Prevalence and Factors Related to Depression among Adolescents Living with HIV/AIDS, in Gasabo District, Rwanda
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Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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Original article
Prevalence and Factors Related to Depression among
Adolescents Living with HIV/AIDS, in Gasabo District, Rwanda
Pacifique Mukangabire1*, Patricia Moreland2, Clementine Kanazayire1, Reverien
Rutayisire3, Aimable Nkurunziza1, Denise Musengimana4, Innocent Kagabo 1
1School of Nursing and Midwifery, College of Medicine and Health Sciences, University of
Rwanda, Kigali
2Nell Hodgson Woodruff School of Nursing, Emory University
3School of Health Sciences, College of Medicine and Health Sciences, University of Rwanda,
Kigali, Rwanda
4School of Nursing and Midwifery, University of Rwanda, Rwamagana, Rwanda
*Corresponding author: Pacifique Mukangabire.School of Nursing and Midwifery, College of
Medicine and Health Sciences, University of Rwanda, Kigali`Email: pacingabire@yahoo.fr,
pacifiquemukangabire@gmail.com
___________________________________________________________________________
Abstract
Background
Adolescents living with HIV are vulnerable to depression with a negative effect
on treatment outcomes. However, there are little data on the factors
associated with depression in adolescents with HIV infection in Rwanda.
Aim
This article aims to assess the prevalence and sociodemographic factors
related to depression among adolescents living with HIV/AIDS.
Methodology
A cross sectional research was conducted with 102 adolescents living with
HIV/AIDS. Depression was measured by Centre for Epidemiological Studies
Depression Scale (CES-DC) in its latest version adapted to the context of
Rwanda. Chi-square test and binary logistic regression were performed to
determine the factors associated with depression.
Results
The prevalence of participants who had symptoms of depression was 31%.
The risk to develop depression increased among HIV infected adolescent who
did not attend school or who lived with another person who is not a parent or
family member. Having both parents deceased increases the risk to develop
depression by 25.07 times compared to when none of them is deceased.
Conclusion
The results have demonstrated that lack of social support is likely to raise
the risk of development of depression symptoms among adolescent with HIV.
It is clearly an urgent priority to implement programs that focus on provision
37Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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and maintenance of psychosocial support to this group in order to reverse the
situation.
Rwanda J Med Health Sci 2021;4(1):37-52
________________________________________________________________________________________________________________
Keywords: Adolescents, HIV, Depression
Introduction body and appearance are essential
to their health and well-being.[7] A
Adolescence is critical period due to teenage experience of a negative
the passage of childhood to body image is not only associated
adulthood. Physical, social and with low self-esteem [8] adolescents
cognitive changes during this health and well-being [9], it is also
period inflict an important connected with severe long-term
stress.[1] Some adolescents develop psychological consequences like
the symptoms of depression that eating disorders and depression
can be liable to suicide. In the in.[10] Since HIV-positive
world, suicide is the third cause of adolescents can develop
morbidity after road traffic injuries, lipodystrophy due to HIV infection
and HIV/AIDS.[2] It is estimated or medication.[11] This body
that about 2.1 million adolescents deformity can lead to mental health
aged 10–19 years lived with HIV issues such as depression.
