Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Psychiatry
Published in: BMC Psychiatry 1/2015

Open Access 01-12-2015 | Research article

Factors associated with depression among adolescents living with HIV in Malawi

Authors: Maria H. Kim, Alick C. Mazenga, Xiaoying Yu, Akash Devandra, Chi Nguyen, Saeed Ahmed, Peter N. Kazembe, Carla Sharp

Published in: BMC Psychiatry | Issue 1/2015

Login to get access

Abstract

Background

Prior research suggests that a high prevalence of depression, with a detrimental impact on treatment outcomes exists among HIV-infected youth. Data on potential risk factors of depression among HIV-infected youth in sub-Saharan Africa are scarce. This cross-sectional study aimed to identify contributory/protective factors associated with depression in Malawian adolescents 12–18 years old living with HIV.

Methods

Depression was measured by a validated Chichewa version of the Beck Depression Inventory version-II (BDI-II) and the Children’s Depression Rating Scale-Revised (CDRS-R). Data on variables thought to potentially be contributory/protective were collected and included: socio-demographics, past traumatic events/stressors, behavioural factors/social support, and bio-clinical parameters. Chi-square test or two-sample t-test was used to explore associations between factors and depression. Additional testing via linear/logistic regression, adjusting for age and sex, identified candidate variables (p < 0.1). Final regression models included variables with significant main effects and interactions.

Results

Of the 562 participants enrolled (mean age, 14.5 years [SD 2.0]; 56.1 % female), the prevalence of depression was 18.9 %. In multivariate linear regression, the variables significantly associated with higher BDI-II score were female gender, fewer years of schooling, death in the family/household, failing a school term/class, having a boyfriend/girlfriend, not disclosed or not having shared one’s HIV status with someone else, more severe immunosuppression, and bullied for taking medications. Bullying victimization was reported by 11.6 % of respondents. We found significant interactions: older participants with lower height-for-age z-scores and dissatisfied with their physical appearance had higher BDI-II scores. In multivariate logistic regression, factors significantly associated with depression were: older age, OR 1.23 (95 % CI 1.07-1.42); fewer years of schooling, OR 3.30 (95 % CI 1.54-7.05); and bullied for taking medications, (OR 4.20 (95 % CI 2.29-7.69).

