Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder

AbstractThe mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher’s exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral.

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Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

AIDS and Behavior ◽

10.1007/s10461-020-03138-z ◽

2021 ◽

Author(s):

Kathryn J. Roberts ◽

Colette Smith ◽

Lucie Cluver ◽

Elona Toska ◽

Lorraine Sherr

Keyword(s):

Mental Health ◽

Systematic Review ◽

Mental Disorder ◽

Protective Factors ◽

Adolescent Pregnancy ◽

Common Mental Disorder ◽

Risk And Protective Factors ◽

Sub Saharan Africa ◽

Sub Saharan ◽

Living With Hiv

AbstractAdolescent (10–19 years) mental health remains an overlooked global health issue. Rates of adolescent pregnancy within sub-Saharan Africa are some of the highest in the world and occur at the epicentre of the global HIV epidemic. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with adverse mental health outcomes, when investigated separately. Poor mental health may have implications for both parent and child. The literature regarding mental health within groups experiencing both HIV and adolescent pregnancy is yet to be summarised. This systematic review sought to identify (1) the prevalence/occurrence of common mental disorder amongst adolescents who are living with HIV and have experienced pregnancy, (inclusive of adolescent fathers) in sub-Saharan Africa (2) risk and protective factors for common mental disorder among this group, and (3) interventions (prevention/treatment) for common mental disorder among this group. A systematic search of electronic databases using pre-defined search terms, supplemented by hand-searching, was undertaken in September 2020. One author and an independent researcher completed a title and abstract screening of results from the search. A full-text search of all seemingly relevant manuscripts (both quantitative and qualitative) was undertaken and data extracted using pre-determined criteria. A narrative synthesis of included studies is provided. Quality and risk of bias within included studies was assessed using the Newcastle-Ottawa scale. A systematic keyword search of databases and follow-up hand searching identified 2287 unique records. Of these, thirty-eight full-text quantitative records and seven full-text qualitative records were assessed for eligibility. No qualitative records met the eligibility criteria for inclusion within the review. One quantitative record was identified for inclusion. This study reported on depressive symptomology amongst 14 pregnant adolescents living with HIV in Kenya, identifying a prevalence of 92.9%. This included study did not meet the high methodological quality of this review. No studies were identified reporting on risk and protective factors for common mental disorder, and no studies were found identifying any specific interventions for common mental disorder for this group, either for prevention or for treatment. The limited data identified within this review provides no good quality evidence relating to the prevalence of common mental disorder among adolescents living with HIV who have experienced pregnancy in sub-Saharan Africa. No data was available relating to risk and protective factors or interventions for psychological distress amongst this group. This systematic review identifies a need for rigorous evidence regarding the mental health of pregnant and parenting adolescents living with HIV, and calls for granular interrogation of existing data to further our understanding of the needs of this group. The absence of research on this topic (both quantitative and qualitative) is a critical evidence gap, limiting evidence-based policy and programming responses, as well as regional development opportunities.

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Relationships with caregivers and mental health outcomes among adolescents living with HIV: a prospective cohort study in South Africa

BMC Public Health ◽

10.1186/s12889-020-10147-z ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yulia Shenderovich ◽

Mark Boyes ◽

Michelle Degli Esposti ◽

Marisa Casale ◽

Elona Toska ◽

...

Keyword(s):

Mental Health ◽

South Africa ◽

Cohort Study ◽

Mental Health Problems ◽

Health Problems ◽

Sub Saharan Africa ◽

Depression Symptoms ◽

Sub Saharan ◽

Positive Caregiving ◽

Living With Hiv

Abstract Background Mental health problems may impact adherence to anti-retroviral treatment, retention in care, and consequently the survival of adolescents living with HIV. The adolescent-caregiver relationship is an important potential source of resilience. However, there is a lack of longitudinal research in sub-Saharan Africa on which aspects of adolescent-caregiver relationships can promote mental health among adolescents living with HIV. We draw on a prospective longitudinal cohort study undertaken in South Africa to address this question. Methods The study traced adolescents aged 10–19 initiated on antiretroviral treatment in government health facilities (n = 53) within a health district of the Eastern Cape province. The adolescents completed standardised questionnaires during three data collection waves between 2014 and 2018. We used within-between multilevel regressions to examine the links between three aspects of adolescent-caregiver relationships (caregiver supervision, positive caregiving, and adolescent-caregiver communication) and adolescent mental health (depression symptoms and anxiety symptoms), controlling for potential confounders (age, sex, rural/urban residence, mode of infection, household resources), n=926 adolescents. Results Improvements in caregiver supervision were associated with reductions in anxiety (0.98, 95% CI 0.97–0.99, p=0.0002) but not depression symptoms (0.99, 95% CI 0.98–1.00, p=.151), while changes in positive caregiving were not associated with changes in mental health symptoms reported by adolescents. Improvements in adolescent-caregiver communication over time were associated with reductions in both depression (IRR=0.94, 95% CI 0.92–0.97, p<.0001) and anxiety (0.91, 95% CI 0.89–0.94, p<.0001) symptoms reported by adolescents. Conclusions Findings highlight open and supportive adolescent-caregiver communication and good caregiver supervision as potential factors for guarding against mental health problems among adolescents living with HIV in South Africa. Several evidence-informed parenting programmes aim to improve adolescent-caregiver communication and caregiver supervision, and their effect on depression and anxiety among adolescents living with HIV should be rigorously tested in sub-Saharan Africa. How to improve communication in other settings, such as schools and clinics, and provide communication support for caregivers, adolescents, and service providers through these existing services should also be considered.