worldwide in 2016 of which 1.7
million (84%) were in Sub-Saharan- The findings from cross-sectional
Africa. The number of adolescents study conducted in Tanzania
living with HIV who died increased documented mental health
and this increase was more challenges in a group of 182
predominant in the African region, adolescents between 12 and 24
while deaths linked to HIV in other years old, living with HIV/AIDS.[12]
population groups decreased.[3] In A study conducted in Uganda
addition, comorbidity of HIV/AIDS among 336 adolescents living with
and psychiatric disorders are a HIV aged 10 to 19-years old
major health challenge.[4] The HIV underscored that 46% of them
infected adolescents develop in an reported depressive symptoms that
environment that exposes them to were higher among adolescents
biological, economic, social, above 15 years.[13] In Rwanda,
familial, genetic, ecological and among 683 adolescents living with
psychological factors that may raise HIV/AIDS aged 10 to 17 years, 20%
their risk of developing mental reported suicide temptation or self-
health problems.[5] Adolescence is harm in the past 6 months and the
a period during which the body, adolescents living with HIV/AIDS
mind and social life change had a significant high risk of
dramatically.[6] The thoughts and developing depression and anxiety,
feelings of adolescents about their
38Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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compared to adolescents non [19] A study conducted in Rwanda
diagnosed with HIV.[14] among 150 HIV-infected children
aged between 7 and 14 years who
Analysis from a 2013 systematic
received Antiretroviral treatment at
review on mental health of HIV
least six months ago showed 25%
infected adolescents revealed that
prevalence of depression based on
compare to non- infected
structured clinical interview.[20]
adolescents, depression and
anxiety were more prevalent among
the perinatally HIV infected The high prevalence of depression
adolescents.[15] Different among adolescents living with HIV
prevalence rates of depression in developing countries is reported
among HIV-infected children and to be linked with factors related to
adolescents across the globe have poverty, stressful life conditions
been documented by several and persons living with HIV who
studies across the globe. A reviewed have low monthly income are likely
of the prevalence of DSM IV to develop depression than those
(Diagnostic and Statistical Manual with high monthly income.[4] On
of Mental Disorders) mental health other hand, living alone,
disorders among adolescents living joblessness, marital status, and low
with HIV/AIDS showed that 25% of social support were reported to be
adolescents diagnosed with significantly associated with the
depression.[16] The findings from a high prevalence of psychiatric
study conducted in Kenya revealed disorders among people living with
the occurrence of one psychiatric HIV/AIDS.[21] The results from a
diagnosis or suicidality at 49% with study done in a Nigerian Hospital
anxiety disorders at 32.3 1% demonstrated that lack social
followed by major depressive support play a major role in the
disorder at 17.8% among development of depression in
adolescents.[17] A study conducted adolescent [22] Another 4‐year
in Uganda among 82 adolescents longitudinal follow up done in
living with HIV/AIDS revealed a south Africa on AIDS‐orphaned
depression prevalence of 51% 12 children with control groups of
and underscored that HIV and other‐orphans and non‐orphans
depression are linked; HIV is a underscored that AIDS‐orphaned
major psychological stressor that children manifested higher
increase psychological distress and depression, anxiety, and post‐
beginning of psychiatric traumatic stress disorder (PTSD)
disorders.[18] A cross-sectional scores compare to other‐orphans
study of 562 adolescents living with and non‐orphan.[23] Additionally, a
HIV from Malawi underscored study conducted in Malawi on
18.9% of depression pre-valence depression among adolescents
39Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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living with HIV highlighted that to 19 years, divided into three
being female, having fewer years of stages: early (10-13 years), middle
schooling, having a diseased family (14-16 years) and late (17-19 years)
member, failing a school adolescence.[24] The present study
term/class, having a targeted the group of HIV infected
boyfriend/girlfriend, not disclosing adolescents between 10 and 19
your HIV status to anyone, having years old with the aim of
severe immunosuppression, and determining the prevalence of
being bullied for medications were depressive symptoms among them
the variables that were significantly and its associated
associated with a higher Beck sociodemographic factors.
Depression Inventory II (BDI-II)
score.[19]
Methods
There are more differences related Study design and setting
to biological sex among adolescents A cross-sectional survey of
living with HIV/AIDS in low-income Adolescents Living With HIV/AIDS
locations. For example, a study (ALWHIV) in Gasabo district of
done in Kenya demonstrated that Kigali city has been conducted
compared to females, being a male between March and May 2017.
was associated with a higher risk of Participants were recruited from
developing depression[17], while in HIV clinic at Kibagabaga Hospital,
Malawi the Beck Depression Remera and Kinyinya Health
Inventory-II scores were higher in centers which are in urban health
female HIV-infected adolescents centers and that are among the first
than in males.[19] A study done in to start offering comprehensive
Rwanda with the aim of assessing HIV/AIDS care in Rwanda.
the prevalence of depression among
HIV infected children between Population and sampling
seven and fourteen years of age technique
found that depression was higher in The study population included 194
female HIV-infected adolescents adolescents between 10 and 19
than males, nevertheless the years of age, infected with HIV,
difference was not significant, this registered in service of HIV in
study though, included younger Kibagabaga Hospital, Remera and
children and adolescents in the Kinyinya health centres.
same group.[20] The present study Convenience sampling was used to
chose the category of adolescence select 102 participants who visited
as defined by the World Health the health facilities during the data
Organization. The World Health collection period.
