Psychiatric disorders in adolescents living with HIV in Botswana

Abstract

Background As children living with HIV transition from adolescence into adulthood, they face a considerable burden of psychiatric disorders (PDs) which may vary between the perinatally and behaviorally infected. The knowledge of the pattern of these PDs in relation to the varying needs of the adolescents living with HIV (ALWHIV) is unclear but necessary for maximizing their linkage to care and improving their quality of life in Botswana. Aim To determine the pattern of PDs in ALWHIV in Botswana; to compare and explore the differences in the pattern and their associated factors between congenitally infected adolescents (CIAs) and behaviorally infected adolescents (BIAs). Methods A cross-sectional survey of 622 ALWHIV (399 CIA and 223 BIA) with the Mini International Neuropsychiatric Interview-Kid Screen. Results The participants' mean age (SD) was 17.71 (1.60) years, with more males (54%), of whom 52.9% had at least one PD, with depression (23.6%) and generalised anxiety disorder (18.0%) being the most prevalent. The externalising disorders were associated with being CIA (OR = 3.99; 95% CI:1.87–8.54), male gender (OR = 3.93; 95% CI:2.02–7.64), and a viral load of 400 and above copies (OR = 3.53; 95%CI:1.92–6.48). Internalising disorders were associated with being BIA (OR = 3.64; 95%; CI: 2.39–5.56), females (OR = 2.59; 95% CI:1.75–3.83), poor counselling (OR = 2.23; 95% CI: 1.42–3.51) and struggling to accept HIV status (OR = 1.73; 95% CI:1.14–2.62). Conclusions Depression and anxiety disorders were the most prevalent PDs in ALWHIV, who differed in psychiatric presentations, the BIAs being more likely to present with internalizing disorders, while the CIAs had more externalizing disorders. Due to the varying needs of ALWHIV, individualized management plans that consider gender, mode of infection, and other psycho-social needs, should be further studied and encouraged.

Emotional and behavioural difficulties among children and adolescents attending “ART teen clubs” in Mzuzu City in northern Malawi: a cross-sectional study

“…This finding is consistent with a previous study which reported that immunosuppression was associated with poor emotional and behavioural outcomes [45]. In a recent study done in Botswana, HIV congenitally infected adolescents were almost four times more likely to present with externalizing disorders like ADHD which may have occurred partly due to the effect of HIV on the brain [46] or immunosuppression resulting from prolonged period of poor ART adherence [47]. Researchers have found a strong association between externalizing disorders and viral load above 400 copies [46].…”

Emotional and behavioural difficulties among children and adolescents attending “ART Teen Clubs” in Mzuzu City in northern Malawi: A cross-sectional study

“…This nding is consistent with a previous study which reported that immunosuppression was associated with poor emotional and behavioural outcomes (54). In a recent study done in Botswana, HIV congenitally infected adolescents were almost four times more likely to present with externalizing disorders like ADHD which may have occurred partly due to the effect of HIV on the brain (55) or prolonged period of poor ART adherence (56). In a study by Van Rie, Harrington, Dow et al (2007) it was reported that HIV infection itself can lead to neurological sequala in children as a result of static or progressive encephalopathy which affects the development of the maturing brain (57).…”

“…In a study by Van Rie, Harrington, Dow et al (2007) it was reported that HIV infection itself can lead to neurological sequala in children as a result of static or progressive encephalopathy which affects the development of the maturing brain (57). Researchers have found a strong association between externalizing disorders and viral load above 400 copies (55). In another study children with low CD4 count <500 cells/mm 3 were more likely to develop emotional and behavioural di culties as compared to children with CD4 count >500 cells/mm 3 (p=0.015)(58).…”

Antiretroviral therapy non-adherence and its relationship with cognitive impairment, alcohol use disorder, and depression in adolescents living with HIV

“…The Socio-demographic subsection contained questions on issues such as participants’ age, religion, ethnicity, educational level and gender, and parent’s marital status. It included questions on the type and level of social support they had access to; clinical variables, such as mode of infection; age at first diagnosis (HIV), and current viral load, with other details having been reported previously [ 11 , 13 ].…”