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Social Support, Stigma and Antenatal Depression Among HIV-Infected Pregnant Women in South Africa

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Abstract

Depression, HIV-related stigma and low levels of social support may be particularly prevalent and adversely affect health and treatment outcomes among HIV-infected pregnant women. We examined factors associated with social support and stigma among pregnant women initiating antiretroviral therapy in the Western Cape, South Africa; and explored associations with depressive symptoms (Edinburgh Postnatal Depression Scale; EPDS) in linear regression models. Among 623 participants, 11 and 19 % had elevated EPDS scores using thresholds described in the original development of the scale (scores ≥13 and ≥10, respectively). Social support and stigma were highly interrelated and were associated with depressive symptoms. Stigma was observed to moderate the association between social support and depression scores; when levels of stigma were high, no association between social support and depression scores was observed. Elevated depression scores are prevalent in this setting, and interventions to reduce stigma and to address risk factors for depressive symptoms are needed.

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References

  1. Walker SP, Wachs TD, Meeks Gardner J, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet. 2007;369(9556):145–57.

    Article  PubMed  Google Scholar 

  2. Walker SP, Wachs TD, Grantham-McGregor S, et al. Inequality in early childhood: risk and protective factors for early child development. Lancet. 2011;378(9799):1325–38.

    Article  PubMed  Google Scholar 

  3. World Health Organization, United Nations Population Fund. Mental health aspects of women’s reproductive health: a global review of the literature. Geneva: World Health Organization; 2009.

  4. Stein A, Pearson RM, Goodman SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014;384(9956):1800–19.

    Article  PubMed  Google Scholar 

  5. Brittain K, Myer L, Koen N, et al. Risk factors for antenatal depression and associations with infant birth outcomes: results from a South African birth cohort study. Paediatr Perinat Epidemiol. 2015;29(6):505–14.

    Article  PubMed  Google Scholar 

  6. Howard LM, Molyneaux E, Dennis C-L, Rochat T, Stein A, Milgrom J. Non-psychotic mental disorders in the perinatal period. Lancet. 2014;384(9956):1775–88.

    Article  PubMed  Google Scholar 

  7. Kapetanovic S, Dass-Brailsford P, Nora D, Talisman N. Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. AIDS Behav. 2014;18(6):1152–73.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kotze M, Visser M, Makin J, Sikkema K, Forsyth B. Psychosocial variables associated with coping of HIV-positive women diagnosed during pregnancy. AIDS Behav. 2013;17(2):498–507.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Peltzer K, Ramlagan S. Perceived stigma among patients receiving antiretroviral therapy: a prospective study in KwaZulu-Natal. South Africa. AIDS Care. 2011;23(1):60–8.

    Article  PubMed  Google Scholar 

  10. Nel A, Kagee A. Common mental health problems and antiretroviral therapy adherence. AIDS Care. 2011;23(11):1360–5.

    Article  PubMed  Google Scholar 

  11. Krumme AA, Kaigamba F, Binagwaho A, Murray MB, Rich ML, Franke MF. Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy. J Epidemiol Community Health. 2015;69(3):284–9.

    Article  PubMed  Google Scholar 

  12. O’Hiarlaithe M, Grede N, de Pee S, Bloem M. Economic and social factors are some of the most common barriers preventing women from accessing maternal and newborn child health (MNCH) and prevention of mother-to-child transmission (PMTCT) services: a literature review. AIDS Behav. 2014;18(Suppl 5):S516–30.

    Article  Google Scholar 

  13. Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16:18588.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hodgson I, Plummer ML, Konopka SN, et al. A systematic review of individual and contextual factors affecting ART initiation, adherence, and retention for HIV-infected pregnant and postpartum women. PLoS ONE. 2014;9(11):e111421.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Seth P, Kidder D, Pals S, et al. Psychosocial functioning and depressive symptoms among HIV-positive persons receiving care and treatment in Kenya, Namibia, and Tanzania. Prev Sci. 2014;15(3):318–28.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Endeshaw M, Walson J, Rawlins S, et al. Stigma in Ethiopia: association with depressive symptoms in people with HIV. AIDS Care. 2014;26(8):935–9.

    Article  PubMed  Google Scholar 

  17. Onyebuchi-Iwudibia O, Brown A. HIV and depression in Eastern Nigeria: the role of HIV-related stigma. AIDS Care. 2014;26(5):653–7.

    Article  PubMed  Google Scholar 

  18. Breet E, Kagee A, Seedat S. HIV-related stigma and symptoms of post-traumatic stress disorder and depression in HIV-infected individuals: does social support play a mediating or moderating role? AIDS Care. 2014;26(8):947–51.

