Mental health issues in Adolescents Living with HIV/AIDS

Mental health issues in Adolescents Living with HIV/AIDS | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Mental health issues in Adolescents Living with HIV/AIDS Mohammed Abdul Azeem, Kamalakshi G BHAT, Rochelle Natasha Gomes, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4540081/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract The Highly-Active Anti-Retroviral Therapy (HAART) has revolutionized the management of People Living With HIV/AIDS (PLWHA) in recent years, however with existing drawbacks with respect to drug resistance, adherence, complications, and importantly, mental health problems. Before the age of 14, half of all severe adult psychiatric issues occur, although therapy generally does not begin for another 6–23 years. We conducted a cross sectional study in adolescents in an ART centre affiliated to a tertiary care district level to assess the proportion of stigma, depression, the correlation between stigma and depression and between the CD4 count, duration/ stage of illness to stigma and depression. We administered the HIV Felt Stigma Scale (HFSS) to assess stigma and Centre for Epidemiological Studies-Depression Scale (CES-D) questionnaire to assess depression. 92.8% felt stigma and 66.3% of the study participants were moderately stigmatised. The proportion of depression was 20.5%, and a statistically significant correlation being observed in between stigma and depression (p value-0.020) and between depression and CD4 count (0.024). A statistically significant association was observed between the total Leukocyte Count and depression (0.01). Therefore, the assessment of youth for stigma leading onto depression allows early intervention in the treatment of depression before symptoms worsen, thereby overcoming a few important barriers to healthy behaviours like adherence to treatment and safer sexual behaviour and aid in reducing the harmful effects of stigma and depression among adolescents with HIV/AIDS. Trial registration number and date of application: not applicable Stigma Depression Adolescents HIV/AIDS Figures Figure 1 Figure 2 INTRODUCTION The WHOs Mental Health Action Plan, 2013–2020, integrates the themes of mental health promotion, mental disease prevention, treatment, and rehabilitation” 1 . It has been noted that in people aged between 9–17, 1 amongst 5 suffer from mental health disorder which causes some level of disability. Before the age of 14, half of all severe adult psychiatric issues occur, although therapy generally does not begin for another 6–23 years 2 . Currently there has been a gradual increase in mental health disorders among these age group and these can be worsened by pre-existing chronic debilitating disease 3 . The studies to date show that mental disorders such as anxiety and depression are more prevalent among the HIV infected adolescents 4 , 5 . The Highly Active Anti-Retroviral Therapy (HAART) has revolutionized the management of PLWHA in recent years 6 . Infected infants now have a longer lifespan, reaching adolescence; with a 54% reduction in deaths, however long-term drawbacks include drug or disease related complications, adherence to therapy, drug resistance and also mental health 6 . The mental effects of being infected and living with HIV/AIDS is greater and it affects individuals’ mental health and these children face unique psychosocial challenges such as anxiety, depression and most important of all – the stigma of being sufferers of this disease 7 . WHO suggested in 2001 that stigma related to HIV acts as barrier to treatment adherence. The prevalence of depression amongst HIV infected adolescents in various studies conducted is around 11.40 to 45.83% 8 . With this perspective we conducted this study aiming to assess the burden of stigma, depression, the correlation between the two and the correlation between the CD4 count, duration of illness, stage of disease to stigma and depression. METHODOLOGY A cross- sectional study was conducted at ART Centre affiliated to a tertiary care district level hospital in costal Karnataka between October 2019 to October 2021 where adolescents visit regularly for follow up. The study was conducted after the due permission from the authorities and IEC. The objectives were to assess – the burden of stigma and depression, to find correlation between stigma and depression and correlation between CD4 count, duration of illness and stage of disease to stigma and depression. 83 adolescents living with HIV/AIDS on ART treatment for a minimum period of 1 year duration and without any pre-existing psychiatric conditions were enrolled in the study. After taking informed consent and assent from the patient [18–19 years] and parents/guardian/caretaker [10–17 years], stigma amongst adolescents with HIV/AIDS was measured using HIV Felt Stigma Scale (HFSS) 7 and depression amongst adolescents infected with HIV/AIDS was measured using ‘Centre for Epidemiological Studies-Depression Scale’ 8 (CES-D) 8 questionnaire was administered. HFSS 7 is a 4-point Likert scale, comprising 17 questions and scores are as follows: strongly disagree-0, disagree-1, agree-2, strongly agree-3 7 . The final score is calculated and graded accordingly as follows 7 (Table 1 ). Table 1 HIV Felt Stigma Scale interpretation 7 No stigma Mild Moderate Severe HIV Felt-Stigma Scale 0–15 16–24 25–35 > 35 Target score for reference to psychologist is > 15 CES-D Scale 8 is 20 item scale. The corresponding values for each question on calculating the overall CES-D – style symptom score are 8 : Not at all/ less than one day = 0 1–2 days = 1 3–4 days = 2 5–7 days = 3 Nearly every day for 2 weeks = 3 Screening test scoring ranges 8 : Less than 16- Not Depressed 16-21- Mildly to Moderately Depressed Over 21- Possibility of Majorly Depressed Target score for reference to psychiatrist for diagnosis and treatment of depression is ≥ 16 The medical records of the adolescents were reviewed retrospectively for the details of the stage, duration of illness, recent CD4 count along with other laboratory parameters of the individuals. It is a comprehensive but concise questionnaire which took 5–10 minutes by the parents or caretakers in the OPD itself. Local translations of the questionnaire were done for language for easy understanding. Data obtained was entered in Microsoft excel, and the analysis analysis was done using SPSS Version 17.0. Statistical tests which were used