Factors associated with depression among adolescents living with HIV in Malawi

BMC Psychiatry

Carla Sharp³  Peter N. Kazembe⁴  Saeed Ahmed¹  Chi Nguyen²  Akash Devandra¹  Xiaoying Yu²  Alick C. Mazenga⁴  Maria H. Kim⁴ 

[1] Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children’s Hospital, Houston, USA;Design and Analysis Core, Baylor-UT Houston Center for AIDS Research, Houston, TX, USA;Department of Psychology, University of Houston, Houston, TX, USA;Baylor College of Medicine Children’s Foundation Centre of Excellence Malawi, Private Bag B-397, Lilongwe 3, Malawi, Africa

关键词: Bullying;    Africa;    Adolescents;    HIV AIDS;    Mental health;    Depression;   

Others  :  1231562
DOI  :  10.1186/s12888-015-0649-9

 received in 2015-03-27, accepted in 2015-10-14,  发布年份 2015

【 摘 要 】

Background

Prior 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.

Methods

Depression 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.

Results

Of 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).

Conclusion

Having 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.

【 授权许可】

   
2015 Kim et al.

【 参考文献 】

• [1]UNICEF: Opportunity in Crisis Preventing HIV from Early Adolescence to young adulthood. UNICEF, In New York; 2011.
• [2]UNAIDS: Securing the Future Today Synthesis of Strategic Information on HIV and Young People. UNAIDS, In Geneva; 2011.
• [3]Dick B, Ferguson BJ: Health for the world's adolescents: a second chance in the second decade. J adolesc health : official publication of the Society for Adolescent Medicine 2015, 56(1):3-6.
• [4]Thapar A, Collishaw S, Pine DS, Thapar AK: Depression in adolescence. Lancet 2012, 379(9820):1056-1067.
• [5]Prinstein MJ, Boergers J, Vernberg EM: Overt and relational aggression in adolescents: Social-psychological adjustment of aggressors and victims. J Clin Child Psychol 2001, 30(4):479-491.
• [6]Casement MD, Guyer AE, Hipwell AE, McAloon RL, Hoffmann AM, Keenan KE, et al.: Girls' challenging social experiences in early adolescence predict neural response to rewards and depressive symptoms. Dev Cogn Neurosci 2014, 8:18-27.
• [7]Hawker DS, Boulton MJ: Twenty years' research on peer victimization and psychosocial maladjustment: a meta-analytic review of cross-sectional studies. J Child Psychol Psychiatry 2000, 41(4):441-455.
• [8]Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN: Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med 2004, 158(8):760-765.
• [9]Ward CL, Flisher AJ, Zissis C, Muller M, Lombard C: Exposure to violence and its relationship to psychopathology in adolescents. Inj Prev 2001, 7(4):297-301.
• [10]Kim J, Cicchetti D: Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children. Child Dev 2006, 77(3):624-639.
• [11]Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I: Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape. J Int AIDS Soc 2010, 13:44. BioMed Central Full Text
• [12]Rubin AG, Gold MA, Primack BA: Associations between depressive symptoms and sexual risk behavior in a diverse sample of female adolescents. J Pediatr Adolesc Gynecol 2009, 22(5):306-312.
• [13]Rudatsikira E, Muula AS, Siziya S, Twa-Twa J: Suicidal ideation and associated factors among school-going adolescents in rural Uganda. BMC Psychiatry 2007, 7:67. BioMed Central Full Text
• [14]Muula AS, Kazembe LN, Rudatsikira E, Siziya S: Suicidal ideation and associated factors among in-school adolescents in Zambia. Tanzan Health Res Bull 2007, 9(3):202-206.
• [15]Cluver L, Gardner F, Operario D: Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychol Psychiatry 2007, 48(8):755-763.
• [16]Ruiz-Casares M, Thombs BD, Rousseau C: The association of single and double orphanhood with symptoms of depression among children and adolescents in Namibia. Eur Child Adolesc Psychiatry 2009, 18(6):369-376.
• [17]Suliman S, Mkabile SG, Fincham DS, Ahmed R, Stein DJ, Seedat S: Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Compr Psychiatry 2009, 50(2):121-127.
