Psychiatric morbidity among HIV infected children and adolescents aged between 6-18 years attending a comprehensive care clinic for HIV/AID in a resource poor Urban Kenyan Community

Abstract

Background With the advent of Anti Retroviral Therapy for HIV/ AIDS, the illness has been transformed from an acute condition in children to a chronic one. While studies have been done to demonstrate cognitive impairment in children infected with HIV, there is a dearth of studies done to establish the prevalence of psychiatric morbidity in children infected with this virus. Patients suffering from chronic conditions have been shown to have a higher prevalence of psychiatric morbidity than the general population. HIV as an illness comes with other unique psycho-social factors that would increase further the risk of developing a psychiatric disorder, such as bereavement, stigma that comes with the illness and financial losses due to disability. Objectives To determine the prevalence and pattern of psychiatric morbidity in children and adolescents between 6 and 18 years of age who are infected with HIV and are on follow up and receiving care for the illness. To determine the relationship between psychiatric morbidity and the socia-demographic factors and immune suppression. Study design This was a cross sectional descriptive study to determine the psychiatric morbidity prevalence and pattern in children and adolescents infected with HIV in Kenya and the associated sociodemographic and immunity factors. Method The study was conducted at The Lea Toto Program Comprehensive Care Clinics at Kariobangi in Nairobi, in the months of February, March and April 2010. These clinics provide care and follow up to children coming from the surrounding resource poor community who are infected with HIV, aged between 0 and 18 years. A hundred and sixty two HIV infected children and adolescents aged between 6 and 18 years were enrolled into the study. The M.I.N.1. Kid questionnaires and the researcher designed socio-demographic and health questionnaire were the instruments used to collect data from the study subjects. The collec-ted data was analyzed usingSPSS. Results There were more males (51.9%) than females enrolled in this study, giving a female: male ratio of 1: 1.1. The ages of the subjects ranged between 6 and 18 years, with a mean age of 9.7 years at a standard deviation of 2.8 years. Fifty six percent of the children enrolled in the study were on ARV drugs. Thirty four percent of the children had been orphaned due to HIV/ AIDS, and 39.5% were living with a non parental guardian. Only 49 (30.2%) of the children knew their status in this study, with the mean age of disclosure being 10 years. Seventy nine (48.8%) of the study subjects were found to have psychiatric morbidity. The DSMIV TR psychiatric disorders found in descending frequency were: Major depression, (17.8%) Social phobia(12.8%), Oppositional Defiant Disorder (12.1%), Attention Deficit Hyperactivity Disorder(12.1%), Specific phobia(7.0%), Bipolar disorders (6.4%), Panic disorder(5.7%), Conduct disorder(4.5%), Agoraphobia(2.5%), Separation anxiety disorder(2.5%), Dysthymia(2.5%), Psychotic disorder(1.9%), Post Traumatic Stress Disorder(1.3%) and Pervasive developmental disorders(0.6%). Twenty five percent of the study subjects had more than one psychiatric disorder. Major depression was significantly associated with male gender (p=O.035) and a low immune state (p=0.04), while specific phobia was significantly associated to female gender (p=0.028). There was a statistically significant association (p=0.04) between knowledge of HIV status and Social Phobia There was no association between psychiatric morbidity and the type of guardian and ARV medication. Conclusions and Recommendations There is indeed psychiatric morbidity in HIV infected children, and at a higher prevalence than the children in the general population. Major depression was linked to low immune status, while social phobia was significantly linked to knowledge of one's HIV status in the current study. The current study was carried out in a resource poor setting, and other issues such as nutrition and poverty may have contributed to the presence of psychiatric morbidity. There is need to integrate psychiatric services into the routine care of HIV infected children. Further studies need to be carried out on other stressors and their influence on the wellbeing of a HIV infected child.