The Silent Pandemic: the Impact of COVID-19 on the Mental Health of Adolescents Living with HIV

Abstract

Purpose of review: The pandemic caused by the coronavirus disease (COVID-19) has resulted in millions of confirmed cases and likely more than six million deaths globally Worldometer (2022). We sought to understand secondary mental effects in adolescents living with HIV (ALHIV) on the African continent caused by lockdowns, school closures, and other restriction measures for infection control. We reviewed the broader literature and conducted 86 retrospective chart reviews of mental health disorders of ALHIV and interventions utilized at a pediatric clinic in Eswatini.

Recent findings: ALHIVs are disproportionately affected by mental health disorders. The COVID-19 pandemic has exacerbated adverse mental health outcomes of adolescents on the African continent, especially for ALHIV. There have been many calls for researchers, clinicians, and governments to prioritize mental health in adolescents going forward.

Summary: In pediatric clinics in Eswatini, Malawi, and Uganda, there were psychosocial measures in place prior to the COVID-19 pandemic for ALHIV. After looking closely at a pediatric clinic in Eswatini, we found that many interventions were paused and new psychosocial interventions compatible with social distancing were instead utilized by clinicians. Even so, after multidisciplinary management comprising of interventions such as psychotherapy, pharmacotherapy, referral to psychologists/psychiatrists, and enrollment in peer support groups, the PHQ-9 depressions scores of ALHIV during the COVID-19 significantly improved. We found that there is a need for age-specific standardized tools to measure depression in ALHIV. Furthermore, more research is needed on the effectiveness and scope of psychosocial interventions for ALHIV post-COVID-19 throughout Eswatini and the African continent.

Keywords: Adolescents; Adolescents living with HIV (ALHIV); Africa; COVID-19; Depression; Eswatini; Mental disorders.

Fig. 1

This is a summary of mental health interventions for ALHIV in place at Baylor College of Medicine Children's Foundation - Uganda (Baylor Uganda), Baylor College of Medicine Children’s Foundation - Malawi (Baylor Malawi), and Baylor College of Medicine Children's Foundation - Eswatini (Baylor Eswatini)

Fig. 2

Number of ALHIV referred for psychosocial interventions pre-COVID-19 (2019) and post-COVID-19 (2021) at Baylor Eswatini

Fig. 3

Monthly trends between January 2019 (pre-COVID-19) and February 2022 (post-COVID-19) in the numbers of ALHIV referred for psychosocial services at Baylor Eswatini

Fig. 4

ALHIV referred for psychosocial services by year at Baylor Eswatini. There was an increase in the total number of ALHIV referred for psychosocial services from 1288 adolescents in 2019, to 1425 adolescents in 2020, to 2038 adolescents in 2021

Fig. 5

Clinical diagnoses and psychosomatic presentation of mental disorders among ALHIV at Baylor Eswatini by gender

Fig. 6

Categories of mental disorders among ALHIV from March 2020 to January 2022 identified from retrospective chart review. The most prevalent mental disorders were mood disorders (n = 55), disruptive behavioral disorders (n = 13), and anxiety disorders (n = 7)

Fig. 7

Box plot depicting improvement in PHQ-9 scores following treatment for depression in ALHIV at Baylor Eswatini