Conclusion

Having fewer years of schooling and being bullied for taking medications were most clearly associated with depression. Programmes to support the mental health needs of HIV-infected adolescents that address issues such as disclosure, educational support, and, most notably, bullying may improve treatment outcomes and are recommended.
Literature
1.
UNICEF. Opportunity in Crisis Preventing HIV from Early Adolescence to young adulthood. In New York: UNICEF; 2011.
2.
UNAIDS. Securing the Future Today Synthesis of Strategic Information on HIV and Young People. In Geneva: UNAIDS; 2011.
3.
Dick B, Ferguson BJ. Health for the world's adolescents: a second chance in the second decade. J adolesc health : official publication of the Society for Adolescent Medicine. 2015;56(1):3–6.CrossRef
4.
5.
Prinstein MJ, Boergers J, Vernberg EM. Overt and relational aggression in adolescents: Social-psychological adjustment of aggressors and victims. J Clin Child Psychol. 2001;30(4):479–91.CrossRefPubMed
6.
Casement MD, Guyer AE, Hipwell AE, McAloon RL, Hoffmann AM, Keenan KE, et al. Girls' challenging social experiences in early adolescence predict neural response to rewards and depressive symptoms. Dev Cogn Neurosci. 2014;8:18–27.CrossRefPubMed
7.
Hawker DS, Boulton MJ. Twenty years' research on peer victimization and psychosocial maladjustment: a meta-analytic review of cross-sectional studies. J Child Psychol Psychiatry. 2000;41(4):441–55.CrossRefPubMed
8.
Saluja G, Iachan R, Scheidt PC, Overpeck MD, Sun W, Giedd JN. Prevalence of and risk factors for depressive symptoms among young adolescents. Arch Pediatr Adolesc Med. 2004;158(8):760–5.CrossRefPubMed
9.
Ward CL, Flisher AJ, Zissis C, Muller M, Lombard C. Exposure to violence and its relationship to psychopathology in adolescents. Inj Prev. 2001;7(4):297–301.CrossRefPubMedPubMedCentral
10.
Kim J, Cicchetti D. Longitudinal trajectories of self-system processes and depressive symptoms among maltreated and nonmaltreated children. Child Dev. 2006;77(3):624–39.CrossRefPubMedPubMedCentral
11.
Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I. Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape. J Int AIDS Soc. 2010;13:44.CrossRefPubMedPubMedCentral
12.
Rubin AG, Gold MA, Primack BA. Associations between depressive symptoms and sexual risk behavior in a diverse sample of female adolescents. J Pediatr Adolesc Gynecol. 2009;22(5):306–12.CrossRefPubMedPubMedCentral
13.
Rudatsikira E, Muula AS, Siziya S, Twa-Twa J. Suicidal ideation and associated factors among school-going adolescents in rural Uganda. BMC Psychiatry. 2007;7:67.CrossRefPubMedPubMedCentral
14.
Muula AS, Kazembe LN, Rudatsikira E, Siziya S. Suicidal ideation and associated factors among in-school adolescents in Zambia. Tanzan Health Res Bull. 2007;9(3):202–6.PubMed
15.
Cluver L, Gardner F, Operario D. Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychol Psychiatry. 2007;48(8):755–63.CrossRefPubMed
16.
Ruiz-Casares M, Thombs BD, Rousseau C. The association of single and double orphanhood with symptoms of depression among children and adolescents in Namibia. Eur Child Adolesc Psychiatry. 2009;18(6):369–76.CrossRefPubMed
17.
Suliman S, Mkabile SG, Fincham DS, Ahmed R, Stein DJ, Seedat S. Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents. Compr Psychiatry. 2009;50(2):121–7.CrossRefPubMed
18.
WHO. The World Health Report 2001: Mental Health: new understanding, new hope. In. Geneva: World Health Organization; 2001.
19.
WHO. Global Burden of Disease, 2004 Update. In. Geneva: World Health Organization; 2008.
20.
World Federation for Mental Health. An International Mental Health Awareness Packet from the WFMH Africa Initiative on Mental Health and HIV/AIDS. In: HIV/AIDS and Depression in Africa. Woodbridge, VA; 2009: 46.
21.
Gupta RD, Packel M, Rutherford L, Leiter G, Phaladze K, Korte N, et al. Depression and HIV in Botswana: a population-based study on gender-specific socioeconomic and behavioral correlates. PLoS One. 2010;5(12), e14252.CrossRefPubMedPubMedCentral
22.
Nakasujja N, Skolasky RL, Musisi S, Allebeck P, Robertson K, Ronald A, et al. Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda. BMC Psychiatry. 2010;10:44.CrossRefPubMedPubMedCentral
