Tan Yuting, Ma Zhiyong, Cao Qian, Gao Shi-Cheng, Xiong Yong
Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China.
BMJ Open. 2025 May 15;15(5):e093320. doi: 10.1136/bmjopen-2024-093320.
Adolescents and young adults (AYA) with HIV are a population at high risk of experiencing mental issues and sleep disorder. We aim to summarise the global prevalence and risks of depression, anxiety, post-traumatic stress disorder (PTSD) and sleep disorder among AYA with HIV.
Systematic review and meta-analysis.
PubMed, Web of Science, Embase and PsycINFO were searched from inception to 3 August 2024.
Observational studies reporting the prevalence of depression, anxiety, PTSD or sleep disorder among AYA with HIV and published in English were included. Reviews, case reports, conference papers, notes, editorials and non-observational research were excluded.
Titles, abstracts and full texts were reviewed and screened, and data were independently extracted. A modified Newcastle-Ottawa Quality Assessment Scale (NOS) was used to evaluate study quality. Heterogeneity was assessed by I statistics, and subgroup analysis was performed to identify the source of heterogeneity. The pooled prevalence and the risks of depression, anxiety, PTSD and sleep disorder by comparison with HIV-uninfected peers were measured with random-effects and fixed-effects models. Publication bias was examined using Egger's correlation tests and funnel plot. The Grading of Recommendations Assessment, Development and Evaluation was used to assess the certainty of evidence.
56 articles were included in the final analysis. According to the modified NOS, 13 (23.2%) studies were considered good, 38 (67.9%) were satisfactory and 5 (8.9%) were unsatisfactory. 51 studies including 21 735 AYA with HIV contributed data for the pooled prevalence of depression (28%, 95% CI 24% to 32%, I=98.68%; low certainty evidence); 21 studies including 8021 cases contributed data for the pooled prevalence of anxiety (22%, 95% CI 17% to 27%, I=98.35%; low certainty evidence); 9 studies including 3691 cases contributed data for the pooled prevalence of PTSD (12%, 95% CI 8% to 17%, I=95.60%; low certainty evidence); and 4 studies including 1909 cases contributed data for the pooled prevalence of sleep disorder (51%, 95% CI 31% to 70%, I=98.37%; low certainty evidence). Compared with AYA without HIV, those with HIV had a higher risk of depression (OR=2.67, 95% CI 1.63 to 5.90, I=84.0%), anxiety (OR=1.89, 95% CI 1.32 to 2.69, I=50.3%), PTSD (OR=1.58, 95% CI 1.23 to 2.04, I=40.1%) and sleep disorder (OR=2.11, 95% CI 1.51 to 2.95, I=0.0%). A subgroup analysis found that studies conducted in Asia had a lower prevalence of depression (21.7% vs 29.6%, p<0.001) and anxiety (14.7% vs 21.9%, p<0.001) than studies conducted in Africa. Egger's test indicated that there was significant publication bias in the estimates of the prevalence of depression (p<0.001), anxiety (p<0.001) and PTSD (p=0.049), but not in the estimates of the prevalence of sleep disorder (p=0.861).
AYA with HIV are a population at high risk of experiencing depression, anxiety, PTSD and sleep disorder. More sensitive screening strategies and more comprehensive intervention methods are needed. However, in view of the high heterogeneity, the differences between studies need to be considered and the pooled estimates interpreted with caution.
感染艾滋病毒的青少年和青年（AYA）是极易出现心理问题和睡眠障碍的人群。我们旨在总结全球感染艾滋病毒的青少年和青年中抑郁症、焦虑症、创伤后应激障碍（PTSD）和睡眠障碍的患病率及风险。
系统评价和荟萃分析。
检索了从数据库建立至2024年8月3日的PubMed、科学网、Embase和PsycINFO。
纳入以英文发表的、报告感染艾滋病毒的青少年和青年中抑郁症、焦虑症、PTSD或睡眠障碍患病率的观察性研究。排除综述、病例报告、会议论文、笔记、社论和非观察性研究。
对标题、摘要和全文进行审查和筛选，并独立提取数据。采用改良的纽卡斯尔-渥太华质量评估量表（NOS）评估研究质量。通过I统计量评估异质性，并进行亚组分析以确定异质性来源。采用随机效应模型和固定效应模型测量与未感染艾滋病毒的同龄人相比，抑郁症、焦虑症、PTSD和睡眠障碍的合并患病率及风险。使用Egger相关性检验和漏斗图检查发表偏倚。采用推荐分级评估、制定和评价方法评估证据的确定性。
最终分析纳入56篇文章。根据改良的NOS，13项（23.2%）研究被认为质量良好，38项（67.9%）令人满意，5项（8.9%）不令人满意。51项研究（包括21735名感染艾滋病毒的青少年和青年）提供了抑郁症合并患病率的数据（28%，95%CI 24%至32%，I=98.68%；低确定性证据）；21项研究（包括8021例）提供了焦虑症合并患病率的数据（22%，95%CI 17%至27%，I=98.35%；低确定性证据）；9项研究（包括3691例）提供了PTSD合并患病率的数据（12%，95%CI 8%至17%，I=95.60%；低确定性证据）；4项研究（包括1909例）提供了睡眠障碍合并患病率的数据（51%，95%CI 31%至70%，I=98.37%；低确定性证据）。与未感染艾滋病毒的青少年和青年相比，感染艾滋病毒的青少年和青年患抑郁症（OR=2.67，95%CI 1.63至5.90，I=84.0%）、焦虑症（OR=1.89，95%CI 1.32至2.69，I=50.3%）、PTSD（OR=1.58，95%CI 1.23至2.04，I=40.1%）和睡眠障碍（OR=2.11，95%CI 1.51至2.95，I=0.0%）的风险更高。亚组分析发现，在亚洲进行的研究中抑郁症（21.7%对29.6%，p<0.001）和焦虑症（14.7%对21.9%，p<0.001）的患病率低于在非洲进行的研究。Egger检验表明，抑郁症（p<0.001）、焦虑症（p<0.001）和PTSD（p=0.049）患病率估计值存在显著发表偏倚，但睡眠障碍患病率估计值不存在显著发表偏倚（p=0.861）。
感染艾滋病毒的青少年和青年是患抑郁症、焦虑症、PTSD和睡眠障碍的高危人群。需要更敏感的筛查策略和更全面的干预方法。然而，鉴于高度异质性，需要考虑研究之间的差异，并谨慎解释合并估计值。
