Factors associated with depression among adolescents living with HIV in Malawi.
Factors associated with depression among adolescents living with HIV in Malawi.
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DOI：
10.1186/s12888-015-0649-9
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发表时间：
2015-10-26
期刊：
影响因子：
4.4
通讯作者：
Sharp C
中科院分区：
文献类型：
--
作者：
Kim MH;Mazenga AC;Yu X;Devandra A;Nguyen C;Ahmed S;Kazembe PN;Sharp C
先前的研究表明，在感染艾滋病毒的青年中，抑郁症的发病率很高，对治疗结果产生了不利影响。关于撒哈拉以南非洲感染艾滋病毒的青年中抑郁的潜在危险因素的数据很少。这项横断面研究旨在确定马拉维12-18岁艾滋病毒携带者中与抑郁相关的促成/保护因素。采用Beck抑郁量表II版(BDI-II)和修订后的儿童抑郁评定量表(CDRS-R)对抑郁进行测量。收集了被认为可能有助于/保护的变量的数据，包括：社会人口学、过去的创伤事件/应激源、行为因素/社会支持和生物临床参数。采用卡方检验或两样本t检验探讨各因素与抑郁的关系。通过线性/Logistic回归进行附加检验，根据年龄和性别进行调整，确定候选变量(p <； 0.1)。最终的回归模型包括具有显著主效应和交互作用的变量。在562名参与者中(平均年龄14.5岁[SD 2.0]；女性56.1%)，抑郁症的患病率为18.9%。在多元线性回归分析中，与BDI-II评分相关的变量有：女性、受教育年限较短、家庭/家庭死亡、学期/课程不及格、有男朋友/女朋友、未披露或未与他人分享艾滋病病毒情况、较严重的免疫抑制和因服药而被欺负。11.6%的受访者报告了欺凌行为。我们发现了显著的交互作用：年龄偏低、对外貌不满意的年龄较大的参与者BDI-II得分较高。多因素Logistic回归分析显示，与抑郁相关的因素有：年龄较大，OR1.23(95%可信区间1.07~1.42)；受教育年限较少，OR 3.30(95%可信区间1.54~7.05)；因服药被欺负(OR 4.20(95%可信区间2.29~7.69))。受教育年限较少和因服药而受到欺凌最明显地与抑郁有关。支持艾滋病毒感染青少年心理健康需求的方案，解决诸如披露、教育支持以及最显著的欺凌等问题，可能会改善治疗结果，并建议这样做。
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. 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. 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). 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.