Skip to main content

Advertisement

SpringerLink
Log in

Pathways to Depression and Poor Quality of Life Among Adolescents in Western Kenya: Role of Anticipated HIV Stigma, HIV Risk Perception, and Sexual Behaviors

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Depression is a major cause of disease burden and is linked to poor quality of life (QOL) among adolescents. We examined the roles of sexual behaviors, HIV risk perception, and anticipated HIV stigma on depressive symptomatology and QOL among 4096 adolescents in a rural region of western Kenya with a high burden of HIV. Participants were aged 15–19 years, had not been tested for HIV in the previous 6 months, and had never been diagnosed with HIV. Anticipated stigma and risk perception were directly associated with depressive symptomatology and QOL. There was evidence of small indirect effects—through stigma—of risk perception on depressive symptomatology and QOL. Gender moderated relationships between sexual behavior and risk perception, depressive symptomatology, and QOL. Results suggest that developing effective gender-based interventions to address stigma, sexual behavior, and risk perception may be important for improving adolescent well-being in high HIV prevalence contexts.

Resumen

La depresión es una de las principales causas de carga de morbilidad y se asocia con una pobre calidad de vida (CdV) de los adolescentes. Nosotros estudiamos el papel de los comportamientos sexuales, la percepción de riesgo del VIH, y el estigma anticipado del VIH en relación con la sintomatología depresiva y la CdV de 4 096 adolescentes provenientes de una región rural del oeste de Kenia con alta carga de VIH. Los participantes, adolescentes de entre 15 y 19 años, no se habían hecho la prueba de detección del VIH en los últimos 6 meses y, además, nunca habían sido diagnosticados con VIH. El estigma anticipado y la percepción de riesgo estaban asociados directamente con la sintomatología depresiva y la CdV. Hubo evidencia de pocos efectos indirectos de percepción de riesgo–generados por el estigma–en la sintomatología depresiva y la CdV. El género moderó las relaciones entre el comportamiento sexual y la percepción de riesgo, la sintomatología depresiva y la CdV. Los resultados sugieren que desarrollar intervenciones con enfoque de género para abordar el tema del estigma, los comportamientos sexuales y la percepción de riesgo, puede ser importante para mejorar el bienestar de los adolescentes que viven en un contexto con alta prevalencia de VIH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Page RM, West JH. Suicide ideation and psychosocial distress in sub-Saharan African youth. Am J Health Behav. 2011;35(2):129–41.

    PubMed  Google Scholar 

  2. Swahn MH, Palmier JB, Kasirye R, Yao H. Correlates of suicide ideation and attempt among youth living in the slums of Kampala. Int J Environ Res Public Health. 2012;9(2):596–609.

    PubMed  PubMed Central  Google Scholar 

  3. James S, Reddy SP, Ellahebokus A, Sewpaul R, Naidoo P. The association between adolescent risk behaviours and feelings of sadness or hopelessness: a cross-sectional survey of South African secondary school learners. Psychol Health Med. 2017;22(7):778–89.

    PubMed  Google Scholar 

  4. Erskine HE, Moffitt TE, Copeland WE, et al. A heavy burden on young minds: the global burden of mental and substance use disorders in children and youth. Psychol Med. 2015;45(7):1551–633.

    CAS  PubMed  Google Scholar 

  5. Kassebaum N, Kyu HH, Zoeckler L, et al. Child and adolescent health from 1990 to 2015: findings from the Global Burden of Diseases, Injuries, and Risk Factors 2015 Study. JAMA Pediatr. 2017;171(6):573–92.

    PubMed  PubMed Central  Google Scholar 

  6. Patel V. Reducing the burden of depression in youth: what are the implications of neuroscience and genetics on policies and programs? J Adolesc Health. 2013;52(2):S36–S3838.

    PubMed  Google Scholar 

  7. Kagee A, Coetzee B, Toit S, Loades M. Psychosocial predictors of quality of life among South Africa adolescents receiving antiretroviral therapy. Qual Life Res. 2019;28(1):57–655.

    CAS  PubMed  Google Scholar 

  8. Skevington SM, Dehner S, Gillison FB, McGrath EJ, Lovell CR. How appropriate is the WHOQOL-BREF for assessing the quality of life of adolescents? Psychol Health. 2014;29(3):297–317.

    CAS  PubMed  Google Scholar 

  9. World Health Organization. Child and adolescent mental health [webpage]. https://www.who.int/mental_health/maternal-child/child_adolescent/en/. Accessed May 28 May 2020.