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Associations between common mental disorders and the Mental Illness Needs Index in community settings

The British Journal of Psychiatry ◽

10.1192/bjp.bp.106.027458 ◽

2007 ◽

Vol 191 (2) ◽

pp. 158-163 ◽

Cited By ~ 13

Author(s):

David L. Fone ◽

Frank Dunstan ◽

Ann John ◽

Keith Lloyd

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorders ◽

Mental Disorder ◽

Small Area ◽

Common Mental Disorders ◽

Common Mental Disorder ◽

Service Planning ◽

Individual Risk ◽

Community Settings

BackgroundThe relationship between the Mental Illness Needs Index (MINI) and the common mental disorders is not known.AimsTo investigate associations between the small-area MINI score and common mental disorder at individual level.MethodMental health status was measured using the Mental Health Inventory of the Short Form 36 instrument (SF-36). Data from the Caerphilly Health and Social Needs population survey were analysed in multilevel models of 10 653 individuals aged 18–74 years nested within the 2001 UK census geographies of 110 lower super output areas and 33 wards.ResultsThe MINI score was significantly associated with common mental disorder after adjusting for individual risk factors. This association was stronger at the smaller spatial scale of the lower super output area and for individuals who were permanently sick or disabled.ConclusionsThe MINI is potentially useful for small-area needs assessment and service planning for common mental disorder in community settings.

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Cancer in HIV-positive and HIV-negative adolescents and young adults in South Africa: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-043941 ◽

2021 ◽

Vol 11 (10) ◽

pp. e043941

Author(s):

Tafadzwa Dhokotera ◽

Julia Bohlius ◽

Matthias Egger ◽

Adrian Spoerri ◽

Jabulani Ronnie Ncayiyana ◽

...

Keyword(s):

South Africa ◽

Young Adults ◽

Cross Sectional Study ◽

Adolescents And Young Adults ◽

Hiv Positive ◽

Sectional Study ◽

Hiv Status ◽

Cross Sectional ◽

Laboratory Service ◽

Living With Hiv

ObjectiveTo determine the spectrum of cancers in adolescents and young adults (AYAs) living with and without HIV in South Africa.DesignCross-sectional study with cancer records provided by the National Cancer Registry (NCR) and HIV records from the National Health Laboratory Service (NHLS).Setting and participantsThe NHLS is the largest provider of pathology services in the South African public sector. The NCR is a division of the NHLS. We included AYAs (aged 10–24 years) diagnosed with cancer by public health sector laboratories between 2004 and 2014 (n=8479). HIV status was obtained through record linkages and text mining.Primary and secondary outcomesWe determined the spectrum of cancers by HIV status in AYAs. We used multivariable logistic regression to describe the association of cancer in AYAs with HIV, adjusting for age, sex, ethnicity and calendar period. We imputed (post hoc) the HIV status for AYA with unknown HIV status.Results8479 AYAs were diagnosed with cancer, HIV status was known for 45% (n=3812). Of those whose status was known, about half were HIV positive (n=1853). AYAs living with HIV were more likely to have Kaposi’s sarcoma (adjusted OR (aOR) 218, 95% CI 89.9 to 530), cervical cancer (aOR 2.18, 95% CI 1.23 to 3.89), non-Hodgkin’s lymphoma (aOR 2.12, 95% CI 1.69 to 2.66) and anogenital cancers other than cervix (aOR 2.73, 95% CI 1.27 to 5.86) than AYAs without HIV. About 44% (n=1062) of AYAs with HIV-related cancers had not been tested for HIV.ConclusionsTargeted HIV testing for AYAs diagnosed with cancer, followed by immediate start of antiretroviral therapy, screening for cervical precancer and vaccination against human papilloma virus is needed to decrease cancer burden in AYAs living with HIV in South Africa.