Organization defines the
adolescence as the life span from 10
40Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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Data collection instrument the above sociodemographic
variables and depression among
For assessing depressive symptoms
adolescents living with HIV/AIDS.
among adolescents, the study used
entirely the Centre for Factors statistically significant
Epidemiological Studies Depression associated with depression were
Scale (CES-DC) in its latest version then investigated among
adapted to the context of adolescents with a reduced
Rwanda.[25] The adapted scale multivariable logistic regression
contains 30 items. The 30 items model at a p-value less than 0.05.
scale have been obtained directly Adjusted odds ratios (OR) and 95%
from these authors. The adapted confidence intervals (95% CI) were
scale includes 20 retained from the estimated.
standardized scale and 10 items
Ethical considerations
added delivered from locally mental
health idioms to improve, according Before conducting data collection,
to the authors, the variability for ethical approval was provided to the
evaluation purpose. Similarly, to researcher by the Institutional
the original scale, the adapted scale Review Board of University of
is scored in a 4-likert scale points Rwanda, College of Medicine and
ranging from 0 (Never), 1 (a little), 2 Health Sciences after submission of
(sometimes), to 3 (often or a lot). the research proposal and then the
The scoring of positive items is permission to conduct research was
reversed. Possible range of scores is requested and granted from
zero to 90, with the higher scores Kibagabaga Hospital which is the
indicating the presence of more hospital supervising the Remera
symptomatology. and Kinyinya Health Center.
Remera and Kinyinya also have
Data analysis
been informed and the permission
Statistical data analysis was to conduct a research was obtained.
performed with STATA (StataCorp. Adolescents above 16 years who
2019. Stata Statistical Software: accepted to participate signed the
Release 16. College Station, TX: ascent and consent form and for
Stata Corp LLC). Descriptive those under 16 years their guardian
statistics have been performed for signed ascent for them. Written
sociodemographic characteristics of parental informed consent and
participants namely age, gender, adolescent assent form were
parent deceased, year in school, obtained prior to data collection,
and with whom the participant is after explaining the purpose of the
living. Bivariate analysis was study, in the form, the researcher
performed using Chi-square to explains also that participation in
determine a relationship between research is voluntary and that the
41Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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participant has the right to Results in Table 1 show that the
withdraw from responding to the respondents were predominantly
research at any time they wish and female (62%) and (61%) of the
there would be no negative participants had their parents alive.
consequences on their treatment About 20% had lost their fathers,
and care they are receiving, and 10% their mothers and 9% both
also there would be no specifics parents. 41% of adolescents were in
benefits to those who would primary school. Those who lived
participate in research but those with both their parents comprised
who would be having depression 29%, 47% with their mothers, 7%
would be screened and oriented to with their fathers while 13% stayed
health care facilities for with other family members.
management.
Results
Sociodemographic
characteristics of participants
(n=102)
Table 1. Sociodemographic characteristics of participants (n=102).
Variables Frequency Percent (%)
Age
10-14 years 35 34
14-17 years 43 42
17-19 years 24 24
Gender
Female 63 62
Male 39 38
Parent deceased
None 62 61
Father 21 20
Mother 10 10
Both 9 9
Year in school
No formal school Attended 17 17
Primary 42 41
Senior 1-Senior 3 32 31
Senior 4-Senior 6 11 11
With whom he/she is living
Both parents 30 29
Mother 48 47
42Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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Father 7 7
Family member 13 13
Other 4 4
Prevalence of depression among Table 2. Levels of depression
adolescents living with HIV/AID among adolescents living
and its association with the with HIV/AIDS.
respondents’ characteristics.
