Factors associated with depression among adolescents living with HIV in Malawi

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.

Mental health challenges among adolescents living with HIV

“…In a study of 162 HIV-infected children and adolescents in Kenya, 49% were reported to have at least one psychiatric diagnosis or suicidality, with anxiety disorders most common (32.3%), followed by major depressive disorder (17.8%) [28]. A cross-sectional study of 562 HIV-infected adolescents from Malawi found a depression prevalence of 18.9% [29,30]. Within another study in Rwanda examining 100 HIV-infected children ages 7–14 years, the prevalence of depression reported was 25% [31].…”

“…One study found male sex to be associated with a greater risk of depression than female sex in Kenya [28], while another found female sex to be associated with higher BDI-II scores in Malawi [30]. Another study found depression rates to be higher among HIV-infected adolescent females than males in Rwanda, but this difference was not significant [31], while another found no significant association between sex and suicidal ideation or behaviour in Rwanda [35].…”

High self‐reported non‐adherence to antiretroviral therapy amongst adolescents living with HIV in Malawi: barriers and associated factors

“…Both measures have been validated in diverse settings and cultures [32][33][34][35][36][37]. A locally validated and culturally adapted Chichewa version of the BDI was used [28,29]. The Cronbach's alpha for the BDI was 0.80 [28,29].…”

Greater retention in care among adolescents on antiretroviral treatment accessing “Teen Club” an adolescent‐centred differentiated care model compared with standard of care: a nested case–control study at a tertiary referral hospital in Malawi

“…Antiretroviral treatment (ART) adherence may be compromised when an adolescent also has to be responsible for their health, food security, livelihood, and shelter. Stigma around HIV from peers at school or in their community may also compromise ART adherence, as ALHIV without peer support can feel isolated . Disclosing HIV status may be difficult, creating a barrier to developing supportive friendships and peer relationships.…”