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Development of a Psychosocial Distress Measure for Ugandan Adolescents Living with HIV

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Abstract

Psychological distress among adolescents living with HIV (ALH) has been associated with risky behaviors including non-adherence to anti-retroviral therapy, leading to increased risk for AIDS morbidity and mortality. Efforts to establish the nature, prevalence, and impact of psychological distress among ALH in Uganda are hindered by the lack of culturally relevant assessment tools. The purpose of this study was to develop and test a measure for psychological distress for Ugandan ALH aged 12–19 years (N = 508; 53.1 % female). Using a mixed method approach, we developed and tested a 25-item checklist with six subscales—anhedonia, depressive-anxiety, isolation, suicidal ideation, sleep problems, and somatization. We found adequate reliability for the scale (α = 0.89), and a satisfactory measurement structure in our confirmatory factor analyses (RMSEA <1.0, and CFI and TLI >0.90). We discuss the potential use of this culturally sensitive scale to examine psychological distress among ALH in Uganda.

Resumen

Los trastornos psicológicos entre los adolescentes que viven con el VIH (ALH) están asociados con comportamientos de riesgo y la falta de adherencia a la terapia antirretroviral (ART), lo cual conduce a un mayor riesgo de morbilidad y mortalidad por SIDA. Los esfuerzos por establecer la naturaleza, la prevalencia y el impacto de los trastornos psicológicos en Uganda se ven obstaculizados por la falta de herramientas de evaluación culturalmente pertinentes. El propósito de este estudio fue desarrollar y evaluar una medida de trastornos psicológicos entre ALH entre las edades de 12 a 19 años (N = 508; 53.1 % mujeres). Usando métodos mixtos, hemos desarrollado y probado una escala de 25 ítems con seis sub-escalas: anodinia, depresión, ansiedad, aislamiento, ideación suicida, problemas de sueño, y somatización. La escala obtuvo una confiabilidad adecuada (α = 0.89) y una estructura de medición adecuada en nuestro análisis factorial confirmatorio (RMSEA <1,0, y el CFI y TLI >0,90). Discutimos la posible utilización de esta escala culturalmente sensible para examinar la presencia de trastornos psicológicos entre ALH en Uganda.

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Acknowledgments

This study was facilitated through grants from various institutions at the University of Michigan: the Rackham School of Graduate Studies, African Studies Center, Center of African and Afro-American Studies, and the Center for Education of Women. We are especially grateful for the management and staff at the Joint Clinical Research Center, particularly those in the Pediatric Clinic for their willingness to share their time and insights, and the research assistants for the dedication and hard work towards making this project a success. We are particularly grateful to Dr. Okello James, Prof. Ssegane Musisi, Prof. Noeline Nakasujja, Dr. Hilda Kizito, Dr. Dickens Akena, and Prof. Bruno Giordani for their assistance in developing this measure, and to Ms. Hellen Nakyambadde, Ms. Ruth Nandugwa, Ms. Christine Karungi, Ms. Annet Nandudu, Mr. Tony Kiiza and Mr. Matthew Odera for their your support and direction throughout the data collection. A special thanks also to all the respondents, who so willingly labored through the interviews and focus group discussions to share their unique insights.

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Authors and Affiliations

  1. Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, 48104-2029, USA

    Massy Mutumba, Ken Resnicow, José A. Bauermeister, Gary W. Harper & Rachel C. Snow

  2. Joint Clinical Research Centre, Kampala, Uganda

    Massy Mutumba & Victor Musiime

  3. Department of Pediatrics, Makerere University College of Health Sciences, Kampala, Uganda

    Victor Musiime

  4. Survey Methodology Program, University of Michigan, Ann Arbor, MI, USA

    James M. Lepkowski

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  1. Massy Mutumba
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  2. Ken Resnicow
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  3. José A. Bauermeister
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  5. Victor Musiime
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  6. Rachel C. Snow
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Correspondence to Massy Mutumba.

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Mutumba, M., Resnicow, K., Bauermeister, J.A. et al. Development of a Psychosocial Distress Measure for Ugandan Adolescents Living with HIV. AIDS Behav 19, 380–392 (2015). https://doi.org/10.1007/s10461-014-0973-y

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