Levels of Freque Percent
The prevalence of depression is depression ncy (%)
presented in Table 2. The severity of No depression 70 68.6
depression was classified in three Mild
categories: mild, moderate, and depression 12 11.8
severe depression. As can been, the Moderate
overall prevalence of depression, as depression 9 8.8
assessed by the adapted Center for Severe
Epidemiological Studies Depression depression 11 10.8
Scale for Children (CES-DC) was Total 102 100
31.4%, 12% had mild depression,
9% moderate depression and 10.8%
In Table 3, the findings show that
had severe depression. Table 2
there is a significant relationship
shows highlights the severity of
between having a deceased parent
depression classified in three
and developing depression
categories: mild, moderate, and
(pRwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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Table 3. Prevalence of depression among adolescents living with
HIV/AIDS and its association with the respondents’
characteristics.
No depression Depression
Factors P value
(n, %) (n, %)
Parent deceasedRwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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[1.15-547.59]). Having one parent father’s death, although it was not
deceased is less likely to be statistically significant (OR=1.29;
associated with development of 95% CI= [0.31-5.34]).
depression symptoms but the
likelihood increased in the case of
Table 4. Multivariable analysis of factors associated with depression
among adolescents living HIV aged between 10-19 years.
Factors Full model Reduced model
OR (CI at 95%) p-value OR (CI at 95%) p-value
Parent
deceased
None 1 1
Father 1.33(0.31-5.77) 0.7 1.29(0.31-5.34) 0.725
Mother 0.73(0.09-6.02) 0.769 0.58(0.076-4.38) 0.593
Both 30.61(1.30-721.67) 0.034 25.07(1.15-547.59) 0.041
Living with
Both parents 1 1
Mother 5.10(0.80-32.71) 0.085 3.71(0.66-20.89) 0.137
Father 18.61(1.46-236.90) 0.024 14.01(1.23-159.60) 0.033
Family
5.12(0.36-72.59) 0.227 4.96(0.401-61.51) 0.212
member
Other 25.49(1.02-639.59) 0.049 23.87(1.03-553.88) 0.048
School
attendance
No 1 1
Primary 0.07(0.00-0.57) 0.014 0.18(0.04-0.89) 0.036
S1-S3 0.07(0.00-0.52) 0.009 0.14(0.03-0.73) 0.02
S3-S6 0.08(0.00-1.52) 0.094 0.06(0.00-0.93) 0.044
45Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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The multivariable analysis shows attended school were less likely to
that all three factors positively develop depression (Primary
influenced the development of (OR=0.18, 95%CI= [0.04-0.89]), S1-
depression among the study S3 (OR=0.14, 95%CI= [0.03-0.73]),
population (parent deceased, the S3-S6 (OR=0.06, 95%CI= [0.00-
person living with the child and the 0.93]). The probability of the
school attendance). Table 4 shows adolescent with HIV to develop the
that adolescents having a deceased depression symptoms is inversely
father were 1.29 times more likely proportional to the adolescent
to develop depression compared to school attendance, the higher the
adolescents having both parents class at school attendance, the
(OR=1.29; 95% CI= [0.31-5.34]); lower the chance to develop
those who have a deceased mother depression symptoms, as shown by
were 42% less likely to develop decreasing odds ratios with
depression compared to increase in level of class.
