Abstract
ABSTRACTAdolescents with perinatal HIV (PHIV) may be at higher risk of anxiety and depression than HIV negative young people. We investigated prevalence of anxiety and depression symptoms in 283 PHIV and 96 HIV-affected (HIV-negative) young people in England recruited into the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort. We used Hospital Anxiety and Depression Scale (HADS) scores and linear regression investigated predictors of higher (worse) scores.115 (41%) and 29 (30%) PHIV and HIV-affected young people were male, median age was 16 [interquartile range 15,18] and 16 [14,18] years and 241 (85%) and 71 (74%) were black African, respectively. There were no differences in anxiety and depression scores between PHIV and HIV-affected participants. Predictors of higher anxiety scores were a higher number of carers in childhood, speaking a language other than English at home, lower self-esteem, ever thinking life was not worth living and lower social functioning. Predictors of higher depression scores were male sex, death of one/both parents, school exclusion, lower self-esteem and lower social functioning. In conclusion, HIV status was not associated with anxiety or depression scores, but findings highlight the need to identify and support young people at higher risk of anxiety and depression.
Highlights
Developmental and etiological models of anxiety suggest exposure to uncontrollable life events in early life may lead individuals to perceive events as out of their control
Most recent USA based studies found no evidence of greater mental health problems in perinatal HIV (PHIV) compared to HIV-affected, young people, but higher prevalence in both PHIV and HIV-affected groups compared to the general population. (Gadow et al, 2010, 2012; Malee et al, 2011; Mellins et al, 2012) These findings highlight the importance of including appropriate control groups in interpreting study findings. (Elkington et al, 2011; Vreeman et al, 2017) We investigated the prevalence of symptoms of anxiety and depression and explored associations with a wide range of psychosocial factors, in older adolescents with and without PHIV in England
These results are similar to other recent studies finding no evidence of a difference in prevalence of mental health problems by HIV status, (Elkington et al, 2011; Gadow et al, 2012; Mellins et al, 2012; Mutumba et al, 2016) and suggest that contextual factors rather than HIV itself may have an important role. (Mellins & Malee, 2013) Another explanation for the lack of difference by HIV status is that anxiety and depression in young people with PHIV may be lessened through regular contact with health services and mental health support.(Gadow et al, 2012)
Summary
Developmental and etiological models of anxiety suggest exposure to uncontrollable life events in early life may lead individuals to perceive events as out of their control. Most recent USA based studies found no evidence of greater mental health problems in PHIV compared to HIV-affected (perinatally HIV exposed or HIV affected), young people, but higher prevalence in both PHIV and HIV-affected groups compared to the general population. (Elkington et al, 2011; Vreeman et al, 2017) We investigated the prevalence of symptoms of anxiety and depression and explored associations with a wide range of psychosocial factors, in older adolescents with and without PHIV in England
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