Mothers with HIV are at high risk of a range of psychosocial issues that may impact HIV disease progression for themselves and their children. Stigma has also become a substantial barrier to accessing HIV/AIDS care and prevention services. The study objective was to determine the prevalence and severity of postpartum depression (PPD) amongst women living with HIV and to further understand the impact of stigma and other psychosocial factors in 123 women living with HIV attending Prevention of Mother to Child transmission (PMTCT) clinic at Kenyatta National Hospital (KNH) located in Nairobi, Kenya. We used the EPDS scale and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N=59) of women screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported high levels of stigma. Multivariate analyses showed that lower education (OR=0.14, 95% CI [0.04 – 0.46], p=0.001) and lack of family support (OR=2.49, 95% CI [1.14 – 5.42], p=0.02) were associated with presence of elevated depressive symptoms. The presence of stigma implied more than 9 fold risk of development of PPD (OR=9.44, 95% CI [1.132–78.79], p=0.04). Stigma was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to women to address mental health problems especially depression screening and offering psychosocial treatments bolstering quality of life of the mother-baby dyad.

IntroductionAdolescent pregnancy is a highly prevalent and significant public health problem in Kenya, and mental health needs of pregnant adolescent girls have been overlooked. Nearly, 50% of the world’s population comprises children and adolescents and 85% live in lower and middle-income countries.ObjectivePregnant adolescents were interviewed to ascertain certain social determinants of mental health such as social support, partner or parent support, and demographic profile and assessed for depression using EPDS and for severity of depression using BDI, and their alcohol abuse assessed using AUDIT.MethodsA cross-sectional descriptive study using a purposive sample of 212 pregnant adolescents visiting Kangemi Health Centre in Nairobi was conducted.ResultsWe found that 60.4% had depressive symptoms scores of 8 and above on EPDS, 51.9% were found to have severe depression score on BDI. About 26.9% were currently consuming alcohol. The more severely depressed participants were demonstrating greater alcohol use. Of the 110 pregnant adolescents who were severely depressed, 39 were currently consuming alcohol. We identified several alcohol use disorder factors associated with depression such as living with an alcoholic, ever and current use of alcohol, alcohol-related harm being experienced, being pressured to take alcohol. On our final multivariate logistic regression, we found that being a student (AOR 5.12, 95% CI 1.19–22.0, P = 0.028); low family income (between 5000 and 10,000 shillings) (AOR 0.22, 95% CI 0.09–0.56, P = 0.02); unplanned pregnancy (AOR 3.41, 95% CI 1.19–9.80, P = 0.023); both negative and ambivalent attitudes of the unborn baby’s father, respectively (AOR 8.72 95% CI 2.88–26.37 P < 0.001; AOR 4.26 95% CI 1.35–13.45, P = 0.013); early age at sexual debut (AOR 0.70, 95% CI 0.55–0.89, P = 0.003); and ever used any psychoactive substances (AOR 3.21, 95% CI 1.31–7.88, P = 0.011).Conclusion and recommendationsAlcohol abuse during pregnancy presents a significant public health burden and the associated health risks for the adolescent mother and her baby are enormous. We need to bolster screening for the comorbid disorders such as depression and substance use disorders, particularly alcohol in order to address mental health and psychosocial functioning of adolescents. The underlying adversities and sociocultural challenges need to be better understood and mechanisms that lead to comorbidities require further research. Depression interventions for Kenyan adolescents would need to embed screening, treatment and management of substance abuse.

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