adolescents having both parents
(OR=0.58; 95% CI= [0.076-4.38]);
Discussion
those who have both deceased The results of this study highlight
parents were 25.07 times more the weight of depressive symptoms
likely to develop depression in adolescents with HIV/AIDS in
compared to adolescents having Rwanda. They indicate that the
both parents (OR=25.07; 95% CI= prevalence of depression among
[1.15-547.59]). adolescents was 31%. The high
prevalence of depression in the
Still, Table 4 shows that the risk of present study might be explained
developing depression is higher by the fact that about 38% of the
when an adolescent lives with participants are orphans. Among
people other than the family 102 participants 40 participants
members (OR=23.87; 95% CI= don’t have both parents and being
[1.03-553.88]). On the other hand, orphan has been identified as a
living with their fathers was 14.1 factor associated with depression
times and significantly more likely among adolescents living with
for the adolescent to develop HIV.[18]
depression (OR=14.01,95%CI=
(1.23-159.60]). Living with their Some other countries reported a
family member, though not higher or lower prevalence. For
statistically significant, was 4.96 example a study conducted in
times more for the adolescent to Uganda found a depression rate of
develop depression 46% among adolescents aged from
(OR=4.96,95%CI= [0.401-61.51]). 15 to 19 years [13] and Malawi
Compared to adolescents who did reported a depression rate of
not attend school, adolescents who 18.9%. The high prevalence of
46Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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depression among adolescents The present study showed that
living with HIV in developing three factors namely having both
countries is reported to be linked parent deceased, living with
with factors related to poverty, another person who is not a family
stressful life conditions and member, and not attending school
persons living with HIV who have were positively associated with the
low monthly income are likely to development of depression among
develop depression than those with the study population. Lack of
high monthly income.[3] A history school attendance has also been
of trauma experience may also identified as a factor associated
explain why the rate of depression with the development of depression
is high among HIV-positive among the study population.
adolescents in Rwanda compared to Adolescents who do not attend
other regions. It has been evidenced school were more likely to develop
that in the community which depression compared to
experienced a traumatic event such adolescents who attend school. The
a genocide, children of the next higher the class at school
generation often manifest the attendance, the lower chance to
psychological trauma symptoms develop depression symptoms. This
.[26] Rwanda has experienced corroborates a study done in
genocide against Tutsis, and Malawi where fewer years of
depression has been documented in schooling was significantly
Rwandan children.[25] The associated with higher Beck
adolescents who participated in the Depression Inventory II (BDI-II)
present study were raised by score.[19] These findings may be
parents or guardians with a trauma explained by the fact that school
history linked to genocide and at connectedness constitutes
the risk of depression. This history protective factors. A study
may exacerbate the impact of HIV conducted in sub-Saharan Africa
on adolescents in Rwanda.[27] among 224 AIDS/HIV orphans, 276
non-AIDS/HIV showed a significant
On other hand, the factors such as
association between school
sex, level of education, having a
connectedness and overall mental
unhealthy family member or
health regardless of group.[28]
household, failing a school, having
a boyfriend/girlfriend, not The findings from bivariate analysis
disclosing HIV status with anybody, performed in the present study
severe immunosuppression, and showed that having one or both
being bullied for drugs were parents dead was associated with
significantly associated with higher the risk of developing depression.
Beck Depression Inventory II (BDI- Likewise in a study that was done
II) score.[19] in South Africa it was revealed that
47Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
_________________________________________________________________________________
being an orphan living with HIV- The results from this study
AIDS increased the probability of highlight the importance of school
being depressed.[18] In addition, it attendance and social support in
was, reported that the risk to preventing depression among HIV
develop depression among infected adolescents and are
adolescent with HIV-AIDS is higher consist with findings from a study
when they live with people other done in Nigerian Hospital which
than the family members. shows that social support is one of
According to the respondents, the the factor to influence the
adolescent who lives with his/her development of depression among
mother is less likely to develop the adolescent.[4] However, the
depression compared to living with present study had some limitations.
the father. This may be explained The study used a depressive
by the fact that in a patriarchal symptom screening tool; this
society, in comparison with men, screening tool cannot determine the
women still bear a much greater extent and the duration of
responsibility to care for the depression. Given that the results
household and the children. of this study are generalizable to
the population of Rwandan, they
underline the contribution of social
Demographic data like age and support in improving psychosocial
gender were not significantly well-being of adolescents with HIV.
associated with development of
depression symptoms. A variation
Conclusion
has been observed in the results As a conclusion, the results have
related to biological sex among demonstrated that adolescents with
adolescents living with HIV/AIDS in HIV/AIDs are likely to develop
low-income locations. Findings depression symptoms. The findings
from one study conducted in Kenya of this study show that the
reported that being male was prevalence of depression among
associated with a higher risk of adolescent with HIV is high
developing depression than being compared to the prevalence
female [16] while in Malawi, it was reported in developed countries.
