\u201cI Found Out I was Pregnant, and I Started Feeling Stressed\u201d: A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Emily L Tuthill,Ann E Maltby,Amy A Conroy,Jennifer A Pellowski,Eliud Akama,Belinda C Odhiambo,Sheri D Weiser,Craig R Cohen

doi:10.1007/s10461-021-03283-z

Abstract

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28–38 weeks pregnant, 6-weeks postpartum and 5–7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Highlights

Poor mental health, including depression, is a pressing global health issue among pregnant and postpartum women living with HIV (WLWH) [1,2,3], in sub-Saharan Africa (SSA) where the prevalence of HIV among women is disproportionately high [4]
Little is known about the lived experience of perinatal depression and HIV, how maternal mental health may vary across the perinatal period, and how social-structural factors such as food insecurity intersect with mental health and HIV to impact maternal and child health, including adherence to lifesaving antiretroviral therapy (ART)
Financial insecurity emerged as the central theme impacting the mental health experience of WLWH across the perinatal period

Summary

Introduction

Poor mental health, including depression, is a pressing global health issue among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) [1,2,3], in sub-Saharan Africa (SSA) where the prevalence of HIV among women is disproportionately high [4]. Little is known about the lived experience of perinatal depression and HIV, how maternal mental health may vary across the perinatal period, and how social-structural factors such as food insecurity intersect with mental health and HIV to impact maternal and child health, including adherence to lifesaving ART. This knowledge is key to addressing the mental health needs of WLWH at different stages of the perinatal period in settings like SSA where social-structural factors have been shown to affect HIV-related health outcomes and mental health [21, 22]. To fill this gap and inform future interventions, we conducted a longitudinal qualitative study with perinatal WLWH in western Kenya exploring the mental health trajectories from pregnancy across the postpartum period

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