Young People, Mental and Substance Use Problems: Perspectives on The Burden, Associated Factors, and Potential for Intervention in The Context of HIV At the Kenyan Coast
Background: Mental and substance use disorders are comorbid conditions of concern in people living with HIV/AIDS (PLWHA), among them young people living with HIV (YLWH). Common mental disorders (CMDs) – mainly depressive and anxiety disorders, are the most frequent comorbid mental disorders. Alcohol use disorder is the most frequent comorbidity but use and abuse of other illicit substances (e.g., marijuana, cocaine, heroin) by PLWHA is documented. In sub-Saharan Africa (SSA), quantitative studies investigating the burden of mental and substance use problems among YLWH are limited. Additionally, qualitative enquiries on the mental health experience of YLWH are scarce. Existing interventions addressing mental health problems comorbid with HIV have almost exclusively been tested among HIV-positive adults, mostly in high-income settings. Little is known about evidence-based mental health interventions for YLWH. Thesis objectives: To: i) understand the living experiences of YLWH aged 18-24 years; ii) adapt and validate measures of CMDs for use with PLWHA, specifically the 9-item patient health questionnaire (PHQ-9) and the 7-item generalized anxiety disorder scale (GAD-7); iii) quantify the burden of common mental health and substance use problems among YLWH aged 18-24 years compared to a similar group of HIV-uninfected peers; and iv) preliminarily evaluate the acceptability and feasibility of an adapted psychological intervention called Problem Management Plus (PM+) for addressing symptoms of CMDs among YLWH (18-24 years), delivered by trained lay helpers using mobile phones. Methods: Studies in this thesis employed qualitative and/or quantitative research methods and were conducted at the Kenyan coast, in Kilifi and Mombasa Counties. Results: Findings showed that YLWH encounter a host of challenges at different levels of their socio-ecological environments – individual, family and the community levels, mostly psychosocial challenges. In particular, the psychosocial challenges of HIV stigma and discrimination were experienced at multiple levels. YLWH also experienced psychological challenges like depression and anxiety. Economic independence, social support and reliance on spirituality aided positive coping among these emerging adults amidst the challenges of living with HIV. The adapted PHQ-9 and GAD-7 proved to be reliable and valid unidimensional measurement scales for assessing depressive and anxiety symptoms. Using these measures, we observed significantly higher prevalence of CMDs among YLWH compared to HIV-uninfected young people. Conversely, we observed significantly lower prevalence of current substance use (alcohol, illicit drug use or both) among YLWH compared to HIV-uninfected young people. Negative life events, HIV-related stigma and low adherence to antiretroviral therapy were significantly associated with elevated CMDs among YLWH. Higher social support and health-related quality of life were protective against CMDs in young people with and without HIV. We observed an overlap of risk indicators for current substance use between YLWH and their HIV-uninfected peers e.g., khat chewing, male sex, and experience of negative life events. We also identified several demographic, socio-economic, psychosocial, and psychological risk indicators that were unique to either group of young people. At the Kenyan coast, the adapted PM+ is highly acceptable and feasible for delivery to YLWH with symptoms of CMDs, by trained lay helpers using mobile phones. It has the potential of addressing CMDs among YLWH. Conclusions: The findings from this thesis highlight the need for prioritization of research and interventions on CMDs and use of substances of abuse among young people at the Kenyan coast. Most of the challenges that YLWH encountered are modifiable and can be addressed through a multi-level intervention approach. The adapted PM+ intervention shows promise in addressing symptoms of CMDs among YLWH at the Kenyan coast. Future work in this setting or a similar one within SSA should focus on examining the effectiveness of the adapted PM+ in reducing CMDs among YLWH.
https://research.vu.nl/ws/files/149170047/M%20K%20%20Nyongesa%20-%20thesis.pdf
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https://research.vu.nl/ws/files/149170051/M%20K%20%20Nyongesa%20-%20toc.pdf
https://research.vu.nl/ws/files/149170053/M%20K%20%20Nyongesa%20-%20title_page.pdf
https://research.vu.nl/en/publications/4db20bfe-10a7-4650-9089-58ea34cd2a82