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Depression, alcohol use, and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa

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Abstract

HIV-infected pregnant women in sub-Saharan Africa are at risk for depression and alcohol abuse. Young women may be more vulnerable, but little is known about the psychosocial functioning of this population. We compared younger (18–24 years old) and older (≥25 years old) HIV-infected pregnant women initiating antiretroviral therapy (ART) in Cape Town, South Africa. Women were assessed on a range of psychosocial measures, including the Alcohol Use Disorders Identification Test and the Edinburgh Postnatal Depression Scale (EPDS). Among 625 women initiating ART, 16 % reported risky alcohol use and 21 % alcohol-related harm; these percentages were similar across age groups. When younger women were stratified by age, 37 % of 18–21 years old versus 20 % of 22–24 years old reported alcohol-related harm (p = 0.02). Overall, 11 % of women had EPDS scores suggesting probable depression, and 6 % reported self-harming thoughts. Younger women reported more depressive symptoms. Report of self-harming thoughts was 11 % in younger and 4 % in older women (p = 0.002). In multivariable analysis, age remained significantly associated with depressive symptoms and report of self-harming thoughts. Level of HIV-related stigma and report of intimate partner violence modified the association between age and depressive symptoms. Young HIV-infected pregnant women in South Africa were more likely to report depressive symptoms and self-harming thoughts compared to older women, and the youngest women reported the highest levels of alcohol-related harm. HIV-related stigma and intimate partner violence may be moderating factors. These findings have implications for maternal and infant health, underscoring the urgent need for effective targeted interventions in this vulnerable population.

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Acknowledgments

We would like to acknowledge the South African women who agreed to participate in this study as well as the Gugulethu Maternal Obstetrics Unit staff and interviewers for their logistical support. This study is funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01-HD074558). Marcia Wong is supported by the National Institute of Allergy and Infectious Disease (T32-AI100852).

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Disease, Columbia University, 622 W 168th Street, PH 8W-876, New York, NY, 10032, USA

    Marcia Wong

  2. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Level 5 Falmouth Building, Anzio Road Observatory, Cape Town, South Africa

    Landon Myer, Tamsin Phillips & Kirsty Brittain

  3. ICAP, Mailman School of Public Health, Columbia University, 722 W 168th Street, New York, NY, 10032, USA

    Allison Zerbe & Elaine J. Abrams

  4. Department of Obstetrics and Gynaecology, University of Cape Town, Level 5 Falmouth Building, Anzio Road Observatory, Cape Town, South Africa

    Greg Petro

  5. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, Unit 15, 1051 Riverside Drive, New York, NY, 10032, USA

    Claude A. Mellins & Robert H. Remien

  6. Department of Epidemiology, Mailman School of Public Health, Columbia University, 622 W 168th Street, 19th Floor, Room 110, New York, NY, 10032, USA

    Stephanie Shiau

  7. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Elaine J. Abrams

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  1. Marcia Wong
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  10. Elaine J. Abrams
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Correspondence to Marcia Wong.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Wong, M., Myer, L., Zerbe, A. et al. Depression, alcohol use, and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa. Arch Womens Ment Health 20, 149–159 (2017). https://doi.org/10.1007/s00737-016-0688-3

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