23.
Mwale C, Stewart R, Mathanga D. The prevalence of psychological distress and associated factors among people living with Aids attending antiretroviral therapy clinics in Mzuzu, Malawi: A cross sectional descriptive study. Typescript. Blantyre: University of Malawi College of Medicine; 2006.
24.
Traube D, Dukay V, Kaaya S, Reyes H, Mellins C. Cross-cultural adaptation of the Child Depression Inventory for use in Tanzania with children affected by HIV. Vulnerable Child Youth Student Studies. 2010;5(2):174–87.CrossRef
25.
Kamau JW, Kuria W, Mathai M, Atwoli L, Kangethe R. Psychiatric morbidity among HIV-infected children and adolescents in a resource-poor Kenyan urban community. AIDS Care. 2012;24(7):836–42.CrossRefPubMed
26.
Kim MH, Mazenga AC, Devandra A, Ahmed S, Kazembe PN, Yu X, et al. Prevalence of depression and validation of the Beck Depression Inventory-II and the Children's Depression Inventory-Short amongst HIV-positive adolescents in Malawi. J Int AIDS Soc. 2014;17:18965.CrossRefPubMedPubMedCentral
27.
Myer L, Smit J, Roux LL, Parker S, Stein DJ, Seedat S. Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22(2):147–58.CrossRefPubMed
28.
Kaharuza FM, Bunnell R, Moss S, Purcell DW, Bikaako-Kajura W, Wamai N, et al. Depression and CD4 cell count among persons with HIV infection in Uganda. AIDS Behav. 2006;10(4 Suppl):S105–11.CrossRefPubMed
29.
Kinyanda E, Hoskins S, Nakku J, Nawaz S, Patel V. Prevalence and risk factors of major depressive disorder in HIV/AIDS as seen in semi-urban Entebbe district, Uganda. BMC Psychiatry. 2011;11(205):11–205.
30.
Klis S, Velding K, Gidron Y, Peterson K. Posttraumatic stress and depressive symptoms among people living with HIV in the Gambia. AIDS Care. 2011;23(4):426–34.CrossRefPubMed
31.
Farinpour R, Miller EN, Satz P, Selnes OA, Cohen BA, Becker JT. Psychosocial risk factors of HIV morbidity and mortality: findings from the Multicenter AIDS Cohort Study (MACS). J Clin Exp Neuropsychol. 2003;25(5):654–70.CrossRefPubMed
32.
Cruess DG, Petitto JM, Leserman J, Douglas SD, Gettes DR, Ten Have TR. Depression and HIV infection: impact on immune function and disease progression. CNS Spectr. 2003;8(1):52–8.CrossRefPubMed
33.
Treisman GJ, Angelino AF, Hutton HE. Psychiatric issues in the management of patients with HIV infection. JAMA. 2001;286(22):2857–64.CrossRefPubMed
34.
Holzemer WLC, Nokes IB, Turner KM, Brown JG, Powell-Cope MA, Inouye GM, et al. Predictors of self-reported adherence in persons living with HIV disease. AIDS Patient Care STDS. 1999;13(3):185–97.CrossRefPubMed
35.
Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.PubMed
36.
37.
Malawi Ministry of Health. Government of Malawi Ministry of Health Integrated HIV Program Report January -March 2014. In Lilongwe: Ministry of Health; 2014: 60.
38.
39.
Adewuya AO, Ola BA, Aloba OO. Prevalence of major depressive disorders and a validation of the Beck Depression Inventory among Nigerian adolescents. Eur Child Adolesc Psychiatry. 2007;16(5):287–92.CrossRefPubMed
40.
Basker MM, Russell PS, Russell S, Moses PD. Validation of the children's depression rating scale- revised for adolescents in primary-care pediatric use in India. Indian J Med Sci. 2010;64(2):72–80.CrossRefPubMed
41.
Rivera CL, Bernal G, Rossello J. The Chidlren Depression Inventory (CDI) and the Beck Depression Inventory (BDI): Their Validity as Acreening Measures for Major Depression in a group of Puerto Rican Adolescents. International Journal of Clinical and Helath Psychology. 2005;5(3):485–98.
42.
Mayes TL, Bernstein IH, Haley CL, Kennard BD, Emslie GJ. Psychometric properties of the Children's Depression Rating Scale-Revised in adolescents. J Child Adolesc Psychopharmacol. 2010;20(6):513–6.CrossRefPubMedPubMedCentral
43.
44.
Plener PL, Grieb J, Sprober N, Straub J, Schneider A, Keller F, et al. Convergence of children’s depression rating scale-revised scores and clinical diagnosis in rating adolescent depressive symptomatology. Ment Illn. 2012;4(1):29–31.
45.
Zalsman G, Misgav S, Sommerfeld E, Kohn Y, Brunstein-Klomek A, Diller R, et al. Children’s Depression Inventory (CDI) and the Children’s Depression Rating Scale-Revised (CDRS-R): Reliability of the Hebrew version. Int J Adolesc Med Health. 2011;17(3):255–7.