for analysis are Karl Pearson Coefficient of Correlation and Chi square test. RESULTS Table 2 shows the sample characteristics. Around two-thirds had a BMI less than 5th percentile, and majority of the study population (91.6%) stayed in care homes. Both parents were dead in 59% of the study population. Also, majority of the participants were in the stage 1 of HIV (88%). Adherence to ART was seen in 96.4% of the sample population and the majority was aware about the diagnosis. About two-thirds had the disease for more than 5 years. Table 2 Sociodemographic details of the study-participants (n = 83) Variable n (%) Gender: Female Male 49 (59.0) 34 (41.0) Age- group in years 10–13 14–16 17–19 21 (25.3) 29 (34.9) 33 (39.8) Nutritional status (BMI) 85th percentile 32 (38.6) 46 (55.4) 5 (6.0) Place of stay Care homes Home 76 (91.6) 7 (8.4) Parents status Single alive Both alive Both dead 23 (27.7) 11 (13.3) 49 (59.1) Clinical staging I II IV 73 (88.0) 8 (9.6) 2 (2.4) Adherence to ART 95–100% 85-94.99% 3–5 >5 17 (20.5) 15 (18.1) 51 (61.4) 2) Laboratory data of the participants- The most used non-nucleoside reverse transcriptase inhibitor was efavirenz (39.8%) and most used nucleoside reverse transcriptase inhibitor was lamivudine (97.6%). Most common protease inhibitor was lopinavir with ritonavir (13.3%). 80.7% of the participants recent viral load testing done showed total copies not detected. 75.9% of the participants had normal CD4 count (500 and above). 56.1% of the subjects having normal Hb levels. 81.7% had normal leukocyte count. In 93.1% of the study participants platelet count was found to be below 1.5lakhs. Majority of them had normal liver enzymes (SGOT < 40 in 75%, SGPT < 40 in 88.5%). Majority of them had normal renal function tests (Serum Creatinine < 1mg/dl in 96.8%). 3) Assessment of Stigma and Depression –As seen in Fig. 1 , as per the HIV Felt Stigma Scale, majority of the study adolescents were moderately stigmatized (66.3%) and 3.6% were severely stigmatized. Also, as seen in Fig. 2 , majority (79.5%) were not depressed, while 6.1% had the possibility of major depression. 4) Association between Stigma and Depression among the HIV/ AIDS infected adolescents - No statistically significant association was observed between stigma and depression or in between stigma and sociodemographic factors or the laboratory values or in between depression and sociodemographic factors. (Table 3 ) Table 3 Correlation between stigma and depression amongst the study population (n = 83) Parameter Stigma (N = 83) Total P value 35 n % N % n % n % Depression No Depression 6 9.1 16 24.2 42 63.6 2 3 66 0.6 Mild- Moderate Depression 0 0 3 25 8 66.7 1 8.3 12 Possibility of Major Depression 0 0 0 0 5 100 0 0 5 Total 6 19 55 3 83 There is statistically significant correlation between stigma and depression among adolescents living/ infected with HIV/AIDS (p value-0.02) (Table 4 ) Table 4 Correlation between stigma with depression using Carl Pearson coefficient of correlation Variables r value P value Depression 0.255 0.020 There is no statistically significant correlation between depression and stage of disease or duration of ART but there is significant correlation between depression and CD4 Count amongst adolescents living with HIV/AIDS. (p value-0.024). Statistically significant association is noted between depression and total leukocyte count (p value- 0.01). No statistically significant Correlation noted between Stigma and Stage of disease or Duration of ART or CD4 Count using Carl Pearson coefficient of correlation (Table 5 ). Table 5 Correlation of Depression with stage of disease, duration of ART and CD4 Count using Carl Pearson coefficient of correlation Variables r value P value WHO Stage 0.001 0.996 Duration of ART 0.075 0.500 CD4 Count 0.247 0.024 DISCUSSION Adolescents living/ infected with HIV/AIDS are at risk for a spectrum of mental health issues, not only because of HIV's direct effects on the brain, but also because of the social, cultural, economic, psychological, and medical stressors and implications that come with it. The present study showed the proportion of stigma was noted to be 92.8% and most of the study participants, accounting to 66.3% were moderately stigmatised for the disease. In a study done by Hubert Barennes 11 et al in Cambodia, the perceived stigma prevalence was 43.2% in children on ART using a 47-item questionnaire. The lesser prevalence in comparison to our study could be attributed to the inclusion criteria being lower in age, and for children under the age of 7, perceived stigma, treatment and ART from the child’s experiences was from the parents/guardian’s point of view. In a prospective study conducted by Lyambai 12 et al, the Strengths and Difficulties Questionnaire (SDQ) was used to determine the mental health problems in adolescents with HIV undergoing treatment, which revealed that over 75% of the study population had mental health issues, most commonly being peer and emotional problems. There was also a significant relationship between the presence of mental health issues and levels of stigma perceived. In our study the proportion of depression was found to be 20.5% which is in comparable a systematic review and meta-analysis by Gatinet Ayano 13 et al done in 2642 adolescents with HIV/AIDS showed 26.07% of adolescents with HIV had depression. In a cross-sectional study carried out by Olashore 5 et al in Botswana in adolescents living with HIV, 99.3% had a psychiatric disorder, with depression and anxiety being the most prevalent. Depression was present in around 24% of the study participants 5 . Five studies 14 conducted in Sub Saharan African adolescents with HIV showed a prevalence ranging from 14%-26%. A study by Kemigisha 15 et al reported a prevalence of 46% among adolescents infected with HIV/AIDS in Uganda. There are wide variations in range, and this is attributed to the individual variations in terms of severity of HIV infection, existing opportunistic infections, stage of disease; the variations in tools used to assess the proportion of depression and the individual variations in terms of the presence of other mental health 13 . In our study although there was no significant association between the categorical groups of depression and stigma (mild, moderate, and severe) but a significant correlation was noted between individual stigma and depression scores. This indicates that those adolescents who were likely to score higher on the