Adolescent Anxiety, Depression Risks Not Directly Associated With Perinatal HIV Status

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Understanding the risk factors associated with anxiety and depression in youth can help to identify resources to support this vulnerable population.
Understanding the risk factors associated with anxiety and depression in youth can help to identify resources to support this vulnerable population.

Although youth living with perinatal HIV (PHIV) may be at increased risk for anxiety and depression, new research published in AIDS Care suggests that this increased risk may not necessarily be due to HIV-positive status. Instead, the study team found that increased risk scores correlated with a variety of social factors that may accompany PHIV but also exist in HIV-affected peers with negative HIV status.

To determine this, researchers conducted a comparative study between patients with a PHIV diagnosis (n=283) and an HIV-affected peer cohort (n=96). The PHIV group came from the Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort and the HIV-affected group was drawn from noninfected siblings, close friends of young people with PHIV, as well as other adolescents with known HIV in their families.

Mental health risks were assessed using an extensive interview and a variety of standardized risk assessment instruments for depression, anxiety, and self-esteem. The researchers then analyzed the scores using multivariate analysis to compare results both between the groups and with mean scores in the United Kingdom.

According to the researchers, “In a multivariable model for anxiety, there was no evidence for young people with PHIV having greater anxiety scores than HIV-affected young people (multivariable coefficient 0.14, 95% CI, −0.03 to 0.31).” For depression, there was no difference in the scores between the groups (multivariable coefficient 0.08, 95% CI, −0.10 to 0.25). Additionally, the study groups' mean scores for both of these factors were very close to those of the overall UK population.

However, for self-esteem, both the PHIV-positive and HIV-affected groups' mean z-scores were significantly lower than those for the United Kingdom population, differing by 2 standard deviations (P >.8).

For those in both groups who were found to have increased depression scores, researchers found associations with the following variables:

  • Being male
  • Death of one or both parents
  • Lower self-esteem
  • Worse social functioning
  • Ever having been excluded from school

For those in both groups who were found to have increased anxiety scores, researchers found associations with the following variables:

  • Having an increased number of main caregivers during childhood
  • Speaking a language other than English at home
  • Ever having felt that life was not worth living
  • Lower self-esteem
  • Worse social functioning

Clinically, increased social support may be necessary for both PHIV and HIV-affected youth, and for others with similar psychosocial factors. Although the overall study suggests that many PHIV-infected youth are “coping well,” the researchers caution that the impacts of mental health for PHIV-positive patients may be higher because of the effect of the virus on overall health.

Per the researchers, “Our findings underscore the need for young people with PHIV to be regularly screened for mental health problems. Where routine screening for anxiety and depression is not possible, [considering psychosocial factors found to be linked with mental health] may be useful for clinical staff to help identify a potentially more vulnerable sub-population to monitor and [prioritize] for assessment.”

Reference

Le Prevost M, Arenas-Pinto A, Melvin D, et al; on behalf of the Adolescents and Adults Living with Perinatal HIV (AALPHI) Steering Committee. Anxiety and depression symptoms in young people with perinatally acquired HIV and HIV affected young people in England [published online March 4, 2018]. AIDS Care. doi10.1080/09540121.2018.1441972

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