Understanding mental health difficulties and associated psychosocial outcomes in adolescents in the HIV clinic at Kenyatta National Hospital, Kenya

Background: Globally adolescents continue to have an upward trend in HIV incidence and AIDS-related mortality. The interplay between the rapid physical growth, sexual maturation, and enormous albeit slow-evolving cognitive and psychological changes in adolescence may partly explain this trend. Our main purpose was to highlight key psychosocial characteristics of HIV-infected adolescents and explore if these characteristics are associated with depression symptoms. Methods: From August to December 2016 after obtaining informed consent, adolescents living with HIV at Kenyatta National Hospital were interviewed using the Home environment, Education and Employment, Activity, Sexuality, Suicide and depression traits (HEADSS) tool combined with the Patient Health Questionnaire (PHQ-9) to elucidate which key symptoms of depression and link with psychosocial characteristics mapped on HEADSS. In order to determine which psychosocial characteristics were linked with risk of depression, the traits of adolescents who were symptomatic were compared to those who were not using univariate and multivariate regression analysis. Results: All the 270 adolescents offered participation in the study accepted to enroll. The aged 10-19 years were recruited and mean age was 14.75 and 53.7% (n = 145) were males. Overall, 269 (99.9%) were still in school and 52.6% of the adolescents had symptoms of depression. The independent predictors of depression were being of ages 15-19 years [OR = 2.34 (95% CI 1.36, 4.04) P < 0.02], ever repeating classes [OR = 1.74 (95% CI 1.0-3.05) P = 0.05], ever being sent away from school due to lack of school fees [OR = 1.71 (95% CI 1.0-2.91) P = 0.05], and non-adherence to medication [OR = 1.84 (95% CI 1.08-3.14) P = 0.03. Missing of meals due to food insecurity was associated with an important trend towards increased risk of depression [OR = 2.42 (CI 0.96-6.14) P = 0.06]. Conclusion: One in two of the adolescents interviewed had depression symptoms which were significantly associated with lack of school fees, missing meals, non-adherence to medication, and substance abuse.