Longitudinal study of emerging mental health concerns in youth perinatally infected with HIV and peer comparisons

Abstract

Objective: Cross-sectional research indicates high rates of mental health concerns among youth with perinatal HIV infection (PHIV), but few studies have examined emerging psychiatric symptoms over time.

Methods: Youth with PHIV and peer comparisons who were HIV-exposed but uninfected or living in households with HIV-infected family members (HIV-affected) and primary caregivers participated in a prospective, multisite, longitudinal cohort study. Groups were compared for differences in the incidence of emerging psychiatric symptoms during 2 years of follow-up and for differences in psychotropic drug therapy. Logistic regression models were used to evaluate the association of emerging symptoms with HIV status and psychosocial risk factors.

Results: Of 573 youth with study entry assessments, 92% attended at least 1 annual follow-up visit (PHIV: 296; comparisons: 229). A substantial percentage of youth who did not meet symptom criteria for a psychiatric disorder at study entry did so during follow-up (PHIV = 36%; comparisons = 42%). In addition, those who met criteria at study entry often met criteria during follow-up (PHIV = 41%; comparisons = 43%). Asymptomatic youth with PHIV were significantly more likely to receive psychotropic medication during follow-up than comparisons. Youth with greater HIV disease severity (entry CD4% <25% vs 25% or more) had higher probability of depression symptoms (19% vs 8%, respectively).

Conclusions: Many youth in families affected by HIV are at risk for development of psychiatric symptoms.

Figure 1

Cumulative prevalence of targeted CASI-4R psychiatric problems (Child or Caregiver Report) from study entry to 2-year follow-up by HIV status. Note: CASI-4R, Child and Adolescent Symptom Inventory-4R; ADHD, attention-deficit hyperactivity disorder; PHIV, perinatally infected HIV; Disruptive behaviors, oppositional defiant disorder, or conduct disorder; depression, dysthymia or major depressive episode; anxiety, generalized anxiety or separation anxiety disorder.

Figure 2

Incidence of emerging symptoms based on CASI-4R Screening Cutoff Scores (Child or Caregiver Report) within 2 years of follow-up (exact 95% CIs) by HIV status. Note: CASI-4R, Child and Adolescent Symptom Inventory-4R; ADHD, attention-deficit hyperactivity disorder; PHIV, perinatally infected HIV; Disruptive behaviors, oppositional defiant disorder, or conduct disorder; depression, dysthymia or major depressive episode; anxiety, generalized anxiety or separation anxiety disorder.