental health comorbidities (MHCs); i.e. if a participant scored above the cut-off on two or more of the mental health measures within the study (see below) they were classified as experiencing mental health comorbidities [ 36 , 42 , 43 ].…”

Section: Methodsmentioning

confidence: 99%

“…Living with HIV may further compound the demands on adolescent mothers. In addition to both adolescent pregnancy [ 17 , 18 ] and living with HIV [ 19 , 20 ] being found to be associated within poor mental health within separate explorations, adolescent mothers living with HIV have been found to have a greater prevalence of reporting a common mental disorder (defined as experiencing depressive, anxiety, posttraumatic stress, or suicidality symptomology) compared to female adolescents not experiencing motherhood and not living with HIV [ 21 ]. The relationship between adolescent motherhood and poor mental health is seemingly complex and likely bidirectional.…”

Section: Introductionmentioning

confidence: 99%

“…There is also a dearth of literature focusing on the mental health of adolescent mothers (inclusive of those living with HIV) from the sub-Saharan African region [ 36 ] and as such, the impacts of maternal mental health, inclusive of implications for the development of children born to adolescent mothers remains unknown. Given previous literature has identified adolescent mothers as being at a greater risk of HIV incidence, [ 16 ] poor mental health, [ 21 ] and poor child development outcomes [ 33 , 34 ] it is essential to explore the combination of these factors in this population. To address this critical evidence gap, it is important to identify if maternal mental health is associated with the cognitive development of children born to adolescent mothers affected by HIV (both living with HIV and living within high HIV prevalence communities).…”

Section: Introductionmentioning

confidence: 99%

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Adolescent mothers and their children affected by HIV—An exploration of maternal mental health, and child cognitive development

Roberts

Smith²,

Cluver³

et al. 2022

PLoS ONE

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Background Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development. Methods Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores. Results The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores. Conclusions This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.

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Exploring the cognitive development of children born to adolescent mothers in South Africa

Roberts

Smith

Toska

et al. 2023

Infant and Child Development

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This study explores the cognitive development of children born to adolescent mothers within South Africa compared to existing reference data, and explores development by child age bands to examine relative levels of development. Cross-sectional analyses present data from 954 adolescents (10-19 years) and their first-born children (0-68 months). All adolescents completed questionnaires relating to themselves and their children, and standardized child cognitive assessments (Mullen Scales of Early Learning) were undertaken. Cognitive development scores of the sample were

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Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder

Cited by 21 publications

References 77 publications

Association of pregnancy‐related stigma and intimate partner violence with anxiety and depression among adolescents

Association of pregnancy‐related stigma and intimate partner violence with anxiety and depression among adolescents

Adolescent mothers and their children affected by HIV—An exploration of maternal mental health, and child cognitive development

Exploring the cognitive development of children born to adolescent mothers in South Africa

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