Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder.
Adolescent Motherhood and HIV in South Africa: Examining Prevalence of Common Mental Disorder.
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DOI：
10.1007/s10461-021-03474-8
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发表时间：
2022-04
影响因子：
4.4
通讯作者：
Sherr L
中科院分区：
文献类型：
--
作者：
Roberts KJ;Smith C;Cluver L;Toska E;Zhou S;Boyes M;Sherr L
青少年（10-19岁）的心理健康仍然是一个被忽视的全球健康问题，特别是在艾滋病毒和怀孕等综合性疾病的情况下。南非青少年的怀孕率和艾滋病毒感染率是世界上最高的。在单独的探索中，发现青春期怀孕和感染艾滋病毒都与心理健康状况不佳有关。然而，文献中仍然没有对经历过怀孕/为人父母的艾滋病毒感染青少年进行心理健康检查。因此，没有与这一群体的心理健康有关的循证政策或方案。这些分析的目的是确定青少年母亲和经历了母亲和艾滋病毒综合症的青少年中可能的常见精神障碍的流行率。分析利用的数据进行访谈，723名女性青少年从一个前瞻性的纵向队列研究的青少年艾滋病毒感染者（n = 1059）和对照组的青少年没有艾滋病毒（n = 467）内进行的东开普省，南非。详细的研究问卷包括与艾滋病毒、青少年母亲和心理健康有关的经验证和研究具体措施。四个自我报告的心理健康措施（抑郁，焦虑，创伤后应激和自杀倾向）被用来探讨可能的常见精神障碍和精神健康共病（同时经历两种或两种以上常见精神障碍）的概念。卡方检验（Fisher精确检验，如适用）和Kruskal沃利斯检验用于根据艾滋病毒状态和母亲身份评估样本特征（包括心理健康状态）的差异。Logistic回归模型被用来探讨合并的母亲和艾滋病毒状态之间的横截面关联，可能常见的精神障碍/精神健康共病。70.5%的参与者是艾滋病毒感染者，15.2%是母亲。8.4%是携带艾滋病毒的母亲。十分之一（10.9%）的样本被归类为报告可能的常见精神障碍，2.8%的样本被归类为经历可能的精神健康共病。出现了三个核心发现：（1）与从未怀孕的青少年相比，青少年母亲的心理健康状况较差（可能的常见精神障碍、精神健康共病、抑郁、焦虑和自杀症状的测量），（2）感染艾滋病毒的母亲中可能的常见精神障碍的患病率最高（23.0%）与其他组相比（范围：8.5-12.8%; 2 = 12.54，p = 0.006）和（3）无论艾滋病毒感染状况如何，母亲中可能的精神健康合并症的患病率较高（艾滋病毒和母亲= 8.2%，无艾滋病毒和母亲= 8.2%，14.5，p = 0.002）。结果发现，与从未怀孕的青少年相比，青少年母亲的心理健康负担更高，与其他群体相比，感染艾滋病毒的青少年母亲的心理健康负担患病率更高，无论艾滋病毒状况如何，青少年母亲的心理健康合并症患病率都较高。这些发现解决了一个关键的证据差距，突出了南非境内青少年母亲和艾滋病毒背景下心理健康负担的共同性，以及迫切需要支持和进一步研究，以确保为这一群体提供有效的循证方案。现有的产前、产后和艾滋病毒护理可能为心理健康筛查、监测和转诊提供机会。在线版本包含补充材料，可通过10.1007/s10461-021-03474-8获得。
The mental health of adolescents (10–19 years) remains an overlooked global health issue, particularly within the context of syndemic conditions such as HIV and pregnancy. Rates of pregnancy and HIV among adolescents within South Africa are some of the highest in the world. Experiencing pregnancy and living with HIV during adolescence have both been found to be associated with poor mental health within separate explorations. Yet, examinations of mental health among adolescents living with HIV who have experienced pregnancy/parenthood remain absent from the literature. As such, there exists no evidence-based policy or programming relating to mental health for this group. These analyses aim to identify the prevalence of probable common mental disorder among adolescent mothers and, among adolescents experiencing the syndemic of motherhood and HIV. Analyses utilise data from interviews undertaken with 723 female adolescents drawn from a prospective longitudinal cohort study of adolescents living with HIV (n = 1059) and a comparison group of adolescents without HIV (n = 467) undertaken within the Eastern Cape Province, South Africa. Detailed study questionnaires included validated and study specific measures relating to HIV, adolescent motherhood, and mental health. Four self-reported measures of mental health (depressive, anxiety, posttraumatic stress, and suicidality symptomology) were used to explore the concept of likely common mental disorder and mental health comorbidities (experiencing two or more common mental disorders concurrently). Chi-square tests (Fisher’s exact test, where appropriate) and Kruskal Wallis tests were used to assess differences in sample characteristics (inclusive of mental health status) according to HIV status and motherhood status. Logistic regression models were used to explore the cross-sectional associations between combined motherhood and HIV status and, likely common mental disorder/mental health comorbidities. 70.5% of participants were living with HIV and 15.2% were mothers. 8.4% were mothers living with HIV. A tenth (10.9%) of the sample were classified as reporting a probable common mental disorder and 2.8% as experiencing likely mental health comorbidities. Three core findings emerge: (1) poor mental health was elevated among adolescent mothers compared to never pregnant adolescents (measures of likely common mental disorder, mental health comorbidities, depressive, anxiety and suicidality symptoms), (2) prevalence of probable common mental disorder was highest among mothers living with HIV (23.0%) compared to other groups (Range:8.5–12.8%; Χ2 = 12.54, p = 0.006) and, (3) prevalence of probable mental health comorbidities was higher among mothers, regardless of HIV status (HIV & motherhood = 8.2%, No HIV & motherhood = 8.2%, Χ2 = 14.5, p = 0.002). Results identify higher mental health burden among adolescent mothers compared to never-pregnant adolescents, an increased prevalence of mental health burden among adolescent mothers living with HIV compared to other groups, and an elevated prevalence of mental health comorbidities among adolescent mothers irrespective of HIV status. These findings address a critical evidence gap, highlighting the commonality of mental health burden within the context of adolescent motherhood and HIV within South Africa as well as the urgent need for support and further research to ensure effective evidence-based programming is made available for this group. Existing antenatal, postnatal, and HIV care may provide an opportunity for mental health screening, monitoring, and referral. The online version contains supplementary material available at 10.1007/s10461-021-03474-8.
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4.5
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