  10. GBD 2017 Child and Adolescent Health Collaborators, Reiner RC Jr, Olsen HE, et al. Diseases, injuries, and risk factors in child and adolescent health, 1990 to 2017: findings from the Global Burden of Diseases, Injuries, and Risk Factors 2017 Study. JAMA Pediatr. 2019;173(6):e190337.

    PubMed  Google Scholar 

  11. Haroz EE, Ybarra ML, Eaton WW. Psychometric evaluation of a self-report scale to measure adolescent depression: the CESDR-10 in two national adolescent samples in the United States. J Affect Disord. 2014;158:154–60.

    PubMed  PubMed Central  Google Scholar 

  12. Li JY, Li J, Liang JH, Qian S, Jia RX, Wang YQ, Xu Y. Depressive symptoms among children and adolescents in China: a systematic review and meta-analysis. Med Sci Monit. 2019;25:7459–70.

    PubMed  PubMed Central  Google Scholar 

  13. Wang L, Feng Z, Yang G, et al. Depressive symptoms among children and adolescents in western China: an epidemiological survey of prevalence and correlates. Psychiatry Res. 2016;246:267–74.

    PubMed  Google Scholar 

  14. Erskine HE, Baxter AJ, Patton G, et al. The global coverage of prevalence data for mental disorders in children and adolescents. Epidemiol Psychiatr Sci. 2017;26(4):395–402.

    CAS  PubMed  Google Scholar 

  15. Barhafumwa B, Dietrich J, Closson K, et al. High prevalence of depression symptomology among adolescents in Soweto, South Africa associated with being female and cofactors relating to HIV transmission. Vulnerable Child Youth Stud. 2016;11(3):263–73.

    Google Scholar 

  16. Khasakhala LI, Ndetei DM, Mutiso V, Mbwayo VAW, Mathai M. The prevalence of depressive symptoms among adolescents in Nairobi public secondary schools: association with perceived maladaptive parental behavior. Afr J Psychiatry. 2012;15(2):106–13.

    CAS  Google Scholar 

  17. Kilburn K, Prencipe L, Hjelm L, Peterman A, Handa S, Palermo T. Examination of performance of the Center for Epidemiologic Studies Depression Scale Short Form 10 among African youth in poor, rural households. BMC Psychiatry. 2018;18(1):1–13.

    Google Scholar 

  18. Nduna M, Jewkes RK, Dunkle KL, Shai NPJ, Colman I. Prevalence and factors associated with depressive symptoms among young women and men in the Eastern Cape Province, South Africa. J Child Adolesc Ment Health. 2013;25(1):43–544.

    PubMed  Google Scholar 

  19. Otiende M, Abubakar A, Mochamah G, et al. Psychometric evaluation of the Major Depression Inventory among young people living in Coastal Kenya. Wellcome Open Res. 2017;2:113.

    PubMed  PubMed Central  Google Scholar 

  20. Cheng Y, Li X, Lou C, et al. The association between social support and mental health among vulnerable adolescents in five cities: findings from the study of the well-being of adolescents in vulnerable environments. J Adolesc Health. 2014;55(6 Suppl):S31–S3838.

    PubMed  Google Scholar 

  21. Mngoma NF, Ayonrinde OA, Fergus S, Jeeves AH, Jolly RJ. Distress, desperation and despair: anxiety, depression and suicidality among rural South African youth. Int Rev Psychiatry. 2020. https://doi.org/10.1080/09540261.2020.1741846.

    Article  PubMed  Google Scholar 

  22. Nalugya-Sserunjogi J, Rukundo GZ, Ovuga E, Kiwuwa SM, Musisi S, Nakimuli-Mpungu E. Prevalence and factors associated with depression symptoms among school-going adolescents in Central Uganda. Child Adolesc Psychiatry Ment Health. 2016;10(1):39.

    PubMed  PubMed Central  Google Scholar 

  23. Nyundo A, Manu A, Regan M, et al. Factors associated with depressive symptoms and suicidal ideation and behaviours amongst sub-Saharan African adolescents aged 10–19 years: cross-sectional study. Trop Med Int Health. 2020;25(1):54–69.

    PubMed  Google Scholar 

  24. Osborn TL, Venturo-Conerly KE, Wasil AR, Schleider JL, Weisz JR. Depression and anxiety symptoms, social support, and demographic factors among Kenyan high school students. J Child Fam Stud. 2020;29(5):1432–43.