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THE THORNY ISSUE OF STATUS DISCLOSURE TO CHILDREN LIVING WITH HIV: THE CASE OF HIV POSITIVE CHILDREN LIVING IN A CHILD AND YOUTH CARE FACILITY IN JOHANNESBURG, SOUTH AFRICA

SOUTHERN AFRICAN JOURNAL OF SOCIAL WORK AND SOCIAL DEVELOPMENT ◽

10.25159/2415-5829/1350 ◽

2016 ◽

Vol 28 (1) ◽

pp. 53-68

Author(s):

Nkosiyazi Dube ◽

Linda Harms Smith

Keyword(s):

South Africa ◽

Social Service ◽

Youth Care ◽

Hiv Positive ◽

Hiv Status ◽

Service Workers ◽

Child And Youth Care ◽

Living With Hiv ◽

Status Disclosure ◽

Hiv Aids

There is a dilemma regarding HIV/AIDS disclosure to children born and living with HIV/AIDS in residential settings. Since the advent and accessibility of Anti-Retroviral Therapy, most children born HIV positive live longer and have healthier lives. Some of these children find themselves in Need of Care due to abandonment, orphanhood and neglect or abuse, and are placed in alternative care such as a Child and Youth Care Centre (CYCC). Social Service Workers are then faced with this dilemma around disclosure of their HIV status, due to the complexities around the consequences of such a disclosure, and the absence of clear policies in this regard. The study explored the perceptions of social service workers regarding disclosure of HIV status to children born HIV positive living in a CYCC in Ekurhuleni, South Africa. The findings indicate that HIV status disclosure is a complex but essential process as it reinforces children’s ability to adhere to medication and dispels anxiety and suspicion within themselves around their status. Recommendations relate to community education and awareness programmes, policy and practice changes and makes suggestions for future research.

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Photovoice as a Social Transformative Tool: Unpacking the Experiences of Immigrants and Refugees Living with HIV in Canada

11th GLOBAL CONFERENCE ON BUSINESS AND SOCIAL SCIENCES - Global Conference on Business and Social Sciences Proceeding ◽

10.35609/gcbssproceeding.2021.12(97) ◽

2021 ◽

Vol 12 (1) ◽

pp. 97-97

Author(s):

Dr. Rita Dhungel

Keyword(s):

Mental Health ◽

Service Providers ◽

Rapid Response ◽

Health Coverage ◽

Hiv Status ◽

Mental Health Needs ◽

Community Based ◽

Immigrants And Refugees ◽

Financial Difficulties ◽

Living With Hiv

1026 immigrants and refugees tested positive for HIV (IRLWH) in Canada in 2018 (Haddad, et al, 2019). IRLWH experience discriminatory behaviors because of because of the immigration and HIV status; culturally appropriate supports and resources for IRLWH are lacking. Financial difficulties are experienced by many new immigrants, they may be unable to meet their health care or mental health needs, particularly if they are IRLWH (Chen et al., 2015). Language barriers, loss of social support and a lack of health coverage can impact the ability for IRLWH to access care (Rapid Response Service, 2014). There can be stigma surrounding HIV within the cultural community, impacting the level of support for IRLWH (Rapid Response Service, 2014). IRLWH experience mistreatment by service providers, lack of culturally and linguistically appropriate services, lack of awareness of local programs, unemployment and housing issues in Canada (Chen et al., 2015; Gatteri et al., 2020). To augment the limited extant knowledge on the challenges of IRLWH and based on the implications of a study that claimed the need for a further research exploring the voices of IRLWH using photovoice (Getteri, et.al., 2020), this community based photovoice study was designed with an aim to understand intersectional oppressions experienced by IRLWH across Alberta in general, with a focus on the COVID-19 pandemic in particular from determinants of health perspectives. Keywords: Immigrants and Refugees; HIV, Photovoice, Intersectional Violence, Mental Health

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Attitudinal and demographic factors associated with seeking help and receiving antidepressant medication for symptoms of common mental disorder

BMC Psychiatry ◽

10.1186/s12888-020-02971-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Elena A. Manescu ◽

Emily J. Robinson ◽

Claire Henderson

Keyword(s):