stigma score would also score positive on the depression scale. The findings of our study are in accordance with a study done by Peilian Chi et al in children infected with HIV/AIDS aged 6–12 showed significant correlation between perceived stigma, enacted stigma and depressive symptoms 15 . Dickens Akena 16 et al concluded that there was a positive association between depression, stigma and CD4 count in adults but in our study, we did not observe any statistical association between them. Present study showed significant correlation between depression with CD4 count- therefore, the lower the CD4 count, the higher are the chances of depression. The proportion of stigma and depression in our study was observed to be higher amongst females, stigma was higher in mid and late adolescent period while depression more in late adolescent period. The high prevalence is in accordance with Claude A. Mellins et al which showed there is high prevalence of psychiatric disorders among female than males 17 . In an Indian study conducted by Verma 18 et al, predictors for emotional distress in adolescents living with HIV and the mediating and moderating effects for the same were analysed; being perceived different from peers in a negative manner, strong parental control, compulsive asexuality, and anger toward parents were the major points. The present study showed high proportion of adherence to ART by adolescents whether they lived with their biological parents or at care-homes. Adequate adherence allows for regular clinical monitoring of disease parameters and essential counseling with interventions during periods of physical and emotional stress. Mellins 17 et al also concluded that youth who lived with a single parent or underwent multiple caretakers transitions due to parental loss had poorer mental health outcomes. In our study we found that most of the participants accounting to 67(80.7%) were aware of their diagnosis of HIV which is in accordance with American Academy of Paediatrics Committee which states that adolescents should be aware of their diagnosis in all cases 19 . In our study, most of the participants who scored positive on stigma and depression questionnaire had no statistical significance with CD4 count, duration of illness and stage of disease with stigma and depression. Our study is in comparison with Okawa et al and Jaime Martinez et al that showed no significant association between stigma and depression with adherence to ART 19 , 20 . Mellins 17 et al also concluded that there was no significant association between viral load and CD4 count with psychiatric disorders, and that most of the sociodemographic characteristics were not associated with psychiatric disorders. A strong point in this study is that it is one among the few in India to study the mental health issues experienced by HIV positive. We have a few recommendations to be considered in further studies: A longitudinal follow-up study could provide better understanding the correlations between stigma and depression and with other measured variables. Further studies are required to assess stigma and depression pan-India using appropriate age and gender matched controls. Studies are also required to assess the children with behavioral problems before and after appropriate interventions to analyze the efficacy of the same. The findings in our study demonstrate that an increasing stigmatising behaviour is associated with an increase in depressive symptoms, therefore there is a need for holistic treatment in creating initiatives to reduce stigma. The assessment of these individuals with high levels of stigma and depression could allow early intervention by the physician and in the treatment of depression before worsening of symptoms. Reducing HIV-related stigma and depression among HIV adolescents could help them overcome a few of the barriers to healthy behaviours like adherence to treatment and safer sexual behaviour. There is also the need for the integration of psychiatric service into the care of adolescents infected with HIV, routine screening for mental health issues and intersectoral development among the health care providers in the comprehensive management of these children. Furthermore, interventions of this nature may aid in reducing the harmful effects of stigma and depression among HIV/AIDS infected adolescents. CONCLUSIONS The participants who scored positive in the stigma scale were 92.8% with the majority, 66.3% being moderately stigmatised for the disease. Depression was noted to be 20.5% in the study population. Statistically significant correlation was observed between the stigma and depression (p value-0.020) by Carl Pearson coefficient of correlation. Statistically significant correlation was observed between depression and CD4 count (0.024) and statistically significant association was observed between depression and Total Leukocyte Count (0.01) Declarations Funding: none Conflicts of Interest/ Competing interests: none stated Availability of data and material: yes (transparent) Code availability: yes Author’s contributions: Kamalakshi G Bhat and Mohammed Abdul Azeem conceptualised the study. Mohammed Abdul Azeem collected the data, analysed, and drafted the manuscript. Rochelle Natasha Gomes and Smitha D’sa critically evaluated and helped in finalising the manuscript. All the authors read and approved the final manuscript, and are accountable for all aspects related to the study. Dr. Kamalakshi G Bhat will act as guarantor for this manuscript. Ethics approval: Approved by the Institutional Ethics Committee, Kasturba Medical College, Mangalore (IEC KMC MLR 10-19/487) Informed consent: Taken Consent for publication: Yes References Omer S (1979) Social Development [Internet]. Twenty-Fir. Vol. 22, International Social Work. Elsevier Inc.; 11–26 p. https://doi.org/10.1016/B978-0-323-52950-1.00132-2 Best A (1987) Adolescent mental health. Nursing standard (Royal College of Nursing (Great Britain): 2008;22(33):59 Adolescent health [Internet] [cited 2021 Sep 26]. https://www.who.int/health-topics/adolescent-health#tab=tab_1 Mellins CA, Malee KM (2013) Understanding the mental health of youth living with perinatal HIV infection: lessons learned and current challenges. J Int AIDS Soc 16:18593 Olashore A, Paruk S, Akanni O, Chiliza B (2023) Psychiatric disorders in adolescents living with HIV in Botswana. AIDS Res Therapy 20:2. https://doi.org/10.1186/s12981-022-00490-z Garcia-Carrion R, Villarejo BC, Villardón-Gallego L (2019) Children and adolescents’ mental health: A systematic review of interaction-based interventions in schools and communities. Vol. 10, Frontiers in Psychology American College of Obstetricians and Gynecologists’ Committee on Adolescent Health Care Mental Health Disorders in Adolescents | ACOG [Internet]. 