    Google Scholar 

  25. Grover S, Raju VV, Sharma A, Shah R. Depression in children and adolescents: a review of Indian studies. Indian J Psychol Med. 2019;41(3):216–27.

    PubMed  PubMed Central  Google Scholar 

  26. Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369(9569):1302–13.

    PubMed  Google Scholar 

  27. Gupta R, Dandu M, Packel L, et al. Depression and HIV in Botswana: a population-based study on gender-specific socioeconomic and behavioral correlates. PLoS ONE. 2010;5(12):e14252.

    PubMed  PubMed Central  Google Scholar 

  28. Kamen C, Arganbright J, Kienitz E, et al. HIV-related stigma: implications for symptoms of anxiety and depression among Malawian women. Afr J AIDS Res. 2015;14(1):67–73.

    PubMed  PubMed Central  Google Scholar 

  29. Starks TJ, Rendina HJ, Breslow AS, Parsons JT, Golub SA. The psychological cost of anticipating HIV stigma for HIV-negative gay and bisexual men. AIDS Behav. 2013;17(8):2732–41.

    PubMed  Google Scholar 

  30. Dow DE, Turner EL, Shayo AM, Mmbaga B, Cunningham CK, O'Donnell K. Evaluating mental health difficulties and associated outcomes among HIV-positive adolescents in Tanzania. AIDS Care. 2016;28(7):825–33.

    PubMed  PubMed Central  Google Scholar 

  31. Boyes ME, Cluver LD. Relationships among HIV/AIDS orphanhood, stigma, and symptoms of anxiety and depression in South African youth: a longitudinal investigation using a path analysis framework. Clin Psychol Sci. 2013;1(3):323–30.

    Google Scholar 

  32. Cluver LD, Gardner F, Operario D. Effects of stigma on the mental health of adolescents orphaned by AIDS. J Adolesc Health. 2008;42(4):410–7.

    PubMed  Google Scholar 

  33. Anderson KG, Beutel AM, Maughan-Brown B. HIV risk perceptions and first sexual intercourse among youth in Cape Town, South Africa. Int Fam Plan Perspect. 2007;33:98–105.

    PubMed  Google Scholar 

  34. Luseno WK, Iritani BJ, Maman S, et al. “If the mother does not know, there is no way she can tell the adolescent to go for drugs”: challenges in promoting health and preventing transmission among pregnant and parenting Kenyan adolescents living with HIV. Child Youth Serv Rev. 2019;103:100–6.

    PubMed  PubMed Central  Google Scholar 

  35. Travaglini LE, Himelhoch SS, Fang LJ. HIV stigma and its relation to mental, physical and social health among Black women living with HIV/AIDS. AIDS Behav. 2018;22(12):3783–94.

    PubMed  Google Scholar 

  36. Ng’eno BN, Kellogg TA, Kim AA, et al. Modes of HIV transmission among adolescents and young adults aged 10–24 years in Kenya. Int J STD AIDS. 2018;29(8):800–5.

    PubMed  PubMed Central  Google Scholar 

  37. Hallfors DD, Waller MW, Bauer D, Ford CA, Halpern CT. Which comes first in adolescence—sex and drugs or depression? Am J Prev Med. 2005;29(3):163–70.

    PubMed  Google Scholar 

  38. Cluver L, Orkin M, Boyes ME, Sherr L, Makasi D, Nikelo J. Pathways from parental AIDS to child psychological, educational and sexual risk: developing an empirically-based interactive theoretical model. Soc Sci Med. 2013;87:185–93.

    PubMed  Google Scholar 

  39. Nyamukapa CA, Gregson S, Lopman B, et al. HIV-associated orphanhood and children’s psychosocial distress: theoretical framework tested with data from Zimbabwe. Am J Public Health. 2008;98(1):133–41.

    PubMed  PubMed Central  Google Scholar 

  40. Government of Kenya MoH, National AIDS Control Council (NACC). Kenya AIDS response progress report 2016. Nairobi: NACC; 2016.

  41. Joint United Nations Programme on AIDS (UNAIDS). AIDS Info 2018. https://aidsinfo.unaids.org/. Accessed 29 Aug 2019.

  42. Cho H, Deming ME, Park J-H, Iritani B. Gender differences in HIV/HSV-2: evidence from a school support randomized controlled trial among orphaned adolescents in Kenya. AIDS Behav. 2019;23(9):2396–406.

