KEMRI-Wellcome Trust Research Programme, Centre for Geographic Medicine Research (Coast), KEMRI, Box 230, Kilifi, Kenya.
Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
BMC Psychiatry. 2021 Feb 10;21(1):90. doi: 10.1186/s12888-021-03079-4.
In sub-Saharan Africa, common mental disorders (CMDs) like depression and anxiety are under-investigated amongst young people living with HIV (YLWH). To address the gap, in Kenya we: a) determined the prevalence of CMDs among YLWH compared to their uninfected peers; b) investigated HIV status as an independent predictor of CMDs in young people; c) investigated CMDs risk and protective indicators with more focus on YLWH.
Between November 2018 and September 2019, 819 young people aged 18-24 years (407 HIV-infected) were recruited from two Counties on the Kenyan coast. Locally adapted pre-existing mental health measures, Patient Health Questionnaire (9-item) and Generalized Anxiety Disorder scale (7-item), were administered among other questionnaires via audio computer-assisted self-interview. Logistic regression was used to determine the correlates of CMDs.
Prevalence of CMDs was significantly elevated among YLWH compared to their uninfected peers i.e. 29% vs. 12%; p < 0.001 for depressive symptoms, 19% vs. 8%; p < 0.001 for anxiety symptoms, and 16% vs. 5%; p < 0.001 for comorbid depressive and anxiety symptoms. HIV status independently predicted depressive symptoms and its co-occurrence with anxiety symptoms. Among YLWH, negative life events, higher perceived HIV-related stigma and low adherence to antiretroviral therapy were the risk indicators for elevated CMDs. Among HIV-uninfected youths, death of both parents was a risk indicator for elevated depressive symptoms. Protective indicators against CMDs among youths with and without HIV included higher social support and health-related quality of life.
At the Kenyan coast, YLWH have significantly higher burden of CMDs compared to their uninfected peers. Being HIV-positive as a youth in this setting is predictive of more depressive symptoms and its comorbidity with anxiety symptoms. YLWH at high risk of CMDs in coastal Kenya can benefit from early detection, referral and treatment if routine screening for CMDs is integrated in their care package. The mental wellbeing of bereaving HIV-unaffected youths could be improved through continued support to help them come to terms with their loss. At the community level, programmes strengthening the social capital or improving the overall quality of life of youths with or without HIV may be beneficial to their mental health.
在撒哈拉以南非洲，年轻人中常见的精神障碍（CMD），如抑郁和焦虑，在艾滋病毒感染者（YLWH）中研究不足。为了填补这一空白，我们在肯尼亚：a）确定了 YLWH 中 CMD 的流行率与未感染同龄人相比；b）调查了 HIV 状况作为年轻人 CMD 的独立预测因素；c）调查了 CMD 的风险和保护指标，更侧重于 YLWH。
2018 年 11 月至 2019 年 9 月，从肯尼亚沿海的两个县招募了 819 名 18-24 岁的年轻人（407 名 HIV 感染者）。通过音频计算机辅助自我访谈，使用当地改编的现有心理健康措施，即 9 项患者健康问卷和 7 项广泛性焦虑症量表，对年轻人进行了评估。使用逻辑回归确定 CMD 的相关性。
与未感染的同龄人相比，YLWH 中 CMD 的患病率显著升高，即抑郁症状为 29% vs. 12%；p < 0.001，焦虑症状为 19% vs. 8%；p < 0.001，抑郁和焦虑症状并存为 16% vs. 5%；p < 0.001。HIV 状况独立预测抑郁症状及其与焦虑症状并存。在 YLWH 中，负性生活事件、较高的 HIV 相关污名和较低的抗逆转录病毒治疗依从性是 CMD 升高的风险指标。在未感染 HIV 的青少年中，父母双亡是抑郁症状升高的风险指标。YLWH 和未感染 HIV 的青少年的 CMD 保护指标包括较高的社会支持和健康相关生活质量。
在肯尼亚沿海地区，YLWH 中 CMD 的负担明显高于未感染的同龄人。在这种情况下，青少年 HIV 阳性是抑郁症状增加及其与焦虑症状并存的预测因素。肯尼亚沿海地区患有 CMD 风险较高的 YLWH，如果将 CMD 常规筛查纳入其护理套餐中，可通过早期发现、转介和治疗受益。通过继续为感染 HIV 但未受影响的青少年提供支持，帮助他们接受自己的损失，可以改善他们的心理健康。在社区层面，加强社会资本或改善有或没有 HIV 的青少年整体生活质量的计划可能对他们的心理健康有益。
