A description of the mental health outcomes of HIV positive adolescents accessing care in Johannesburg
| Autor: | Woollett, Nataly Caren |
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| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Druh dokumentu: | Diplomová práce |
| Popis: | A thesis completed by published work. Submitted to the School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, in fulfillment of the requirements for the degree of Doctor of Philosophy. johannesburg, South Africa. September, 2017. Background: Adolescents living with HIV are an emerging group in the global HIV/AIDS epidemic. Mental health in this population impacts HIV care, treatment, consequential morbidity and secondary transmission. Perinatally infected HIV positive adolescents (PIA) have high prevalence of mental health disorders; loss and bereavement are particularly pervasive in their lives, however little is known about the mental health of PIA retained in care in South Africa. How PIA beliefs concerning their HIV infection are affected by the cumulative effect of bereavement (particularly of parents), the failure to disclose to them the cause of death and the manner in which they learn their own HIV positive status, is a subject understudied. Similarly, there is a paucity of research on effective ways to manage such bereavement. Resilience, or positive adaptation to challenging situations, may be particularly important for PIA, who are exposed to significant stigma, risks and stressors. However, there is limited research regarding adolescents in South Africa, partly because section 71 of the National Health Act (NHA) requires parental or guardian's consent. This presents a significant barrier to research on HIV infected adolescents aged under 18 years. The aim of this research is to describe the mental health of HIV positive adolescents (13-19 years) accessing care and treatment in Johannesburg and generate evidence to inform mental health policy for this population in South Africa. The study describes the mental health outcomes of this population with a focus on how bereavement and disclosure impacts on mental health, as well as how resilience is manifest in this group. Methods: Prior to commencement of the research, an order was obtained from the High Court in Johannesburg as upper guardian of minor children for the statutory parental or guardian’s consent. For the thesis, data from three studies are presented in five published papers. These studies were conducted using a combination of qualitative and quantitative techniques resulting in a mixed methods study design. For the quantitative study, HIV positive adolescents aged 13-19 years (n=343) accessing five pediatric antiretroviral clinics in Johannesburg were assessed using standardized measures for depression (Children’s Depression Inventory), anxiety (Children’s Manifext Anxiety Scale), post traumatic stress disorder (PTSD) (Child PTSD Checklist) and suicidality (MINI International Psychiatric Interview). In addition to mental health, the survey captured information regarding HIV, sexual reproductive health and coping. Descriptive and bivariate analyses were conducted on all variables using Statistica v13. Two qualitative studies were conducted. The first purposively selected 25 participants from the larger study. The aim was to identify elements of resilience through in-depth interviews in this group of PIA. The second identified the most and least symptomatic participants (n=26) from the larger cohort on scores for mental health (depression, anxiety, post traumatic stress disorder, suicidality). Drawings and written accounts of the loss of a significant attachment figure of participants were assessed and compared by professionals (art therapists, psychologists, social workers and counsellors) in three focus group discussions. The goal of this study was to understand the influence of bereavement on mental health and the use of drawing and writing in expressing the experience of loss. Data were analysed in NVIVO 10 using a thematic approach to coding. The final paper details the process of obtaining ethical approval for research with adolescents in public health facilities through a case study (this PhD). Results: Of the enrolled 343 participants, 27% were symptomatic for depression, anxiety or PTSD; 24% reported suicidality. Results indicated high rates of comorbidity amongst depression, anxiety and PTSD. Females scored significantly higher for depression (p LG2018 |
| Databáze: | Networked Digital Library of Theses & Dissertations |
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