Steventon Roberts, Kathryn J.; (2023) Exploring the mental health of adolescent parent families affected by HIV within the Eastern Cape province of South Africa: Addressing a critical evidence gap. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Adolescent (10-19 years) pregnancy and poor adolescent mental health remain prominent global health issues. Sub-Saharan Africa has the highest rates of adolescent pregnancy globally and is the epicentre of the global HIV epidemic – both phenomena are associated with poor mental health. This thesis explores the potential synergistic impacts when adolescent pregnancy and HIV co-occur by examining i) prevalence and correlates of likely common mental disorder (CMD) among adolescent mothers, ii) the association between likely maternal CMD, HIV, and child cognitive development, iii) likely paternal CMD among the fathers of children born to adolescent mothers, and iv) whether fatherhood characteristics differ according to core maternal characteristics (e.g., HIV and mental health status). Cross-sectional data were drawn from two linked studies: the Adolescent HIV study (n=1059 adolescents living with HIV and a comparison group [n=467]), and the HEY BABY study (n=1046 young mothers and their child(ren)), undertaken between 2015-2019. Participants completed validated and study specific questionnaires including items on sociodemographic information, health and wellbeing, and parenting experience (within the HEY BABY study). Child development was assessed utilising the Mullen Scales of Early Learning (HEY BABY study). Likely CMD was measured utilising a battery of validated symptomology scales (depression, anxiety, posttraumatic stress, suicidality). Quantitative methodologies including regression modelling are utilised to explore data. Prevalence of likely CMD among adolescent mothers was 18.8% (Adolescent HIV) and 12.6% (HEY BABY). Compared to adolescent mothers not living with HIV, adolescent mothers living with HIV were more likely to report probable CMD (HEY BABY: 16.2% vs. 11.2%, X2=4.41, p=0.04). Identified risk factors (correlates) for likely CMD among adolescent mothers included violence exposure (verbal, physical or sexual abuse; OR=2.54 [95%CI:1.20-5.40], p=0.01]), exposure to community violence; (OR=2.09 [95%CI:1.33-3.27], p=0.001), and perceived lack of social support (OR=4.09 [95%CI:2.48-6.74], p=<0.0001). There was limited evidence of interactions, suggesting that the risk factors for likely CMD are similar among adolescent mothers living with and without HIV. When considering child cognitive development, maternal HIV was found to be associated with reduced child gross motor scores (B=-2.90 [95%CI:-5.35,-0.44], p=0.02), however, no associations were identified with either maternal likely CMD, nor maternal HIV status (inclusive of interaction terms). Prevalence of likely CMD among adolescent fathers was 12.5% (Adolescent HIV: n=8). Father involvement was low (HEY BABY: 19.5% were involved with their child at least once every two weeks). Adolescent mothers reporting probable CMD were less likely to be in a relationship with the father of their child (41.8% vs. 54.1%, X2=7.32, p=0.03), more likely to experience domestic violence perpetrated by the father of their child (8.2% vs. 3.3%, X2=6.07, p=0.01), and more likely to engage in arguments about finances with the father of their child (30.0% vs. 17.0%, X2=10.8, p=0.001). Findings highlight the commonality of mental health burden within the context of adolescent pregnancy and HIV, and the urgent need for effective evidence-based programming for adolescent parent families living with and affected by HIV within South Africa.

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