Mental health in South African adolescents living with HIV: correlates of internalising and externalising symptoms

ABSTRACT

Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa’s Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication side-effects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally.

KEYWORDS:

• HIV/AIDS
• adolescents
• mental health
• socioecological
• depression
• anxiety
• posttraumatic stress
• conduct problems

Acknowledgements

The authors wish to thank all the adolescents who participated in the research, as well as the research assistants who worked tirelessly to gather the data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

The study was supported by the Nuffield Foundation under [CPF/41513], Janssen Pharmaceutica N.V., part of the Janssen Pharmaceutical Companies of Johnson & Johnson, Evidence for HIV Prevention in Southern Africa (EHPSA), a UKAID programme managed by Mott MacDonald [MM/EHPSA/UCT/05150014], the International AIDS Society through CIPHER [155-Hod], the Regional Inter-Agency Task Team for Children Affected by AIDS - Eastern and Southern Africa (RIATT-ESA), UNFPA South Africa, UNICEF-ESARO, and the University of Oxford’s Clarendon-Green Templeton College Scholarship. Additional support for LC was provided by the European Research Council (ERC) under the European Union’s Seventh Framework Programme [FP7/2007-2013/ERC grant agreement no 313421]. Additional support for MB was provided by a New Independent Researcher Infrastructure Award from the Department of Health (Government of Western Australia). EN was supported by a Curtin University Research Fellowship. FM was funded by the Economic and Social Research Council [ES/N017447/1]. Further support for the project is received from the John Fell Fund [161/033 & 103/757], the Philip Leverhulme Trust [PLP-2014-095], and the University of Oxford’s ESRC Impact Acceleration Account (IAA) [IAA-MT13-003, 1602-KEA-189, 1311-KEA-004 & 1069-GCRF-227].