2017 [cited 2021 Oct 5]. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2017/07/mental-health-disorders-in-adolescents LeBlanc LA, Goldsmith T, Patel DR (2003) Behavioral aspects of chronic illness in children and adolescents. Pediatr Clin North Am. ;50(4):859 – 78. 10.1016/s0031-3955(03)00072-5 . PMID: 12964698 Jimenez JC, Puig M, Ramos JC, Morales M, Asencio G, Sala AC, Castro E, Velez Santori C, Santiago L, Zorrilla C (2010) Measuring HIV felt stigma: a culturally adapted scale targeting PLWHA in Puerto Rico. AIDS Care 22(11):1314–1322. 10.1080/09540121003758481 PMID: 20665283; PMCID: PMC4803499 Center for Epidemiologic Studies Depression Scale (CES-D), NIMH. 148:148–62 Barennes H, Tat S, Reinharz D, Vibol U (2014) Perceived stigma by children on antiretroviral treatment in Cambodia. [cited 2021 Sep 28]; http://www.biomedcentral.com/1471-2431/14/300 Lyambai K, Mwape L (2018) A Case of Choma District, Zambia. Open J Psychiatry 8:97–114. https://doi.org/10.4236/ojpsych.2018.82009 . Mental Health Problems Experienced by HIV Positive Adolescents Ayano G, Demelash S, Abraha M et al (2021) The prevalence of depression among adolescent with HIV/AIDS: a systematic review and meta-analysis. AIDS Res Ther 18:23. https://doi.org/10.1186/s12981-021-00351-1 Chi P, Li X (2013) Impact of parental HIV/AIDS on children's psychological well-being: a systematic review of global literature. 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AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, pp 953–962. 8 Verma A, Kota KK, Bangar S, Rahane G, Yenbhar N, Sahay S, Child, Psychiatry A, and Mental Health (2023) 17:401–416. Doi: https://doi.org/10.1186/s13034-023-00587-x Martinez J, Harper G, Carleton RA, Hosek S, Bojan K, Glum G et al (2012) The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care STDs 26(2):108–115 Okawa S, Mwanza Kabaghe S, Mwiya M, Kikuchi K, Jimba M, Kankasa C, Ishikawa N (2018) Psychological well-being and adherence to antiretroviral therapy among adolescents living with HIV in Zambia. AIDS Care. ;30(5):634–642. doi: 10.1080/09540121.2018.1425364. Epub 2018 Jan 18. PMID: 29347827 Vranda MN, Mothi SN (2013) Psychosocial Issues of Children Infected with HIV/AIDS. Indian J Psychol Med 35(1):19–22. 10.4103/0253-7176.112195 PMID: 23833337; PMCID: PMC3701354 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4540081","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":314920840,"identity":"79005a9a-1520-454a-b0ce-9100a48f61be","order_by":0,"name":"Mohammed Abdul Azeem","email":"","orcid":"","institution":"Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India","correspondingAuthor":false,"prefix":"","firstName":"Mohammed","middleName":"Abdul","lastName":"Azeem","suffix":""},{"id":314920841,"identity":"5b0199de-3bb4-47ad-b95b-1665aa514307","order_by":1,"name":"Kamalakshi G BHAT","email":"data:image/png;base64,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","orcid":"","institution":"Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India","correspondingAuthor":true,"prefix":"","firstName":"Kamalakshi","middleName":"G","lastName":"BHAT","suffix":""},{"id":314920842,"identity":"2ecca538-5771-429e-ab22-a0382067b5f3","order_by":2,"name":"Rochelle Natasha Gomes","email":"","orcid":"","institution":"Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India","correspondingAuthor":false,"prefix":"","firstName":"Rochelle","middleName":"Natasha","lastName":"Gomes","suffix":""},{"id":314920843,"identity":"b05a880a-1dbe-4dc1-9944-b579d1d0211c","order_by":3,"name":"Smitha Sharlette Dsa","email":"","orcid":"","institution":"Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India","correspondingAuthor":false,"prefix":"","firstName":"Smitha","middleName":"Sharlette","lastName":"Dsa","suffix":""}],"badges":[],"createdAt":"2024-06-06 11:40:27","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4540081/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4540081/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":59241644,"identity":"2b323061-655c-4758-99ec-424160bf4042","added_by":"auto","created_at":"2024-06-28 05:31:14","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26463,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportion of stigma amongst the study participants (N=83)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4540081/v1/7ae0dcbcaa5604703aba1e28.png"},{"id":59241024,"identity":"3ad6c660-7a80-41ca-883f-3595322f39ba","added_by":"auto","created_at":"2024-06-28 05:23:16","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":26730,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eProportion of depression amongst study participants (N=83)\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4540081/v1/24f63ca12c4c5a1f9feb54e2.png"},{"id":59771320,"identity":"3c91fa5d-0a97-4827-801c-28e328db6617","added_by":"auto","created_at":"2024-07-06 12:10:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479171,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4540081/v1/08c3403a-a107-4afa-b37f-c45a76ca9314.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Mental health issues in Adolescents Living with HIV/AIDS","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe WHOs Mental Health Action Plan, 2013\u0026ndash;2020, integrates the themes of mental health promotion, mental disease prevention, treatment, and rehabilitation\u0026rdquo; \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. It has been noted that in people aged between 9\u0026ndash;17, 1 amongst 5 suffer from mental health disorder which causes some level of disability. Before the age of 14, half of all severe adult psychiatric issues occur, although therapy generally does not begin for another 6\u0026ndash;23 years \u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Currently there has been a gradual increase in mental health disorders among these age group and these can be worsened by pre-existing chronic debilitating disease \u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. The studies to date show that mental disorders such as anxiety and depression are more prevalent among the HIV infected