Institute for Global Health, University College London, London, UK.
Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
AIDS Behav. 2021 Jul;25(7):2094-2107. doi: 10.1007/s10461-020-03138-z. Epub 2021 Jan 15.
Adolescent (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.
青少年(10-19 岁)的心理健康仍然是一个被忽视的全球健康问题。撒哈拉以南非洲地区的青少年怀孕率是世界上最高的,而这些地区也是全球艾滋病毒流行的中心。分别研究发现,经历青少年怀孕和感染艾滋病毒都与不良心理健康结果有关。心理健康状况不佳可能对父母和孩子都有影响。关于同时感染艾滋病毒和经历青少年怀孕的人群的心理健康问题的文献尚未得到总结。本系统评价旨在确定:(1) 撒哈拉以南非洲地区感染艾滋病毒并经历过怀孕(包括青少年父亲)的青少年中常见精神障碍的流行/发生率;(2) 该人群中常见精神障碍的风险和保护因素;(3) 该人群中常见精神障碍的干预措施(预防/治疗)。2020 年 9 月,使用预先定义的搜索词对电子数据库进行了系统搜索,并辅以手工搜索。一位作者和一位独立研究人员完成了对搜索结果的标题和摘要筛选。对所有看似相关的手稿(定量和定性)进行了全文搜索,并使用预先确定的标准提取数据。提供了纳入研究的叙述性综合。使用纽卡斯尔-渥太华量表评估纳入研究的质量和偏倚风险。系统的关键词搜索数据库并进行后续手工搜索,共确定了 2287 条独特记录。其中,对 38 篇全文定量记录和 7 篇全文定性记录进行了资格评估。没有定性记录符合本综述的纳入标准。只有一篇定量记录被确定为符合纳入条件。这项研究报告了肯尼亚 14 名感染艾滋病毒的怀孕青少年的抑郁症状,发现患病率为 92.9%。这项包括研究没有达到本综述的高质量方法学标准。没有研究报告常见精神障碍的风险和保护因素,也没有研究发现针对该人群的任何特定的常见精神障碍干预措施,无论是预防还是治疗。本综述中确定的有限数据没有提供关于撒哈拉以南非洲地区感染艾滋病毒并经历过怀孕的青少年中常见精神障碍流行的高质量证据。没有关于该人群心理困扰的风险和保护因素或干预措施的数据。本系统评价确定了需要针对感染艾滋病毒的怀孕和育儿青少年的心理健康问题提供严格的证据,并呼吁对现有数据进行深入研究,以进一步了解该人群的需求。关于这一主题(定量和定性)的研究缺失是一个关键的证据空白,限制了基于证据的政策和方案应对,以及区域发展机会。
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