Author: Kwame Shanaube
Citation Style For This Article: Shanaube K. Prevalence and correlates of depressive symptoms among adolescents in a population with high prevalence of TB/HIV in Zambia and South Africa: HPTN 071 (PopART) for Youth study.. The Health Press Zambia Bull. 2020; 4(4); pp 28
Mental health is a critical and neglected public health challenge for adolescents in sub-Sahara Africa. Poor mental health accounts for a large proportion of the disease burden among adolescents. Data on potential risk factors of depression among HIV-infected and uninfected adolescents in SSA are scarce. We aimed to determine the prevalence and correlates of depressive symptoms among adolescents aged 15-19 years in 7 control communities of the HPTN071 (PopART) trial (4 in Zambia and 3 in South Africa (SA).
A cross-sectional survey was done from August-November 2017 enrolling approximately 1400 adolescents, 200-350 from each community. Communities were subdivided into blocks, each block consisted on average 50 (~40-60) households in Zambia and 80 (~70-90) households in SA. Blocks visited were randomly assigned to the study. All households within a sampling block and all adolescents aged 15-19 years residing in these households were eligible for inclusion. Written informed consent was obtained. The questionnaire was self-administered for the mental health section. HIV status was self-reported. Depression was measured by a 13-questions self-administered short Mood and Feelings Questionnaire (SMFQ). Each individual was scored by summing the 13 questions and a ≥12 cutoff of the scale response (0-26) was used to determine underlying depressive symptoms. To determine the correlates of depressive symptoms, a binomial regression model was fitted and further a subgroup analysis among those who self-reported to have engaged in sexual intercourse. Sensitivity analysis was done for different outcome definitions.
On average, 15-17 blocks with 15-22 adolescents per community were visited in Zambia and SA. A total of 1,453 and 667 adolescents in Zambia and SA respectively were administered the SMFQ and overall responses are shown in figure 1. Overall the prevalence of depressive symptoms was 432/1453; 29.7% (95% Confidence-Interval [CI]: 27.4%-32.2%) in Zambia and 152/667; 22.8% (95% CI: 19.7%-26.2%) in SA.
Community, sex, sexual intercourse, and having Presumptive-Tuberculosis (PrTB) symptoms were identified as correlates of depressive symptoms across the two countries with HIV-related stigma being specific to Zambia (Table 1). After adjusting for potential confounders; there are differences in odds of depression among communities (Table 1). In Zambia, adolescent girls were at least one and a half times more likely to experience depressive symptoms compared to boys (Odds ratio (OR)=1.58 (95%CI:1.23-2.02, p-value<0.0001). In SA, adolescents with PrTB symptoms were twice more likely to experience depressive symptoms (OR=2.25(95%CI: 1.51-3.37), p-value<0.0001), however, there was borderline evidence in Zambia (OR=1.28 (95%CI:1.0-1.65), p-value=0.05).
Adolescents who reported use of alcohol/drugs during their last sexual encounter were twice more likely to experience depressive symptoms in both countries (Zambia: OR=1.96 (95%CI:1.08-3.56), p-value=0.027; SA: OR=2.67(95%CI:1.29-5.54), p-value=0.008) as were those who did not use condoms (OR=2.29(95%CI:1.29-4.07), p-value=0.005) in SA. There was borderline evidence of depressive symptoms among adolescents who reported HIV-related stigma (OR=1.41 (95%CI: 1.09-1.82), p-value=0.009) in Zambia. Sensitivity analysis showed that the prevalence and correlates of depressive symptoms change with the change of the cut-off.
Depressive symptoms among adolescents seem to be associated with sexual and reproductive health-related issues and risk factors are different by country.