adolescents\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. The Highly Active Anti-Retroviral Therapy (HAART) has revolutionized the management of PLWHA in recent years\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Infected infants now have a longer lifespan, reaching adolescence; with a 54% reduction in deaths, however long-term drawbacks include drug or disease related complications, adherence to therapy, drug resistance and also mental health\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. The mental effects of being infected and living with HIV/AIDS is greater and it affects individuals\u0026rsquo; mental health and these children face unique psychosocial challenges such as anxiety, depression and most important of all \u0026ndash; the stigma of being sufferers of this disease\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e. WHO suggested in 2001 that stigma related to HIV acts as barrier to treatment adherence. The prevalence of depression amongst HIV infected adolescents in various studies conducted is around 11.40 to 45.83%\u003csup\u003e8\u003c/sup\u003e. With this perspective we conducted this study aiming to assess the burden of stigma, depression, the correlation between the two and the correlation between the CD4 count, duration of illness, stage of disease to stigma and depression.\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eA cross- sectional study was conducted at ART Centre affiliated to a tertiary care district level hospital in costal Karnataka between October 2019 to October 2021 where adolescents visit regularly for follow up. The study was conducted after the due permission from the authorities and IEC.\u003c/p\u003e \u003cp\u003eThe objectives were to assess \u0026ndash; the burden of stigma and depression, to find correlation between stigma and depression and correlation between CD4 count, duration of illness and stage of disease to stigma and depression.\u003c/p\u003e \u003cp\u003e83 adolescents living with HIV/AIDS on ART treatment for a minimum period of 1 year duration and without any pre-existing psychiatric conditions were enrolled in the study. After taking informed consent and assent from the patient [18\u0026ndash;19 years] and parents/guardian/caretaker [10\u0026ndash;17 years], stigma amongst adolescents with HIV/AIDS was measured using HIV Felt Stigma Scale (HFSS)\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e and depression amongst adolescents infected with HIV/AIDS was measured using \u0026lsquo;Centre for Epidemiological Studies-Depression Scale\u0026rsquo;\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e (CES-D)\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e questionnaire was administered.\u003c/p\u003e \u003cp\u003eHFSS\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e is a 4-point Likert scale, comprising 17 questions and scores are as follows: strongly disagree-0, disagree-1, agree-2, strongly agree-3\u003csup\u003e7\u003c/sup\u003e. The final score is calculated and graded accordingly as follows\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eHIV Felt Stigma Scale interpretation\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo stigma\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMild\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSevere\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHIV Felt-Stigma Scale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTarget score for reference to psychologist is \u0026gt;\u0026thinsp;15\u003c/p\u003e \u003cp\u003eCES-D Scale\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e is 20 item scale. The corresponding values for each question on calculating the overall CES-D \u0026ndash; style symptom score are\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e:\u003c/p\u003e \u003cp\u003eNot at all/ less than one day\u0026thinsp;=\u0026thinsp;0\u003c/p\u003e \u003cp\u003e1\u0026ndash;2 days\u0026thinsp;=\u0026thinsp;1\u003c/p\u003e \u003cp\u003e3\u0026ndash;4 days\u0026thinsp;=\u0026thinsp;2\u003c/p\u003e \u003cp\u003e5\u0026ndash;7 days\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003eNearly every day for 2 weeks\u0026thinsp;=\u0026thinsp;3\u003c/p\u003e \u003cp\u003eScreening test scoring ranges\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e:\u003c/p\u003e \u003cp\u003eLess than 16- Not Depressed\u003c/p\u003e \u003cp\u003e16-21- Mildly to Moderately Depressed\u003c/p\u003e \u003cp\u003eOver 21- Possibility of Majorly Depressed\u003c/p\u003e \u003cp\u003eTarget score for reference to psychiatrist for diagnosis and treatment of depression is \u0026ge;\u0026thinsp;16\u003c/p\u003e \u003cp\u003eThe medical records of the adolescents were reviewed retrospectively for the details of the stage, duration of illness, recent CD4 count along with other laboratory parameters of the individuals. It is a comprehensive but concise questionnaire which took 5\u0026ndash;10 minutes by the parents or caretakers in the OPD itself. Local translations of the questionnaire were done for language for easy understanding.\u003c/p\u003e \u003cp\u003eData obtained was entered in Microsoft excel, and the analysis analysis was done using SPSS Version 17.0. Statistical tests which were used for analysis are Karl Pearson Coefficient of Correlation and Chi square test.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the sample characteristics. Around two-thirds had a BMI less than 5th percentile, and majority of the study population (91.6%) stayed in care homes. Both parents were dead in 59% of the study population. Also, majority of the participants were in the stage 1 of HIV (88%). Adherence to ART was seen in 96.4% of the sample population and the majority was aware about the diagnosis. About two-thirds had the disease for more than 5 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic details of the study-participants (n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender: Female\u003c/p\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e49 (59.0)\u003c/p\u003e \u003cp\u003e34 (41.