• [18]WHO: The World Health Report 2001: Mental Health: new understanding, new hope. World Health Organization, In. Geneva; 2001.
• [19]WHO: Global Burden of Disease, 2004 Update. World Health Organization, In. Geneva; 2008.
• [20]World Federation for Mental Health. An International Mental Health Awareness Packet from the WFMH Africa Initiative on Mental Health and HIV/AIDS. In: HIV/AIDS and Depression in Africa. Woodbridge, VA; 2009: 46.
• [21]Gupta RD, Packel M, Rutherford L, Leiter G, Phaladze K, Korte N, et al.: Depression and HIV in Botswana: a population-based study on gender-specific socioeconomic and behavioral correlates. PLoS One 2010., 5(12) Article ID e14252
• [22]Nakasujja N, Skolasky RL, Musisi S, Allebeck P, Robertson K, Ronald A, et al.: Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda. BMC Psychiatry 2010, 10:44. BioMed Central Full Text
• [23]Mwale C, Stewart R, Mathanga D: The prevalence of psychological distress and associated factors among people living with Aids attending antiretroviral therapy clinics in Mzuzu, Malawi: A cross sectional descriptive study. Typescript . University of Malawi College of Medicine, Blantyre; 2006.
• [24]Traube D, Dukay V, Kaaya S, Reyes H, Mellins C: Cross-cultural adaptation of the Child Depression Inventory for use in Tanzania with children affected by HIV. Vulnerable Child Youth Student Studies 2010, 5(2):174-187.
• [25]Kamau JW, Kuria W, Mathai M, Atwoli L, Kangethe R: Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community. AIDS Care 2012, 24(7):836-842.
• [26]Kim MH, Mazenga AC, Devandra A, Ahmed S, Kazembe PN, Yu X, et al.: Prevalence of depression and validation of the Beck Depression Inventory-II and the Children's Depression Inventory-Short amongst HIV-positive adolescents in Malawi. J Int AIDS Soc 2014, 17:18965.
• [27]Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S: Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS 2008, 22(2):147-158.
• [28]Kaharuza FM, Bunnell R, Moss S, Purcell DW, Bikaako-Kajura W, Wamai N, et al.: Depression and CD4 cell count among persons with HIV infection in Uganda. AIDS Behav 2006, 10(4 Suppl):S105-S111.
• [29]Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V: Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district, Uganda. BMC Psychiatry 2011, 11(205):11-205.
• [30]Klis S, Velding K, Gidron Y, Peterson K: Posttraumatic stress and depressive symptoms among people living with HIV in the Gambia. AIDS Care 2011, 23(4):426-434.
• [31]Farinpour R, Miller EN, Satz P, Selnes OA, Cohen BA, Becker JT: Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol 2003, 25(5):654-670.
• [32]Cruess DG, Petitto JM, Leserman J, Douglas SD, Gettes DR, Ten Have TR: Depression and HIV infection: impact on immune function and disease progression. CNS Spectr 2003, 8(1):52-58.
• [33]Treisman GJ, Angelino AF, Hutton HE: Psychiatric issues in the management of patients with HIV infection. JAMA 2001, 286(22):2857-2864.
• [34]Holzemer WLC, Nokes IB, Turner KM, Brown JG, Powell-Cope MA, Inouye GM, et al.: Predictors of self-reported adherence in persons living with HIV disease. AIDS Patient Care STDS 1999, 13(3):185-197.
• [35]Gonzalez JS, Batchelder AW, Psaros C, Safren SA: Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr 2011, 58(2):181-187.
• [36]Malawi: HIV and AIDS estimates (2013). http://www.unaids.org/en/regionscountries/countries/malawi webcite
• [37]Malawi Ministry of Health. Government of Malawi Ministry of Health Integrated HIV Program Report January -March 2014. In Lilongwe: Ministry of Health; 2014: 60.
• [38]Beck A, Steer RA, Brown, GK: RCMAR Measurement Tools: Beck Depression Inventory - 2nd Edition (BDI-II). 2006. Available from:. http://academicdepartments.musc.edu/family_medicine/rcmar/beck.htm webcite
• [39]Adewuya AO, Ola BA, Aloba OO: Prevalence of major depressive disorders and a validation of the Beck Depression Inventory among Nigerian adolescents. Eur Child Adolesc Psychiatry 2007, 16(5):287-292.
