Factors associated with depression among adolescents living with HIV in Malawi.

Maria H Kim,Xiaoying Yu,Peter N Kazembe,Alick C Mazenga,Chi Nguyen,Akash Devandra,Saeed Ahmed,Carla Sharp

doi:10.1186/s12888-015-0649-9

Abstract

BackgroundPrior research suggests that a high prevalence of depression, with a detrimental impact on treatment outcomes exists among HIV-infected youth. Data on potential risk factors of depression among HIV-infected youth in sub-Saharan Africa are scarce. This cross-sectional study aimed to identify contributory/protective factors associated with depression in Malawian adolescents 12–18 years old living with HIV.MethodsDepression was measured by a validated Chichewa version of the Beck Depression Inventory version-II (BDI-II) and the Children’s Depression Rating Scale-Revised (CDRS-R). Data on variables thought to potentially be contributory/protective were collected and included: socio-demographics, past traumatic events/stressors, behavioural factors/social support, and bio-clinical parameters. Chi-square test or two-sample t-test was used to explore associations between factors and depression. Additional testing via linear/logistic regression, adjusting for age and sex, identified candidate variables (p < 0.1). Final regression models included variables with significant main effects and interactions.ResultsOf the 562 participants enrolled (mean age, 14.5 years [SD 2.0]; 56.1 % female), the prevalence of depression was 18.9 %. In multivariate linear regression, the variables significantly associated with higher BDI-II score were female gender, fewer years of schooling, death in the family/household, failing a school term/class, having a boyfriend/girlfriend, not disclosed or not having shared one’s HIV status with someone else, more severe immunosuppression, and bullied for taking medications. Bullying victimization was reported by 11.6 % of respondents. We found significant interactions: older participants with lower height-for-age z-scores and dissatisfied with their physical appearance had higher BDI-II scores. In multivariate logistic regression, factors significantly associated with depression were: older age, OR 1.23 (95 % CI 1.07-1.42); fewer years of schooling, OR 3.30 (95 % CI 1.54-7.05); and bullied for taking medications, (OR 4.20 (95 % CI 2.29-7.69).ConclusionHaving fewer years of schooling and being bullied for taking medications were most clearly associated with depression. Programmes to support the mental health needs of HIV-infected adolescents that address issues such as disclosure, educational support, and, most notably, bullying may improve treatment outcomes and are recommended.

Highlights

Prior research suggests that a high prevalence of depression, with a detrimental impact on treatment outcomes exists among HIV-infected youth
Adolescents living with HIV/AIDS are vulnerable for a variety of biological, behavioural, social and structural reasons, and providing holistic care to this group presents many unique challenges [1, 2]
After adjustment for age and sex, a higher Beck Depression Inventory version-II (BDI-II) score was potentially associated with fewer years of schooling, living in a rural area or outside the city, primary caregiver type, maternal death, change in caregiver, death in the family/ household, failing a school term/class, experience of forced sex, physical abuse or witnessed physical violence in the home, bullied for one’s physical appearance or for taking medicines, hospital admission in the past year, experience of being in a romantic relationship, dissatisfaction with physical appearance, use of alcohol, being disclosed to and not sharing one’s HIV status with someone else, higher recent CD4 count/worse immunological stage, being malnourished, or lower height-for-age z-score

Summary

Introduction

Prior research suggests that a high prevalence of depression, with a detrimental impact on treatment outcomes exists among HIV-infected youth. Data on potential risk factors of depression among HIV-infected youth in sub-Saharan Africa are scarce. This cross-sectional study aimed to identify contributory/protective factors associated with depression in Malawian adolescents 12–18 years old living with HIV. An estimated 2.1 million adolescents (aged 10–19 years) are living with HIV, the vast majority in sub-Saharan Africa [1]. High-risk behaviours, such as earlier debut of sexual activity, substance misuse, and increased number of sexual partners, have been associated with depression in youth [8, 11, 12]. In sub-Saharan Africa, evidence on factors potentially associated with depression amongst adolescents such as bullying [13], and substance abuse [13, 14] have just begun to emerge. Correlates, which might be relevant in the African setting including orphanhood [15, 16], exposure to violence [17], poverty, and food insecurity, peer social support, and death in the family, and have been insufficiently described

Methods

Results

Discussion

Conclusion