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge- group in years\u003c/p\u003e \u003cp\u003e10\u0026ndash;13\u003c/p\u003e \u003cp\u003e14\u0026ndash;16\u003c/p\u003e \u003cp\u003e17\u0026ndash;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (25.3)\u003c/p\u003e \u003cp\u003e29 (34.9)\u003c/p\u003e \u003cp\u003e33 (39.8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNutritional status (BMI)\u003c/p\u003e \u003cp\u003e\u0026lt;5th percentile\u003c/p\u003e \u003cp\u003e5th \u0026minus;\u0026thinsp;85th percentile\u003c/p\u003e \u003cp\u003e\u0026gt;85th percentile\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (38.6)\u003c/p\u003e \u003cp\u003e46 (55.4)\u003c/p\u003e \u003cp\u003e5 (6.0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlace of stay\u003c/p\u003e \u003cp\u003eCare homes\u003c/p\u003e \u003cp\u003eHome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76 (91.6)\u003c/p\u003e \u003cp\u003e7 (8.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents status\u003c/p\u003e \u003cp\u003eSingle alive\u003c/p\u003e \u003cp\u003eBoth alive\u003c/p\u003e \u003cp\u003eBoth dead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23 (27.7)\u003c/p\u003e \u003cp\u003e11 (13.3)\u003c/p\u003e \u003cp\u003e49 (59.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClinical staging\u003c/p\u003e \u003cp\u003eI\u003c/p\u003e \u003cp\u003eII\u003c/p\u003e \u003cp\u003eIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e73 (88.0)\u003c/p\u003e \u003cp\u003e8 (9.6)\u003c/p\u003e \u003cp\u003e2 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAdherence to ART\u003c/p\u003e \u003cp\u003e95\u0026ndash;100%\u003c/p\u003e \u003cp\u003e85-94.99%\u003c/p\u003e \u003cp\u003e\u0026lt;85%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (96.4)\u003c/p\u003e \u003cp\u003e1 (1.2)\u003c/p\u003e \u003cp\u003e2 (2.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePast History of Tuberculosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (18.1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAware about diagnosis of HIV\u003c/p\u003e \u003cp\u003eYes\u003c/p\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e67 (80.7)\u003c/p\u003e \u003cp\u003e16 (19.27)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of HIV disease (years)\u003c/p\u003e \u003cp\u003e1\u0026ndash;3\u003c/p\u003e \u003cp\u003e\u0026gt;3\u0026ndash;5\u003c/p\u003e \u003cp\u003e\u0026gt;5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 (20.5)\u003c/p\u003e \u003cp\u003e15 (18.1)\u003c/p\u003e \u003cp\u003e51 (61.4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"2\"\u003e2) Laboratory data of the participants-\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe most used non-nucleoside reverse transcriptase inhibitor was efavirenz (39.8%) and most used nucleoside reverse transcriptase inhibitor was lamivudine (97.6%). Most common protease inhibitor was lopinavir with ritonavir (13.3%). 80.7% of the participants recent viral load testing done showed total copies not detected. 75.9% of the participants had normal CD4 count (500 and above). 56.1% of the subjects having normal Hb levels. 81.7% had normal leukocyte count. In 93.1% of the study participants platelet count was found to be below 1.5lakhs. Majority of them had normal liver enzymes (SGOT\u0026thinsp;\u0026lt;\u0026thinsp;40 in 75%, SGPT\u0026thinsp;\u0026lt;\u0026thinsp;40 in 88.5%). Majority of them had normal renal function tests (Serum Creatinine\u0026thinsp;\u0026lt;\u0026thinsp;1mg/dl in 96.8%).\u003c/p\u003e \u003cp\u003e3) Assessment of Stigma and Depression \u0026ndash;As seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, as per the HIV Felt Stigma Scale, majority of the study adolescents were moderately stigmatized (66.3%) and 3.6% were severely stigmatized.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAlso, as seen in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, majority (79.5%) were not depressed, while 6.1% had the possibility of major depression.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e4) Association between Stigma and Depression among the HIV/ AIDS infected adolescents -\u003c/p\u003e \u003cp\u003eNo statistically significant association was observed between stigma and depression or in between stigma and sociodemographic factors or the laboratory values or in between depression and sociodemographic factors. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between stigma and depression amongst the study population (n\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eParameter\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"8\" nameend=\"c9\" namest=\"c2\"\u003e \u003cp\u003eStigma (N\u0026thinsp;=\u0026thinsp;83)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;15\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e16\u0026ndash;24\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eN\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e63.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild- Moderate Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e66.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e8.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePossibility of Major Depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c10\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c11\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere is statistically significant correlation between stigma and depression among adolescents living/ infected with HIV/AIDS (p value-0.02) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCorrelation between stigma with depression using Carl Pearson coefficient of correlation\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThere is no statistically significant correlation between depression and stage of disease or duration of ART but there is significant correlation between depression and CD4 Count amongst adolescents living with HIV/AIDS. (p value-0.024). Statistically significant association is noted between depression and total leukocyte count (p value- 0.01). No statistically significant Correlation noted between Stigma and Stage of disease or Duration of ART or CD4 Count using Carl Pearson coefficient of correlation (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eCorrelation of Depression with stage of disease, duration of ART and CD4 Count using Carl Pearson coefficient of correlation\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003er value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWHO Stage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.996\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of ART\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCD4 Count\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eAdolescents living/ infected with HIV/AIDS are at risk for a spectrum of mental health issues, not only because of HIV's direct effects on the brain, but also because of the social, cultural, economic, psychological, and medical stressors and implications that come with it.