Speaker
Description
Background: Adolescent girls and young women (AGYW) living with HIV are at increased risk of peripartum depression, which negatively affects maternal wellbeing and HIV care outcomes. This elevated risk is driven by multiple factors, including HIV-related stigma, recent HIV diagnosis, intimate partner violence, and limited social support. To inform the development of targeted perinatal mental health interventions, we assessed the prevalence of, and factors associated with peripartum depression among AGYW living with HIV in Kenya.
Methods: We utilized baseline data from an ongoing hybrid cluster-randomized clinical trial running across 30 facilities in Kenya evaluating the effectiveness of a brief transdiagnostic psychological intervention among AGYW between ages 16–24 years with depressive symptoms (Patient Health Questionnaire-9 [PHQ-9] scores>4). In addition to sociodemographic and psychosocial assessments, pregnant and postpartum AGYW (within one year of delivery) completed the Edinburgh Postnatal Depression Scale (EPDS); scores >8 were considered indicative of a positive screen for peripartum depression. Descriptive statistics summarized participant characteristics and estimated the prevalence of peripartum depression. Bivariate logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for factors associated with positive EPDS screening.
Results: Of the 399/600 (66.5%) AGYW enrolled, 70 (17.5%) were pregnant or postpartum and completed EPDS screening. Among these participants, 49 (70%) were breastfeeding, 36 (59%) had completed secondary education, and 39 (56%) had a single parent. Their mean age was 21.9-23 years of age. Overall, 54 (77%) screened positive for peripartum depression (EPDS >8). In addition, 54 (77%) screened positive for depressive symptoms (PHQ-9 >4), 18 (26%) for anxiety (GAD-7 >9) while 20 (29%) reported suicidal thoughts on the ASQ (score ≥1). 21 (30%) endorsed suicidal ideation on PHQ-9 item 9 and 36 (79.9%) have had thoughts of harming themselves on EPDS item 10. Positive EPDS screening was significantly associated with parent status (p=0.016), employment status (p=0.033), suicidal thoughts (p=0.003), suicidal ideation (p=0.002), and anxiety (p=0.007), while no significant associations were observed with age, pregnancy status, education, marital status, income, or support group participation.
Conclusion: Peripartum depression was highly prevalent among pregnant and postpartum AGYW living with HIV and was significantly associated with parent status, employment, anxiety, and suicidality. These findings underscore the need for routine perinatal mental health screening and integrated mental health services within HIV care to support the development of targeted interventions for this vulnerable population.