    PubMed  Google Scholar 

  43. National AIDS and STI Control Programme (NASCOP) Kenya. Regional fact sheet (Nyanza). Kenya AIDS Indicator Survey 2012. Nairobi: NASCOP; 2014.

  44. Van Dam NT, Earleywine M. Validation of the Center for Epidemiologic Studies Depression Scale-Revised (CESD-R): pragmatic depression assessment in the general population. Psychiatry Res. 2011;186(1):128–32.

    PubMed  Google Scholar 

  45. Olagunju AT, Aina OF, Fadipe B. Screening for depression with Centre for Epidemiological Studies Depression Scale Revised and its implication for consultation–liaison psychiatry practice among cancer subjects: a perspective from a developing country. Psychooncology. 2013;22(8):1901–6.

    PubMed  Google Scholar 

  46. Skevington SM, Lotfy M, O'Connell KA. The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res. 2004;13(2):299–310.

    CAS  Google Scholar 

  47. World Health Organization (WHO). The World Health Organization Quality of Life (WHOQOL)-BREF. Geneva: World Health Organization; 2004.

    Google Scholar 

  48. Enimil A, Nugent N, Amoah C, et al. Quality of life among Ghanaian adolescents living with perinatally acquired HIV: a mixed methods study. AIDS Care. 2016;28(4):460–4.

    PubMed  Google Scholar 

  49. Ongeri L, McCulloch CE, Neylan TC, et al. Suicidality and associated risk factors in outpatients attending a general medical facility in rural Kenya. J Affect Disord. 2018;225:413–21.

    CAS  PubMed  Google Scholar 

  50. MacPherson P, Webb EL, Choko AT, et al. Stigmatising attitudes among people offered home-based HIV testing and counselling in Blantyre, Malawi: construction and analysis of a stigma scale. PLoS ONE. 2011;6(10):1–9.

    Google Scholar 

  51. Musyimi CW, Mutiso VN, Nayak SS, Ndetei DM, Henderson DC, Bunders J. Quality of life of depressed and suicidal patients seeking services from traditional and faith healers in rural Kenya. Health Qual Life Outcomes. 2017;15(1):95.

    PubMed  PubMed Central  Google Scholar 

  52. Rosseel Y. lavaan: an R package for structural equation modelling. 2012. J Stat Softw. 2012;48(2):36.

    Google Scholar 

  53. MacQuarrie KLD, Mallick L, Allen C. Sexual and reproductive health in early and later adolescence: DHS data on youth age 10–19. DHS Comparative Reports No. 45. Rockville, Maryland, USA: ICF; 2017.

  54. Obeng Gyimah S, Kodzi I, Emina J, Adjei J, Ezeh A. Adolescent sexual risk-taking in the informal settlements of Nairobi, Kenya: understanding the contributions of religion. J Relig Health. 2014;53(1):13–26.

    PubMed  Google Scholar 

  55. Kamau JW, Omigbodun OO, Bella-Awusah T, Adedokun B. Who seeks child and adolescent mental health care in Kenya? A descriptive clinic profile at a tertiary referral facility. Child Adolesc Psychiatry Ment Health. 2017;11:14.

    PubMed  PubMed Central  Google Scholar 

  56. Kiima D, Jenkins R. Mental health policy in Kenya—an integrated approach to scaling up equitable care for poor populations. Int J Ment Health Syst. 2010;4:19.

    PubMed  PubMed Central  Google Scholar 

  57. National Academies of Sciences, Engineering, and Medicine. Providing sustainable mental and neurological health care in Ghana and Kenya: Workshop summary. Washington, DC: The National Academies Press; 2016.

  58. Morrison-Beedy D, Mazurek MB. Making a case for integrating evidence-based sexual risk reduction and mental health interventions for adolescent girls. Issues Ment Health Nurs. 2019;40(11):932–41.

    PubMed  PubMed Central  Google Scholar 

  59. Burk J, Park M, Saewyc EM. A media-based school intervention to reduce sexual orientation prejudice and its relationship to discrimination, bullying, and the mental health of lesbian, gay, and bisexual adolescents in Western Canada: a population-based evaluation. Int J Environ Res Public Health. 2018;15(11):2447.

    PubMed Central  Google Scholar 

  60. Brown CH, Brincks A, Huang S, et al. Two-year impact of prevention programs on adolescent depression: an integrative data analysis approach. Prev Sci. 2018;19(Suppl 1):74–94.

