Risk and protective factors in the mental health of adolescents living with HIV in Namibia

Resumen

BACKGROUND: Very little research has examined the impact of HIV status on the mental health of HIV-positive adolescents in sub-Saharan Africa. These adolescents may face additional risk factors, such as poverty, poor social support and stigma. This study examines the mental health of HIV-positive adolescents in Namibia, and whether these adolescents show increased mental health problems compared to a matched community comparison group. The study also examines the role of risk and protective factors on mental health, including their potential role as mediating factors. METHODS: A qualitative pilot stage with 34 adolescents and eight key informants explored local perceptions of mental health and risk and protective factors for mental health problems in Namibia. The psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), was examined in a quantitative pilot phase with 236 participants between the ages of 12 and 18, as the tool had never been used in Namibia. For the main study, 99 fully disclosed HIV-positive adolescents between the ages of 12 and 18 were interviewed at a Hospital in Windhoek, using a standardised questionnaire and compared to 159 adolescents randomly selected from the community and matched to the HIV group. Interviews assessed emotional and behavioural symptoms of distress, using the SDQ, as well as poverty, social support, orphan status and stigma. Data were analysed with t-tests, chi-squares, ANOVAs and regression analysis. RESULTS: HIV-positive adolescents reported significantly more total difficulties and conduct problems than the comparison group. Using Western established cut-offs, 12 percent of the HIV group had scores in the clinical range on the total difficulties scale. A high number of participants (22 percent) in this group had scores in the clinical range for the emotional symptoms scale. Significantly more participants in the HIV group were orphaned, with only 36 percent still having both parents living. The HIV group scored lower on total social support and caregiver support. The groups showed no differences in poverty factors. After controlling for the effects of orphanhood and social support, group differences in mental health were not significant, suggesting that these factors may play a mediating role. The strongest predictors for symptoms of emotional and behavioural distress for the HIV group were social support, poverty and stigma. CONCLUSION: HIV-positive adolescents experience more mental health problems than their peers. However being orphaned and lower social support may mediate these differences. For HIV-positive adolescents, interventions should improve caregiver support, target poverty factors, especially food insecurity, and alleviate the effects of orphanhood. Early identification for emotional problems adolescents is recommended, particularly as those with more mental health problems showed increased adherence problems. Assistance with decisions regarding HIV status disclosure and a focussed effort on reducing HIV-related stigma is recommended.