Mental Health ◽

Mental Illness ◽

Mental Disorder ◽

Mental Health Problem ◽

Health Problem ◽

Help Seeking ◽

Common Mental Disorder ◽

General Health Questionnaire ◽

Seeking Help ◽

Positive Effect

Abstract Background Despite the increased attention given to improvement of mental health-related knowledge and attitudes, rates of help-seeking for mental illness remain low even in countries with well-developed mental health services. This study examines the relationships between attitudes to mental illness, symptoms of common mental disorder and seeking-help and receiving medication for a mental health problem. Methods We used data from the nationally representative Health Survey for England 2014 to design three logistic regression models to test for the effects of attitudes to mental illness (measured by a shortened version of the Community Attitudes toward the Mentally Ill, CAMI scale) on: recent contact with a doctor for a mental health problem; use of any type of mental health service in the last 12 months; and having antidepressants currently prescribed, while controlling for symptoms of common mental disorder (measured by the General Health Questionnaire, GHQ). We also tested for an interaction between attitudes to mental illness and symptoms of common mental disorder on the outcomes. Results A significant but very small effect of CAMI score was found on ‘antidepressants currently prescribed’ model (OR = 1.01(1.00, 1.02) but not on the two indicators of help-seeking. We also found a significant but very small interaction between CAMI and GHQ scores on recent contact with a doctor (OR = 0.99, 95% CI (0.990, 0.998); adjusted Wald test P = 0.01)). Knowing someone with a mental illness had a significant positive effect on help-seeking indicated by: (a) recent contact with a doctor (2.65 (1.01, 6.98)) and (b) currently prescribed antidepressant (2.67 (1.9, 3.75)) after controlling for attitudes to mental illness. Conclusions Our results suggest that knowing someone with a mental health problem seems to have a further positive effect on help-seeking, beyond improving attitudes to mental illness. Furthermore, multiple different types and aspects of stigma may contribute to help-seeking behaviours, consequently multi-faceted approaches are likely to be most efficient.

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Trends in mental health, non‐suicidal self‐harm and suicide attempts in 16–24-year old students and non-students in England, 2000–2014

Social Psychiatry and Psychiatric Epidemiology ◽

10.1007/s00127-019-01797-5 ◽

2019 ◽

Vol 55 (1) ◽

pp. 125-128 ◽

Cited By ~ 2

Author(s):

S. McManus ◽

D. Gunnell

Keyword(s):

Mental Health ◽

Young People ◽

Mental Disorder ◽

Suicide Attempts ◽

Common Mental Disorder ◽

Psychiatric Morbidity ◽

Female Students ◽

Self Harm ◽

Using Data ◽

Over Time

Abstract There are concerns about high levels of mental ill-health amongst university students, but little is known about the mental health of students compared to non-students over time. Using data on young people (16–24) from three UK National Psychiatric Morbidity Surveys (2000, 2007, and 2014), we found no evidence that the overall prevalence of common mental disorder (CMD), suicide attempts, or non-suicidal self-harm (NSSH) differed between students and non-students, although there was an indication that CMDs rose markedly in female students between 2007 and 2014. A rise in NSSH is apparent in both students and non-students.

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Gender differences in mental health expectancies in early- and midlife in six European countries

The British Journal of Psychiatry ◽

10.1192/bjp.bp.111.107003 ◽

2013 ◽

Vol 202 (4) ◽

pp. 294-300 ◽

Cited By ~ 6

Author(s):

Traolach S. Brugha ◽

Ruth Matthews ◽

Jordi Alonso ◽

Gemma Vilagut ◽

Tony Fouweather ◽

...

Keyword(s):

Mental Health ◽

Gender Differences ◽

Mental Disorders ◽

Life Expectancy ◽

Mental Disorder ◽

Common Mental Disorders ◽

Common Mental Disorder ◽

Mortality Data ◽

Male Population ◽

Female Population

BackgroundHealth expectancies, taking into account both quality and quantity of life, have generally been based on disability and physical functioning.AimsTo compare mental health expectancies at age 25 and 55 based on common mental disorders both across countries and between males and females.MethodMental health expectancies were calculated by combining mortality data from population life tables and the age-specific prevalence of selected common mental disorders obtained from the European Study of the Epidemiology of Mental Disorders (ESEMeD).ResultsFor the male population aged 25 (all countries combined) life expectancy was 52 years and life expectancy spent with a common mental disorder was 1.8 years (95% CI 0.7-2.9),3.4% of overall life expectancy. In comparison, for the female population life expectancy at age 25 was higher (57.9 years) as was life expectancy spent with a common mental disorder (5.1 years, 95% CI 3.6-6.6) and as a proportion of overall life expectancy, 8.8%. By age 55 life expectancy spent with a common mental disorder had reduced to 0.7 years (males) and 2.3 years (females).ConclusionsAge and gender differences underpin our understanding of years spent with common mental disorders in adulthood. Greater age does not mean living relatively more years with common mental disorder. However, the female population spends more years with common mental disorders and a greater proportion of their longer life expectancy with them (and with each studied separate mental disorder).

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