\u003c/p\u003e \u003cp\u003eThe present study showed the proportion of stigma was noted to be 92.8% and most of the study participants, accounting to 66.3% were moderately stigmatised for the disease. In a study done by Hubert Barennes\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e et al in Cambodia, the perceived stigma prevalence was 43.2% in children on ART using a 47-item questionnaire. The lesser prevalence in comparison to our study could be attributed to the inclusion criteria being lower in age, and for children under the age of 7, perceived stigma, treatment and ART from the child\u0026rsquo;s experiences was from the parents/guardian\u0026rsquo;s point of view. In a prospective study conducted by Lyambai\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e et al, the Strengths and Difficulties Questionnaire (SDQ) was used to determine the mental health problems in adolescents with HIV undergoing treatment, which revealed that over 75% of the study population had mental health issues, most commonly being peer and emotional problems. There was also a significant relationship between the presence of mental health issues and levels of stigma perceived.\u003c/p\u003e \u003cp\u003eIn our study the proportion of depression was found to be 20.5% which is in comparable a systematic review and meta-analysis by Gatinet Ayano\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e et al done in 2642 adolescents with HIV/AIDS showed 26.07% of adolescents with HIV had depression. In a cross-sectional study carried out by Olashore\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e et al in Botswana in adolescents living with HIV, 99.3% had a psychiatric disorder, with depression and anxiety being the most prevalent. Depression was present in around 24% of the study participants\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Five studies\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e conducted in Sub Saharan African adolescents with HIV showed a prevalence ranging from 14%-26%. A study by Kemigisha\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e et al reported a prevalence of 46% among adolescents infected with HIV/AIDS in Uganda. There are wide variations in range, and this is attributed to the individual variations in terms of severity of HIV infection, existing opportunistic infections, stage of disease; the variations in tools used to assess the proportion of depression and the individual variations in terms of the presence of other mental health\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study although there was no significant association between the categorical groups of depression and stigma (mild, moderate, and severe) but a significant correlation was noted between individual stigma and depression scores. This indicates that those adolescents who were likely to score higher on the stigma score would also score positive on the depression scale. The findings of our study are in accordance with a study done by Peilian Chi et al in children infected with HIV/AIDS aged 6\u0026ndash;12 showed significant correlation between perceived stigma, enacted stigma and depressive symptoms\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eDickens Akena\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e et al concluded that there was a positive association between depression, stigma and CD4 count in adults but in our study, we did not observe any statistical association between them. Present study showed significant correlation between depression with CD4 count- therefore, the lower the CD4 count, the higher are the chances of depression.\u003c/p\u003e \u003cp\u003eThe proportion of stigma and depression in our study was observed to be higher amongst females, stigma was higher in mid and late adolescent period while depression more in late adolescent period. The high prevalence is in accordance with Claude A. Mellins et al which showed there is high prevalence of psychiatric disorders among female than males\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. In an Indian study conducted by Verma\u003csup\u003e\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e et al, predictors for emotional distress in adolescents living with HIV and the mediating and moderating effects for the same were analysed; being perceived different from peers in a negative manner, strong parental control, compulsive asexuality, and anger toward parents were the major points.\u003c/p\u003e \u003cp\u003eThe present study showed high proportion of adherence to ART by adolescents whether they lived with their biological parents or at care-homes. Adequate adherence allows for regular clinical monitoring of disease parameters and essential counseling with interventions during periods of physical and emotional stress. Mellins\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e et al also concluded that youth who lived with a single parent or underwent multiple caretakers transitions due to parental loss had poorer mental health outcomes. In our study we found that most of the participants accounting to 67(80.7%) were aware of their diagnosis of HIV which is in accordance with American Academy of Paediatrics Committee which states that adolescents should be aware of their diagnosis in all cases\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn our study, most of the participants who scored positive on stigma and depression questionnaire had no statistical significance with CD4 count, duration of illness and stage of disease with stigma and depression. Our study is in comparison with Okawa et al and Jaime Martinez et al that showed no significant association between stigma and depression with adherence to ART\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. Mellins\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e et al also concluded that there was no significant association between viral load and CD4 count with psychiatric disorders, and that most of the sociodemographic characteristics were not associated with psychiatric disorders.