    Article  PubMed  Google Scholar 

  19. World Health Organization. Programmatic update: use of antiretroviral drugs for treating pregnant women and preventing HIV infection in infants. Available at: http://www.who.int/hiv/PMTCT_update.pdf. Acessed: September 21, 2015.

  20. Kaplan R, Orrell C, Lawn SD, Bekker L-G, Wood R. The Hannan Crusaid Treatment Centre - early beginnings and lessons learnt. South Afr J HIV Med. 2014;15(1):35–7.

    Article  Google Scholar 

  21. Strategic Development Information, City of Cape Town GIS Department. City of Cape Town - Census 2011 - Gugulethu. Available at: http://www.capetown.gov.za/en/stats/2011CensusSuburbs/2011_Census_CT_Suburb_Gugulethu_Profile.pdf. Acessed: September 8, 2015.

  22. Barrera MA. A method for assessing social support networks in community survey research. Connections. 1980;3(3):8–13.

    Google Scholar 

  23. Arnsten JH, Li X, Mizuno Y, et al. Factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users. J Acquir Immune Defic Syndr. 2007;46(Suppl 2):S64–71.

    Article  PubMed  Google Scholar 

  24. Yeji F, Klipstein-Grobusch K, Newell M-L, Hirschhorn LR, Hosegood V, Barnighausen T. Are social support and HIV coping strategies associated with lower depression in adults on antiretroviral treatment? Evidence from rural KwaZulu-Natal. South Africa. AIDS Care. 2014;26(12):1482–9.

    Article  PubMed  Google Scholar 

  25. Fife BL, Wright ER. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav. 2000;41(1):50–67.

    Article  CAS  PubMed  Google Scholar 

  26. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150(6):782–6.

    Article  CAS  PubMed  Google Scholar 

  27. Murray D, Cox JL. Screening for depression during pregnancy with the Edinburgh Depression scale (EDDS). J Reprod Infant Psychol. 1990;8(2):99–107.

    Article  Google Scholar 

  28. Lawrie TA, Hofmeyr GJ, de Jager M, Berk M. Validation of the Edinburgh Postnatal Depression Scale on a cohort of South African women. S Afr Med J. 1998;88(10):1340–4.

    CAS  PubMed  Google Scholar 

  29. Tsai AC, Tomlinson M, Dewing S, et al. Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application. Arch Womens Ment Health. 2014;17(5):423–31.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Baron E, Field S, Kafaar Z, Honikman S. Patterns of use of a maternal mental health service in a low-resource antenatal setting in South Africa. Health Soc Care Community. 2015;23(5):502–12.

    Article  PubMed  Google Scholar 

  31. Schneider M, Baron E, Davies T, Bass J, Lund C. Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha. Cape Town. Soc Psychiatry Psychiatr Epidemiol. 2015;50:797–806.

    Article  PubMed  Google Scholar 

  32. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3 Suppl 2):18734.

    PubMed  PubMed Central  Google Scholar 

  33. Takada S, Weiser SD, Kumbakumba E, et al. The dynamic relationship between social support and HIV-related stigma in rural Uganda. Ann Behav Med. 2014;48(1):26–37.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgments

The authors would like to thank the women who participated in this study, as well as the study staff for their support of this research. This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), Grant Number 1R01HD074558. Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation. Drs. Mellins and Remien are also supported by a Grant from NIMH to the HIV Center for Clinical and Behavioral Studies (P30-MH45320).

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Authors and Affiliations

  1. Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa

    Kirsty Brittain, Tamsin Phillips & Landon Myer

  2. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA

    Claude A. Mellins & Robert H. Remien

  3. ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA

    Allison Zerbe & Elaine J. Abrams

  4. College of Physicians & Surgeons, Columbia University, New York, NY, USA

    Elaine J. Abrams

Authors
  1. Kirsty Brittain
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  2. Claude A. Mellins
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  3. Tamsin Phillips
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  4. Allison Zerbe
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  5. Elaine J. Abrams
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  6. Landon Myer
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  7. Robert H. Remien
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Correspondence to Kirsty Brittain.

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Brittain, K., Mellins, C.A., Phillips, T. et al. Social Support, Stigma and Antenatal Depression Among HIV-Infected Pregnant Women in South Africa. AIDS Behav 21, 274–282 (2017). https://doi.org/10.1007/s10461-016-1389-7

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  • DOI: https://doi.org/10.1007/s10461-016-1389-7

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