Prevalence and factors associated with common mental disorders in young people living with HIV in sub‐Saharan Africa: a systematic review

Abstract

Introduction Common mental disorders (CMDs) particularly depression and anxiety, are highly comorbid with HIV also in young people living with HIV (YLWH). In sub‐Saharan Africa (SSA) where most YLWH reside, there are limited summary data on CMDs among these youths, yet there are previous systematic reviews summarizing data on CMDs among adults living with HIV. We conducted a systematic literature review on the prevalence and correlates of CMDs among YLWH, aged 10 to 24 years, from SSA. Methods We searched African Index Medicus, African Journals Online and five other electronic databases (from database inception up to 31 December 2020) for relevant studies published in English. The key search terms applied were as follows: “Depression OR Anxiety”, “Young people”, “HIV infections” and “sub‐Saharan Africa”. Results and discussion Out of 3989 articles, 31 studies were included in the review. The prevalence of CMDs in YLWH widely varied ranging between 16.0% and 40.8% for major depression, 4.4% and 52.6% for depressive symptoms and 2.2% and 25.0% for anxiety symptoms. Anxiety disorder was estimated at 45.6%. Four of the five included studies with a comparison group of HIV‐negative young people reported significantly higher prevalence estimates of depressive disorders among YLWH. Several sociodemographic, psychosocial and HIV‐related correlates of CMDs were reported but most lacked consensus across studies. Nevertheless, female sex, older age, fewer schooling years, HIV‐positive status, bullying, sexual abuse, HIV‐related stigma, social support and poor antiretroviral therapy adherence were frequently reported (in ≥2 studies) as significant correlates of depressive symptoms among YLWH. Higher social support was the only frequent significant correlate of anxiety symptoms. Conclusions The burden of CMDs among YLWH from SSA is substantial and appears to be significantly higher when compared with HIV‐negative peers, particularly for depressive disorders. However, more comparative research is needed. Importantly, screening for CMDs at the youth HIV‐clinics should be prioritized especially for YLWH at high risk of CMDs, to facilitate early management or referral for treatment. Furthermore, youth‐friendly psychological interventions addressing CMDs in YLWH should urgently be piloted in SSA, incorporating contextual components that may directly or indirectly reduce symptoms of CMDs among YLWH, such as social support.

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“…Participants appeared to benefit most from the expansion of their social network and felt their stress and anxiety were alleviated through meeting and discussing shared experiences with peers. This resonates with findings from a recent systematic review of studies on the mental health of adolescents and young people living with HIV in which higher social support was the only factor significantly associated with lower rates of anxiety [ 38 ]. Peer-led social support also underpins successful interventions to improve vulnerable adolescents’ risk behaviour and engagement with services [ 39–41 ].…”

Psychometric Properties of the Berger HIV Stigma Scale: A Systematic Review

“…The lack of adequately validated tools for use in a given setting can contribute to the under investigation or underreporting of patient-reported health outcomes. For instance, the paucity of validated screening tools for anxiety disorders has previously been cited as a reason for the lower screening of anxiety disorders among young people living with HIV from sub-Saharan Africa [ 192 ].…”

Mental health and well-being of older adults living with HIV in sub-Saharan Africa: a systematic review

“…This finding corroborates previous review findings on the prevalence of CMDs in the region, although in younger HIV populations. 69 The observed variation could reflect significant contextual differences across the SSA region, for example, social environmental milieu, healthcare systems, patterns of the burden of diseases and mental health resources, which are likely to alter the risk profile of these adults. 70 It could also be attributed to potential differences in study populations, study participants and the use of diverse measurement tools (including different cut-offs for the same measures).…”