\u003c/p\u003e \u003cp\u003eA strong point in this study is that it is one among the few in India to study the mental health issues experienced by HIV positive. We have a few recommendations to be considered in further studies: A longitudinal follow-up study could provide better understanding the correlations between stigma and depression and with other measured variables. Further studies are required to assess stigma and depression pan-India using appropriate age and gender matched controls. Studies are also required to assess the children with behavioral problems before and after appropriate interventions to analyze the efficacy of the same.\u003c/p\u003e \u003cp\u003eThe findings in our study demonstrate that an increasing stigmatising behaviour is associated with an increase in depressive symptoms, therefore there is a need for holistic treatment in creating initiatives to reduce stigma. The assessment of these individuals with high levels of stigma and depression could allow early intervention by the physician and in the treatment of depression before worsening of symptoms. Reducing HIV-related stigma and depression among HIV adolescents could help them overcome a few of the barriers to healthy behaviours like adherence to treatment and safer sexual behaviour. There is also the need for the integration of psychiatric service into the care of adolescents infected with HIV, routine screening for mental health issues and intersectoral development among the health care providers in the comprehensive management of these children. Furthermore, interventions of this nature may aid in reducing the harmful effects of stigma and depression among HIV/AIDS infected adolescents.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eThe participants who scored positive in the stigma scale were 92.8% with the majority, 66.3% being moderately stigmatised for the disease.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDepression was noted to be 20.5% in the study population.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStatistically significant correlation was observed between the stigma and depression (p value-0.020) by Carl Pearson coefficient of correlation.\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eStatistically significant correlation was observed between depression and CD4 count (0.024) and statistically significant association was observed between depression and Total Leukocyte Count (0.01)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eFunding: none\u003c/p\u003e\n\u003cp\u003eConflicts of Interest/ Competing interests: none stated\u003c/p\u003e\n\u003cp\u003eAvailability of data and material: yes (transparent)\u003c/p\u003e\n\u003cp\u003eCode availability: yes\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthor\u0026rsquo;s contributions: Kamalakshi G Bhat and Mohammed Abdul Azeem conceptualised the study. Mohammed Abdul Azeem collected the data, analysed, and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003eRochelle Natasha Gomes and Smitha D\u0026rsquo;sa critically evaluated and helped in finalising the manuscript. All the authors read and approved the final manuscript, and are accountable for all aspects related to the study. Dr. Kamalakshi G Bhat will act as guarantor for this manuscript.\u003c/p\u003e\n\u003cp\u003eEthics approval: Approved by the Institutional Ethics Committee, Kasturba Medical College, Mangalore (IEC KMC MLR 10-19/487)\u003c/p\u003e\n\u003cp\u003eInformed consent: Taken\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConsent for publication: Yes\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOmer S (1979) Social Development [Internet]. Twenty-Fir. Vol. 22, International Social Work. 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PMID: 29347827\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVranda MN, Mothi SN (2013) Psychosocial Issues of Children Infected with HIV/AIDS. Indian J Psychol Med 35(1):19\u0026ndash;22. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/0253-7176.112195\u003c/span\u003e\u003cspan address=\"10.4103/0253-7176.112195\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 23833337; PMCID: PMC3701354\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Stigma, Depression, Adolescents, HIV/AIDS","lastPublishedDoi":"10.21203/rs.3.rs-4540081/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4540081/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe Highly-Active Anti-Retroviral Therapy (HAART) has revolutionized the management of People Living With HIV/AIDS (PLWHA) in recent years, however with existing drawbacks with respect to drug resistance, adherence, complications, and importantly, mental health problems. Before the age of 14, half of all severe adult psychiatric issues occur, although therapy generally does not begin for another 6\u0026ndash;23 years. We conducted a cross sectional study in adolescents in an ART centre affiliated to a tertiary care district level to assess the proportion of stigma, depression, the correlation between stigma and depression and between the CD4 count, duration/ stage of illness to stigma and depression. We administered the HIV Felt Stigma Scale (HFSS) to assess stigma and Centre for Epidemiological Studies-Depression Scale (CES-D) questionnaire to assess depression. 92.8% felt stigma and 66.3% of the study participants were moderately stigmatised. The proportion of depression was 20.5%, and a statistically significant correlation being observed in between stigma and depression (p value-0.020) and between depression and CD4 count (0.024). A statistically significant association was observed between the total Leukocyte Count and depression (0.01). Therefore, the assessment of youth for stigma leading onto depression allows early intervention in the treatment of depression before symptoms worsen, thereby overcoming a few important barriers to healthy behaviours like adherence to treatment and safer sexual behaviour and aid in reducing the harmful effects of stigma and depression among adolescents with HIV/AIDS.\u003c/p\u003e \u003cp\u003eTrial registration number and date of application: not applicable\u003c/p\u003e","manuscriptTitle":"Mental health issues in Adolescents Living with HIV/AIDS","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-28 05:23:09","doi":"10.21203/rs.3.rs-4540081/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"66e116ce-cd60-49e9-be88-7affc8253aa7","owner":[],"postedDate":"June 28th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-07-13T03:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-06-28 05:23:09","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4540081","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4540081","identity":"rs-4540081","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}