46.
Jain S, Carmody TJ, Trivedi MH, Hughes C, Bernstein IH, Morris DW, et al. A psychometric evaluation of the CDRS and MADRS in assessing depressive symptoms in children. J Am Acad Child Adolesc Psychiatry. 2007;46(9):1204–12.CrossRefPubMedPubMedCentral
47.
Mellins CA, Malee KM. Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc. 2013;16:18593.CrossRefPubMedPubMedCentral
48.
Wood SM, Shah SS, Steenhoff AP, Rutstein RM. The impact of AIDS diagnoses on long-term neurocognitive and psychiatric outcomes of surviving adolescents with perinatally acquired HIV. AIDS (London, England). 2009;23(14):1859–65.CrossRef
49.
Boivin MJ, Green SD, Davies AG, Giordani B, Mokili JK, Cutting WA. A preliminary evaluation of the cognitive and motor effects of pediatric HIV infection in Zairian children. Health psychol : official journal of the Division of Health Psychology, American Psychological Association. 1995;14(1):13–21.CrossRef
50.
Drotar D, Olness K, Wiznitzer M, Schatschneider C, Marum L, Guay L, et al. Neurodevelopmental outcomes of Ugandan infants with HIV infection: an application of growth curve analysis. Health psychol : official journal of the Division of Health Psychology, American Psychological Association. 1999;18(2):114–21.CrossRef
51.
Nozyce ML, Lee SS, Wiznia A, Nachman S, Mofenson LM, Smith ME, et al. A behavioral and cognitive profile of clinically stable HIV-infected children. Pediatrics. 2006;117(3):763–70.CrossRefPubMed
52.
Misdrahi D, Vila G, Funk-Brentano I, Tardieu M, Blanche S, Mouren-Simeoni MC. DSM-IV mental disorders and neurological complications in children and adolescents with human immunodeficiency virus type 1 infection (HIV-1). Eur psychiatry : the journal of the Association of European Psychiatrists. 2004;19(3):182–4.CrossRef
53.
Elliott-DeSorbo DK, Martin S, Wolters PL. Stressful life events and their relationship to psychological and medical functioning in children and adolescents with HIV infection. J Acquir Immune Defic Syndr. 2009;52(3):364–70.CrossRefPubMedPubMedCentral
54.
Wiener LS, Battles HB. Untangling the web: A close look at diagnosis disclosure among HIV-infected adolescents. J Adolesc Health. 2006;38(3):307–9.CrossRefPubMed
55.
Arseneault L, Bowes L, Shakoor S. Bullying victimization in youths and mental health problems: 'much ado about nothing'? Psychol Med. 2010;40(5):717–29.CrossRefPubMed
56.
Kumar SP, Dandona R, Kumar GA, Ramgopal S, Dandona L. Depression among AIDS-orphaned children higher than among other orphaned children in southern India. Int j ment heal systs. 2014;8:13.CrossRef
57.
Boyes ME, Cluver LD. Relationships Between Familial HIV/AIDS and Symptoms of Anxiety and Depression: The Mediating Effect of Bullying Victimization in a Prospective Sample of South African Children and Adolescents. J Youth Adolesc. 2014;44(4):847–59.CrossRefPubMed
Metadata
Title
Factors associated with depression among adolescents living with HIV in Malawi
Authors
Maria H. Kim
Alick C. Mazenga
Xiaoying Yu
Akash Devandra
Chi Nguyen
Saeed Ahmed
Peter N. Kazembe
Carla Sharp
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-015-0649-9

Other articles of this Issue 1/2015

BMC Psychiatry 1/2015 Go to the issue

Research article

Psychiatric and neurological disorders in late adolescence and risk of convictions for violent crime in men

Research article

The Agewell trial: a pilot randomised controlled trial of a behaviour change intervention to promote healthy ageing and reduce risk of dementia in later life

Research article

Anxiety and depression during pregnancy in Central America: a cross-sectional study among pregnant women in the developing country Nicaragua

Research article

Mental health literacy measures evaluating knowledge, attitudes and help-seeking: a scoping review

Research article

A qualitative process evaluation of a randomised controlled trial of a parenting intervention in community (school) settings for children at risk of attention deficit hyperactivity disorder (ADHD)

Research article

Serum brain-derived neurotrophic factor levels and personality traits in patients with major depression