Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Jan-Dec:23:23259582241298166.
doi: 10.1177/23259582241298166.

'You Are Always Worried and Have No Peace, You Cannot Be a Normal Adolescent': A Qualitative Study of the Effects of Mental Health Problems on the Social Functioning of Adolescents Living with HIV in Uganda

Esther Kalule Nanfuka  1 , Agatha Kafuko  1 , Rita Nakanjako  2 , James Thomas Ssenfuuma  1 , David Kaawa-Mafigiri  1
Affiliations

'You Are Always Worried and Have No Peace, You Cannot Be a Normal Adolescent': A Qualitative Study of the Effects of Mental Health Problems on the Social Functioning of Adolescents Living with HIV in Uganda

Esther Kalule Nanfuka et al. J Int Assoc Provid AIDS Care. 2024 Jan-Dec.

Abstract

Adolescents living with HIV (ALHIV) are at heightened risk of experiencing mental health problems. However, research on the impact of mental health problems on ALHIV's everyday life is scanty. This article explores the effects of anxiety, depression and suicidal behaviour on the social functioning of ALHIV in a low-resource setting. The three mental health conditions were screened using the Patient Health Questionnaire modified for adolescents (PHQ-A) and Screen for Child Anxiety Related Disorder (SCARED), while social functioning was defined by normative role expectations of adolescents in the study setting. We conducted in-depth interviews with 31 ALHIV receiving care at two hospitals in Central Uganda. Data were analysed using thematic analysis techniques. We found that mental health problems impair the social functioning of ALHIV by obstructing them from realising normative expectations of adolescents within their socio-cultural milieu, including academic excellence, maintaining amicable relationships and good physical health. In a context of scarcity, impaired social functioning has grave implications for ALHIV's physical, psychological and social and economic wellbeing and concomitantly HIV treatment outcomes in the immediate and long term. Integration of mental health into HIV care is imperative, if the global goal to end AIDS is to be achieved.

Keywords: Uganda; adolescents living with HIV; anxiety; depression; mental health; social functioning; suicidal behaviour.

Plain language summary

The effects of mental health problems on the daily lives and functioning of adolescents living with HIV in UgandaAdolescents living with HIV (ALHIV) have an elevated risk of suffering from mental health problems particularly depression, anxiety and suicidal behaviour (which includes suicidal ideation, suicide attempts and self-harm) compared to their negative peers. In spite of the high burden of mental health problems among ALHIV, there is little research on how they impact their daily life and functioning. This article examines the effects of depression, anxiety and suicidal behaviour on ALHIV’s ability to meet standards of behaviour, attitudes and roles and responsibilities expected of adolescents in their communities. Interviews were held with 31 ALHIV receiving HIV treatment at two health facilities in Uganda. We found that having suicidal behaviour and symptoms of depression and anxiety made it immensely difficult for ALHIV to live by expected standards for adolescents in their communities, including academic excellence, ability to initiate and maintain good relationships with others in their social network and looking physically healthy. In a low-resource setting, problems in conforming to expected social and behavioural standards increases ALHIV’s risk for social isolation, poverty and poor physical and mental health and consequently poor HIV treatment adherence in the present and future. High levels of adherence to HIV treatment are critical for ending the HIV/AIDS epidemic. Therefore, it is important that the mental health needs of ALHIV are urgently addressed by integrating mental health into child and adolescent HIV care, if real progress towards achieving the global goal to end HIV/AIDS by 2030 is to be realised.

PubMed Disclaimer

Conflict of interest statement

Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

    1. Bonnie RJ, Backes EP, Alegria M, Diaz A, Brindis CD. Fulfilling the promise of adolescence: realizing opportunity for all youth. J Adolesc Health. 2019;65(4):440-442. doi: 10.1016/j.jadohealth.2019.07.018 - DOI - PubMed
    1. Laurenzi CA, Gordon S, Abrahams N, et al. Psychosocial interventions targeting mental health in pregnant adolescents and adolescent parents: a systematic review. Reprod Health. 2020;17:1-5. doi: 10.1002/jia2.25556 - DOI - PMC - PubMed
    1. World Health Organisation. Mental health of adolescents: key facts; 2021. Accessed March 3, 2024. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
    1. Shorey S, Ng ED, Wong CH. Global prevalence of depression and elevated depressive symptoms among adolescents: a systematic review and meta-analysis. Br J Clin Psychol. 2021;61(2):287-305. - PubMed
    1. United Nations Children’s Fund. Mental health: ensuring mental health and well-being in an adolescent’s formative years can foster a better transition from childhood to adulthood; 2023. Accessed March 10, 2024. https://data.unicef.org/topic/child-health/mental-health/#status.