• [40]Basker MM, Russell PS, Russell S, Moses PD: Validation of the children's depression rating scale- revised for adolescents in primary-care pediatric use in India. Indian J Med Sci 2010, 64(2):72-80.
• [41]Rivera CL, Bernal G, Rossello J: The Chidlren Depression Inventory (CDI) and the Beck Depression Inventory (BDI): Their Validity as Acreening Measures for Major Depression in a group of Puerto Rican Adolescents. International Journal of Clinical and Helath Psychology 2005, 5(3):485-498.
• [42]Mayes TL, Bernstein IH, Haley CL, Kennard BD, Emslie GJ: Psychometric properties of the Children's Depression Rating Scale-Revised in adolescents. J Child Adolesc Psychopharmacol 2010, 20(6):513-516.
• [43]Children's Depression Inventory – Second Edition (CDI-2) [Internet] Toronto. Multi Health Systems Inc. 2004. Available from:. http://www.mhs.com/product.aspx?gr=edu&prod=cdi2&id=overview#scales webcite
• [44]Plener PL, Grieb J, Sprober N, Straub J, Schneider A, Keller F, et al.: Convergence of children’s depression rating scale-revised scores and clinical diagnosis in rating adolescent depressive symptomatology. Ment Illn 2012, 4(1):29-31.
• [45]Zalsman G, Misgav S, Sommerfeld E, Kohn Y, Brunstein-Klomek A, Diller R, et al.: Children’s Depression Inventory (CDI) and the Children’s Depression Rating Scale-Revised (CDRS-R): Reliability of the Hebrew version. Int J Adolesc Med Health 2011, 17(3):255-257.
• [46]Jain S, Carmody TJ, Trivedi MH, Hughes C, Bernstein IH, Morris DW, et al.: A psychometric evaluation of the CDRS and MADRS in assessing depressive symptoms in children. J Am Acad Child Adolesc Psychiatry 2007, 46(9):1204-1212.
• [47]Mellins CA, Malee KM: Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc 2013, 16:18593.
• [48]Wood SM, Shah SS, Steenhoff AP, Rutstein RM: The impact of AIDS diagnoses on long-term neurocognitive and psychiatric outcomes of surviving adolescents with perinatally acquired HIV. AIDS (London, England) 2009, 23(14):1859-1865.
• [49]Boivin MJ, Green SD, Davies AG, Giordani B, Mokili JK, Cutting WA: A preliminary evaluation of the cognitive and motor effects of pediatric HIV infection in Zairian children. Health psychol : official journal of the Division of Health Psychology, American Psychological Association 1995, 14(1):13-21.
• [50]Drotar D, Olness K, Wiznitzer M, Schatschneider C, Marum L, Guay L, et al.: Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis. Health psychol : official journal of the Division of Health Psychology, American Psychological Association 1999, 18(2):114-121.
• [51]Nozyce ML, Lee SS, Wiznia A, Nachman S, Mofenson LM, Smith ME, et al.: A behavioral and cognitive profile of clinically stable HIV-infected children. Pediatrics 2006, 117(3):763-770.
• [52]Misdrahi D, Vila G, Funk-Brentano I, Tardieu M, Blanche S, Mouren-Simeoni MC: DSM-IV mental disorders and neurological complications in children and adolescents with human immunodeficiency virus type 1 infection (HIV-1). Eur psychiatry : the journal of the Association of European Psychiatrists 2004, 19(3):182-184.
• [53]Elliott-DeSorbo DK, Martin S, Wolters PL: Stressful life events and their relationship to psychological and medical functioning in children and adolescents with HIV infection. J Acquir Immune Defic Syndr 2009, 52(3):364-370.
• [54]Wiener LS, Battles HB: Untangling the web: A close look at diagnosis disclosure among HIV-infected adolescents. J Adolesc Health 2006, 38(3):307-309.
• [55]Arseneault L, Bowes L, Shakoor S: Bullying victimization in youths and mental health problems: 'much ado about nothing'? Psychol Med 2010, 40(5):717-729.
• [56]Kumar SP, Dandona R, Kumar GA, Ramgopal S, Dandona L: Depression among AIDS-orphaned children higher than among other orphaned children in southern India. Int j ment heal systs 2014, 8:13. BioMed Central Full Text
• [57]Boyes ME, Cluver LD: Relationships Between Familial HIV/AIDS and Symptoms of Anxiety and Depression: The Mediating Effect of Bullying Victimization in a Prospective Sample of South African Children and Adolescents. J Youth Adolesc 2014, 44(4):847-859.