Shenderovich Yulia, Boyes Mark, Esposti Michelle Degli, Casale Marisa, Toska Elona, Roberts Kathryn J, Cluver Lucie
Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia.
BMC Public Health. 2021 Jan 20;21(1):172. doi: 10.1186/s12889-020-10147-z.
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.
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.
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.
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.
心理健康问题可能会影响抗逆转录病毒治疗的依从性、持续接受治疗的情况，进而影响感染艾滋病毒青少年的生存。青少年与照顾者的关系是恢复力的一个重要潜在来源。然而，撒哈拉以南非洲地区缺乏关于青少年与照顾者关系的哪些方面能够促进感染艾滋病毒青少年心理健康的纵向研究。我们利用在南非进行的一项前瞻性纵向队列研究来解决这个问题。
该研究追踪了东开普省一个卫生区内在政府卫生设施中开始接受抗逆转录病毒治疗的10至19岁青少年（n = 53）。这些青少年在2014年至2018年期间的三次数据收集浪潮中完成了标准化问卷。我们使用组内-组间多层回归来检验青少年与照顾者关系的三个方面（照顾者监督、积极的照顾行为以及青少年与照顾者的沟通）与青少年心理健康（抑郁症状和焦虑症状）之间的联系，同时控制潜在的混杂因素（年龄、性别、农村/城市居住情况、感染方式、家庭资源），n = 926名青少年。
照顾者监督的改善与焦虑症状的减轻相关（0.98，95%置信区间0.97 - 0.99，p = 0.0002），但与抑郁症状无关（0.99，95%置信区间0.98 - 1.00，p = 0.151），而积极照顾行为的变化与青少年报告的心理健康症状变化无关。随着时间推移，青少年与照顾者沟通的改善与青少年报告的抑郁症状（发病率比值比 = 0.94，95%置信区间0.92 - 0.97，p < 0.0001）和焦虑症状（0.91，95%置信区间0.89 - 0.94，p < 0.0001）的减轻相关。
研究结果强调了开放且支持性的青少年与照顾者沟通以及良好的照顾者监督是南非感染艾滋病毒青少年预防心理健康问题的潜在因素。一些基于证据的育儿项目旨在改善青少年与照顾者的沟通以及照顾者监督，其对感染艾滋病毒青少年抑郁和焦虑的影响应在撒哈拉以南非洲地区进行严格测试。还应考虑如何在其他环境（如学校和诊所）中改善沟通，并通过这些现有服务为照顾者、青少年和服务提供者提供沟通支持。