the contrary.[18] In another study The socio-demographic factors
done in Rwanda among a group of associated with depression are
children between 7 and 14 years, mainly related to lack of family
the difference in depression support where the child is
between males and females was not supposed to get the psychosocial
significant, although more females support. The risk to develop
were depressed.[20] depression increases among
adolescent with HIV as the child
48Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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lives alone and most likely not being Authors’ contributions
able to attend school. The results
MP* and PM conceptualized and
of this study show that for better
designed the study. MP*, NA, KI,
management of mental health
MD and RJ collected data. MP, KC
problems of the HIV infected
and RR analyzed the data. MP, NA,
adolescents, the integration of
KC, and RR drafted the manuscript.
mental health services in HIV/AIDs
PM*, KC, RR, NA, and MD made the
clinics has to be strengthened.
Critical review of the manuscript.
Some factors like being orphan, not
MP and PM made the final review
going to school and living with a
before submission. All authors have
person who is not a family member
read and approved the final
are likely to raise the risk of
manuscript.
development of depression
symptoms among adolescent living Competing interests
with HIV. It clearly an urgent
The authors declare that they have
priority to implement programs is
no competing interests.
targeting this group to provide and
maintain psychosocial support that This article is published open access under the
Creative Commons Attribution-NonCommercial
would reverse the situation. NoDerivatives (CC BYNC-ND4.0). People can
copy and redistribute the article only for
Acknowledgements noncommercial purposes and as long as they
give appropriate credit to the authors. They
I acknowledge Mrs. Betancourt and cannot distribute any modified material
team for providing me the tool used obtained by remixing, transforming or building
to collect data. upon this article. See
https://creativecommons.org/licenses/by-nc-
Funding nd/4.0/
None
49Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
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References tal_health_EN_27_08_12.pdf
1. V. Ashok, A. Rajan, and R. 6. E. H. Wertheim and S. J.
Maben, “STRESSORS IN Paxton, “Body image
ADOLESCENCE: AN development - adolescent
ANALYTICAL CROSS- girls,” in Encyclopedia of Body
SECTIONAL STUDY,” Indian Image and Human
J. Child Health, vol. 4, no. 1, Appearance, 2012.
pp. 72–74, Mar. 2017. 7. K. H. Gattario, Body image in
2. W. H. Organization, “Injuries adolescence : through the
and violence: the facts.,” Inj. lenses of culture, gender, and
violence facts., 2010. positive psychology. 2013.
3. A. Slogrove, A. S.-C. O. 8. J. A. O’dea, “Body image and
in H. and AIDS, and self-esteem,” in Encyclopedia
undefined 2018, “The global of Body Image and Human
epidemiology of adolescents Appearance, 2012.
living with HIV: time for more 9. E. Meland, S. Haugland, and
granular data to improve H. J. Breidablik, “Body image
adolescent health outcomes,” and perceived health in
https://www.ncbi.nlm.nih.go adolescence,” Health Educ.
v/pmc/articles/PMC5929160 Res., 2007.
/.
10. J. Westerberg-Jacobson, B.
4. Y. B. Bezatu Mengistie1, Edlund, and A. Ghaderi, “A 5-
Alemayehu Worku, B. year longitudinal study of the
Mengistie, Y. Berhane, and A. relationship between the wish
Worku, “Prevalence of to be thinner, lifestyle
diarrhea and associated risk behaviours and disturbed
factors among children eating in 9-20-year old girls,”
under-five years of age in Eur. Eat. Disord. Rev., 2010.
Eastern Ethiopia: A cross- 11. C. Adams, A. Stears, D.
sectional study,” Open J. Prev. Savage, and C. Deaton,
Med., vol. 3, no. 7, pp. 446– “‘We’re stuck with what we’ve
453, Oct. 2013. got’: The impact of
5. WHO, “Risks To Mental lipodystrophy on body image,”
Health: An Overview of J. Clin. Nurs., 2018.
Vulnerabilities and Risk 12. D. E. Dow, E. L. Turner, A. M.
