Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community

Abstract

The course of HIV/AIDS in children has been transformed from an acute to a chronic one with the advent of Anti-Retroviral Therapy. The aim of this study was to determine the prevalence and pattern of psychiatric morbidity in HIV-infected children and adolescents between 6 and 18 years of age and the relationship between their socio-demographic factors, immune suppression and psychiatric morbidity. The study was conducted at a paediatric HIV clinic in Nairobi, between February and April 2010. One hundred and sixty-two HIV-infected children and adolescents aged between 6 and 18 years and their guardians were interviewed. Seventy-nine (48.8%) of the study participants were found to have psychiatric morbidity. The most prevalent Diagnostic Statistical Manual, 4th Edition TR psychiatric disorders were: Major depression (17.8%), Social phobia (12.8%), Oppositional Defiant Disorder (12.1%) and Attention Deficit Hyperactivity Disorder (12.1%). Twenty-five per cent of the study participants had more than one psychiatric disorder. The prevalence of psychiatric morbidity in HIV-infected children is higher than that found in children in the general population. There is therefore a need to integrate psychiatric services into the routine care of HIV-infected children.

Growing up HIV-positive in Uganda: “psychological immunodeficiency”? A qualitative study

“…The lack of stability in care environment and shortcomings in the emotional support to these adolescents are detrimental for their well-being and seem a risk factor for the development of mental disorders as they could not develop sufficient psychological resilience. Confronted with the findings of Musisi & Kinyanda [10] and Kamau et al [11], who find approximately half of the children and adolescents with HIV displaying psychological distress above threshold, it seems worthwhile to focus on the care environment as possible arena for the development of a vulnerability for mental disorder. According to Kemph & Voeller [37] it is unlikely that the diagnosis of Reactive Attachment Disorder (RAD) "…can be made in the absence of comorbid diagnoses in adolescence because these children usually have symptoms which meet the criteria for other diagnoses, such as attention deficit disorder (ADHD), post-traumatic stress disorder (PTSD), oppositional defiant disorder (ODD), mood disorder, or conduct disorder (CD) by the time they become early or mid-adolescent ages.…”

“…The most common diagnoses were depression, anxiety and somatisation. In a more recent Kenyan study, Kamau and colleagues [11] reported a rate of 48.8% for at least one psychiatric disorder with the most reported psychiatric disorders being depression, social phobia, oppositional defiant disorder and attention deficit hyperactivity disorder.…”

HIV-1 proteins accelerate HPA axis habituation in female rats

“…However, individuals living with HIV have a higher incidence of stress-associated disorders. The development of these disorders has been proposed to be due to the psychosocial burden that is associated with the diagnosis of HIV positive status (Lichtenstein, Laska et al 2002), stress stemming from occupational-related problems, lack of social support, cultural biases associated with infection, and/or resource-poor environments (Brown 2001; Wohl, Galvan et al 2010; Kamau, Kuria et al 2012). It is estimated that 30 - 50% of people living with HIV have a stress-related mood disorder such as depression, compared to only 6.5% of the general population (Hinkin, Castellon et al 2002; Lopes, Olfson et al 2012).…”

Psychosocial issues among children and adolescents in an integrated paediatric HIV psychology service in Botswana

“…Addressing the interplay of mental health and adherence during adolescence will be important to the long term health of Botswana's HIV-positive population. The Kenyan-based study reported by Kamau et al (2012) also found that anxiety disorders and depression were the most common psychological disorders for children and adolescents with HIV. Given that many behavioural and educational problems can be a manifestation of depression or anxiety, it is not surprising that these were common issues in our sample.…”

“…Due to limited staffing resources, this psychology service used a referral system rather than screening all clinic children. A Kenyan clinic-based study (Kamau, Kuria, Mathai, Atwoli, & Kangethe, 2012) screened a purposive sample of 162 HIV-positive children aged 6-18 years for psychiatric morbidities using the Mini International Neuropsychiatric Interview (MINI) and 49% of the children had at least one psychiatric disorder. Their higher proportion of pathology could be attributed to their purposive sampling method, medical provider unawareness for conditions that warrant referral for psychotherapy at the clinic, and limited staffing resources at the clinic.…”