Factors associated with depression among adolescents living with HIV in Malawi.
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).


CONCLUSIONS
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.
Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA. mhkim@bcm.edu.|Baylor College of Medicine Children's Foundation Centre of Excellence Malawi, Private Bag B-397, Lilongwe 3, Malawi, Africa. mhkim@bcm.edu.
Maria H
MH
Kim
Baylor College of Medicine Children's Foundation Centre of Excellence Malawi, Private Bag B-397, Lilongwe 3, Malawi, Africa. amazenga@baylor-malawi.org.
Alick C
AC
Mazenga
Department of Medicine Baylor College of Medicine, Houston, TX, USA. xiaoyiny@bcm.edu.|Design and Analysis Core, Baylor-UT Houston Center for AIDS Research, Houston, TX, USA. xiaoyiny@bcm.edu.
Xiaoying
X
Yu
Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA. akashdevendra@hotmail.com.
Akash
A
Devandra
Department of Medicine Baylor College of Medicine, Houston, TX, USA. chi.h.nguyen@uth.tmc.edu.|Design and Analysis Core, Baylor-UT Houston Center for AIDS Research, Houston, TX, USA. chi.h.nguyen@uth.tmc.edu.
Chi
C
Nguyen
Baylor College of Medicine International Paediatric AIDS Initiative, Texas Children's Hospital, Houston, USA. saeeda@bcm.edu.
Saeed
S
Ahmed
Baylor College of Medicine Children's Foundation Centre of Excellence Malawi, Private Bag B-397, Lilongwe 3, Malawi, Africa. pnkazembe@baylor-malawi.org.
Peter N
PN
Kazembe
Department of Psychology, University of Houston, Houston, TX, USA. csharp2@central.uh.edu.
Carla
C
Sharp
D000293:Adolescent; D058445:Bullying / Q000706:statistics & numerical data; D002648:Child; D003863:Depression / Q000453:epidemiology / Q000209:etiology*; D030881:Disclosure; D004812:Epidemiologic Methods; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D011569:Psychiatric Status Rating Scales; D012574:Schools / Q000706:statistics & numerical data