Predictors of mental health problems in adolescents living with HIV in Namibia

Abstract

Background Little research in sub‐Saharan Africa has looked at factors that predict mental health problems in adolescents living with HIV (ALHIV). This study examines the psychological impact of HIV in adolescents in Namibia, including risk and protective factors associated with mental health. Methods Ninety‐nine fully disclosed ALHIV between the ages of 12 and 18 were interviewed at a State Hospital in Windhoek. A structured questionnaire assessed mental health, using the SDQ (Goodman, 1997), sociodemographic factors, poverty, social support, adherence and stigma. Results Mean age was 14.3 years, 52.5% were female and most were healthy. Twelve percent scored in the clinical range for total mental health difficulties and 22% for emotional symptoms. Poverty was associated with more total mental health difficulties, t(96) = −2.63, p = .010, and more emotional symptoms, t(96) = −3.45, p = .001, whereas better social support was a protective factor, particularly caregiver support (r = −.337, p = .001). Adherence problems, HIV‐related stigma and disclosing one's own HIV status to others were also associated with more total mental health difficulties. Poverty (β = −.231, p = .023) and stigma (β = .268, p = .009) were the best predictors for total mental health difficulties, whereas stigma (β = .314, p = .002) predicted emotional symptoms. Social support had a protective effect on peer problems (p = .001, β = −.349). Conclusions Several contextual factors associated with poorer mental health in ALHIV are identified.

Editorial: Global child mental health – emerging challenges and opportunities

“…Principles for addressing children's mental health needs are emerging across a range of policy domains including child protection, welfare, physical health and education. These principles and practices are influenced by the emergence of findings from epidemiological research; studies about the impact of trauma on groups such as children living in orphanages, child refugees and children who have been affected by HIV; and the development and evaluation of mental health interventions for children (Gentz, Calonge, Martínez, Rosario, & Ruiz‐Casares, ; Hamdan‐Mansour, Abdel Razeq, AbdulHaq, Arabiat, & Khalil, ). A number of other factors have aided this process, and in particular, the development, testing and availability of a range of methods and instruments; their cross‐cultural validation; and the formation of international collaborative research groups.…”

Informing the measurement of wellbeing among young people living with HIV in sub-Saharan Africa for policy evaluations: a mixed-methods systematic review

“…Among these studies, the largest effect of stigma was documented in Zambia, which found that the odds of having higher depressive symptom scores was almost three times higher for YPLHIV who experienced stigma than in those who did not (aOR = 2.99; 95% CI [1.07-8.41], p = 0.01) [94]. Having someone to talk to or feeling satisfied with health services or the social support received promoted positive mental health functioning in four studies (Namibia (n = 1) [92], Uganda (n = 2) [95,96], Zambia (n = 1) [94]. In an Ethiopian study, Abebe, Shumet [98] reported that those with low social support were 2.74 times more likely to develop depressive symptoms than those with strong social support (95% CI [1.42-5.27], p = < 0.01).…”

“…Being female was strongly correlated with poor mental health functioning in four studies (note, the outcome definition was different in each of the four studies) [92,93,96,99]. The largest gender effect was observed in Malawi, with females almost eight times as likely compared to males to exhibit higher depression-related symptoms scores (β = 2.13, 95% CI [0.82-3.43], p = 0.002) [93].…”

“…Of the ten quantitative studies ( Table 2), five were conducted in southern Africa: South Africa [90,91], Namibia [92], Malawi [93], Zambia [94] ( Table 3). The remainder conducted in eastern Africa: Uganda (n = 2) [95,96], Kenya (n = 1) [97], Ethiopia (n = 1) [98] and Tanzania (n = 1) [99].…”

“…iii. Psycho-social HIV-related stigma was strongly positively associated with poor mental health functioning in six studies [91,92,94,96,98,99]. Among these studies, the largest effect of stigma was documented in Zambia, which found that the odds of having higher depressive symptom scores was almost three times higher for YPLHIV who experienced stigma than in those who did not (aOR = 2.99; 95% CI [1.07-8.41], p = 0.01) [94].…”