    PubMed  PubMed Central  Google Scholar 

  61. Price JT, Rosenberg NE, Vansia D, et al. Predictors of HIV, HIV risk perception, and HIV worry among adolescent girls and young women in Lilongwe, Malawi. J Acquir Immune Defic Syndr. 2018;77(1):53–63.

    PubMed  PubMed Central  Google Scholar 

  62. Hill LM, Gottfredson NC, Kajula LJ, et al. Changes in anxiety and depression symptoms predict sexual risk behaviors among young men living in Dar es Salaam, Tanzania. AIDS Behav. 2018;22(5):1435–45.

    PubMed  PubMed Central  Google Scholar 

  63. Plummer ML, Ross DA, Wight D, et al. "A bit more truthful": the validity of adolescent sexual behaviour data collected in rural northern Tanzania using five methods. Sex Transm Infect. 2004;80(Suppl 2):ii49–56.

    PubMed  PubMed Central  Google Scholar 

  64. Beguy D, Kabiru CW, Nderu EN, Ngware MW. Inconsistencies in self-reporting of sexual activity among young people in Nairobi, Kenya. J Adolesc Health. 2009;45(6):595–601.

    PubMed  PubMed Central  Google Scholar 

  65. Cho H, Luseno W, Halpern C, et al. Discordance of HIV and HSV-2 biomarkers and self-reported sexual behaviour among orphan adolescents in Western Kenya. Sex Transm Infect. 2015;91(4):260–5.

    PubMed  Google Scholar 

  66. Cho H, Mbai I, Luseno WK, Hobbs M, Halpern C, Hallfors DD. School support as structural HIV prevention for adolescent orphans in Western Kenya. J Adolesc Health. 2018;62(1):44–51.

    PubMed  Google Scholar 

  67. Borgdorff MW, Kwaro D, Obor D, et al. HIV incidence in Western Kenya during scale-up of antiretroviral therapy and voluntary medical male circumcision: a population-based cohort analysis. Lancet HIV. 2018;5(5):e241–e249249.

    PubMed  Google Scholar 

  68. Hatcher AM, Gibbs A, Jewkes R, McBride R-S, Peacock D, Christofides N. Effect of childhood poverty and trauma on adult depressive symptoms among young men in Peri-urban South African settlements. J Adolesc Health. 2019;64(1):79–85.

    PubMed  Google Scholar 

  69. Teitelman AM, Jemmott JB, Bellamy SL, et al. Partner violence, power, and gender differences in South African adolescents' HIV/sexually transmitted infections risk behaviors. Health Psychol. 2016;35(7):751–60.

    PubMed  PubMed Central  Google Scholar 

  70. Maughan-Brown B, Evans M, George G. Sexual behaviour of men and women within age-disparate partnerships in South Africa: implications for young women's HIV risk. PLoS ONE. 2016;11(8):e0159162.

    PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We thank all participants for their contributions to this study. We are also grateful to the research staff at PIRE and KEMRI for their work and dedication to this research. Research reported in this publication was supported by funding from the National Institute of Mental Health and the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number R01MH102125 (Luseno, W.K., PI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The research used the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). We are grateful to Shane Hartman and research assistants at KEMRI for their important contributions to this research.

Author information

Authors and Affiliations

  1. Pacific Institute for Research and Evaluation (PIRE), 101 Conner Dr., Suite 200, Chapel Hill, NC, USA

    Winnie Kavulani Luseno & Bonita J. Iritani

  2. Independent Statistical Consultant, Chapel Hill, NC, USA

    Samuel H. Field

  3. Centre for Global Health Research, Kenya Medical Research Institute (KEMRI), Kisumu, Kenya

    Fredrick S. Odongo, Daniel Kwaro & Nyaguara Ombek Amek

  4. Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Stuart Rennie

Authors
  1. Winnie Kavulani Luseno
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuel H. Field
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bonita J. Iritani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fredrick S. Odongo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Kwaro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Nyaguara Ombek Amek
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Stuart Rennie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Winnie Kavulani Luseno.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 42 kb)

Supplementary file2 (DOCX 27 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Luseno, W.K., Field, S.H., Iritani, B.J. et al. Pathways to Depression and Poor Quality of Life Among Adolescents in Western Kenya: Role of Anticipated HIV Stigma, HIV Risk Perception, and Sexual Behaviors. AIDS Behav 25, 1423–1437 (2021). https://doi.org/10.1007/s10461-020-02980-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-020-02980-5

Keywords

Search

Navigation