Factors,” 2012. Shayo, B. Mmbaga, C. K.
https://www.who.int/mental Cunningham, and K.
_health/mhgap/risks_to_men O’Donnell, “Evaluating
50Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
_________________________________________________________________________________
mental health difficulties and AIDS/HIV, 2012.
associated outcomes among
18. M. Mutumba et al.,
HIV-positive adolescents in
“Examining the relationship
Tanzania,” AIDS Care -
between psychological
Psychol. Socio-Medical Asp.
distress and adherence to
AIDS/HIV, 2016.
anti-retroviral therapy among
13. E. Kemigisha et al., Ugandan adolescents living
“Prevalence of depressive with HIV,” AIDS Care -
symptoms and associated Psychol. Socio-Medical Asp.
factors among adolescents AIDS/HIV, 2016.
living with HIV/AIDS in South
19. M. H. Kim et al., “Factors
Western Uganda,” AIDS Care -
associated with depression
Psychol. Socio-Medical Asp.
among adolescents living with
AIDS/HIV, 2019.
HIV in Malawi,” BMC
14. T. Betancourt et al., “HIV and Psychiatry, 2015.
child mental health: A case-
20. A. Binagwaho et al.,
control study in Rwanda,”
“Validating the Children’s
Pediatrics, 2014.
Depression Inventory in the
15. C. A. Mellins and K. M. Malee, context of Rwanda,” BMC
“Understanding the mental Pediatr., 2016.
health of youth living with
21. S. Algoodkar, A.
perinatal HIV infection:
Kidangazhiathmana, P. P.
Lessons learned and current
Rejani, and K. S. Shaji,
challenges,” Journal of the
“Prevalence and Factors
International AIDS Society.
associated with Depression
2013.
among Clinically Stable
16. A. Scharko, “DSM psychiatric People Living with HIV/AIDS
disorders in the context of on Antiretroviral Therapy,”
pediatric HIV/AIDS,” AIDS 2017.
Care - Psychol. Socio-Medical
22. S. Adeyemo et al., “Depression
Asp. AIDS/HIV, 2006.
and suicidality among
17. J. W. Kamau, W. Kuria, M. adolescents living with
Mathai, L. Atwoli, and R. human immunodeficiency
Kangethe, “Psychiatric virus in Lagos, Nigeria,” Child
morbidity among HIV-infected Adolesc. Psychiatry Ment.
children and adolescents in a Health, 2020.
resource-poor Kenyan urban
23. L. D. Cluver, M. Orkin, F.
community,” AIDS Care -
Gardner, and M. E. Boyes,
Psychol. Socio-Medical Asp.
51Rwanda Journal of Medicine and Health Sciences Vol.4 No.1, March 2021 https://dx.doi.org/10.4314/rjmhs.v4i1.4
_________________________________________________________________________________
“Persisting mental health 26. H. Rieder and T. Elbert,
problems among AIDS- “Rwanda - Lasting imprints of
orphaned children in South a genocide: Trauma, mental
Africa,” J. Child Psychol. health and psychosocial
Psychiatry Allied Discip., conditions in survivors,
2012. former prisoners and their
children,” Confl. Health, vol.
24. M. Mohammed, B. Mengistie,
7, no. 1, 2013.
Y. Dessie, and W. Godana,
“Prevalence of Depression and 27. UNAIDS, “HIV and AIDS
Associated Factors among estimates,” Geneva: UNAIDS,
HIV Patients Seeking 2014. [Online]. Available:
Treatments in ART Clinics at http://www.unaids.org/en/r
Harar Town , Eastern egionscountries/countries/r
Ethiopia,” open access J. Vol., wanda.
vol. 6, no. 6, 2015.
28. C. Sharp, F. Penner, L.
25. T. Betancourt et al., Marais, and D. Skinner,
“Validating the center for “School connectedness as
epidemiological studies psychological resilience factor
depression scale for children in children affected by
in rwanda,” J. Am. Acad. Child HIV/AIDS,” AIDS Care, vol.
Adolesc. Psychiatry, 2012. 30, no. sup4, pp. 34–41, Jul.
2018.
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