A scoping review of the associations between mental health and factors related to HIV acquisition and disease progression in conflict-affected populations

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Abstract

The association between poor mental health and factors related to HIV acquisition and disease progression (also referred to as HIV-related factors) may be stronger among conflict-affected populations given elevated rates of mental health disorders. We conducted a scoping review of the literature to identify evidence-based associations between mental health (depression, anxiety, and post-traumatic stress disorder [PTSD]) and factors related to HIV acquisition and progression in conflict-affected populations. Five electronic databases were searched on October 10, 2014 and updated on March 7, 2017 to identify peer-reviewed publications presenting primary data from January 1, 1994 to March 7, 2017. Articles were included if: 1) depression, anxiety, and/or PTSD was assessed using a validated scale, 2) HIV or HIV-related factors were a primary focus, 3) quantitative associations between depression/anxiety/PTSD and HIV or HIV-related factors were assessed, and 4) the study population was conflict-affected and from a conflict-affected setting. Of 714 citations identified, 33 articles covering 110,818 participants were included. Most were from sub-Saharan Africa ( n = 25), five were from the USA, and one each was from the Middle East, Europe, and Latin America. There were 23 cross-sectional, 3 time-series, and 7 cohort studies. The search identified that mental health has been quantitatively associated with the following categories of HIV-related factors in conflict-affected populations: markers of HIV risk, HIV-related health status, sexual risk behaviors, and HIV risk exposures (i.e. sexual violence). Further, findings suggest that symptoms of poor mental health are associated with sexual risk behaviors and HIV markers, while HIV risk exposures and health status are associated with symptoms of poor mental health. Results suggest a role for greater integration and referrals across HIV and mental health programs for conflict-affected populations.

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Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo.

Ricardo Ong, Bigy Rughita, Michael Kisielewski … (2010)

Studies from the Eastern Region of the Democratic Republic of the Congo (DRC) have provided anecdotal reports of sexual violence. This study offers a population-based assessment of the prevalence of sexual violence and human rights abuses in specific territories within Eastern DRC. To assess the prevalence of and correlations with sexual violence and human rights violations on residents of specific territories of Eastern DRC including information on basic needs, health care access, and physical and mental health. A cross-sectional, population-based, cluster survey of 998 adults aged 18 years or older using structured interviews and questionnaires, conducted over a 4-week period in March 2010. Sexual violence prevalence and characteristics, symptoms of major depressive disorder (MDD) and posttraumatic stress disorder (PTSD), human rights abuses, and physical and mental health needs among Congolese adults in specific territories of Eastern DRC. Of the 1005 households surveyed 998 households participated, yielding a response rate of 98.9%. Rates of reported sexual violence were 39.7% (95% confidence interval [CI], 32.2%-47.2%; n = 224/586) among women and 23.6% (95% CI, 17.3%-29.9%; n = 107/399) among men. Women reported to have perpetrated conflict-related sexual violence in 41.1% (95% CI, 25.6%-56.6%; n = 54/148) of female cases and 10.0% (95% CI, 1.5%-18.4%; n = 8/66) of male cases. Sixty-seven percent (95% CI, 59.0%-74.5%; n = 615/998) of households reported incidents of conflict-related human rights abuses. Forty-one percent (95% CI, 35.3%-45.8%; n = 374/991) of the represented adult population met symptom criteria for MDD and 50.1% (95% CI, 43.8%-56.3%; n = 470/989) for PTSD. Self-reported sexual violence and other human rights violations were prevalent in specific territories of Eastern DRC and were associated with physical and mental health outcomes.

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Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda

Bayard Roberts, Kaducu Ocaka, John Browne … (2008)

Background The 20 year war in northern Uganda between the Lord's Resistance Army and the Ugandan government has resulted in the displacement of up to 2 million people within Uganda. The purpose of the study was to measure rates of post-traumatic stress disorder (PTSD) and depression amongst these internally displaced persons (IDPs), and investigate associated demographic and trauma exposure risk factors. Methods A cross-sectional multi-staged, random cluster survey with 1210 adult IDPs was conducted in November 2006 in Gulu and Amuru districts of northern Uganda. Levels of exposure to traumatic events and PTSD were measured using the Harvard Trauma Questionnaire (original version), and levels of depression were measured using the Hopkins Symptom Checklist-25. Multivariate logistic regression was used to analyse the association of demographic and trauma exposure variables on the outcomes of PTSD and depression. Results Over half (54%) of the respondents met symptom criteria for PTSD, and over two thirds (67%) of respondents met symptom criteria for depression. Over half (58%) of respondents had experienced 8 or more of the 16 trauma events covered in the questionnaire. Factors strongly linked with PTSD and depression included gender, marital status, distance of displacement, experiencing ill health without medical care, experiencing rape or sexual abuse, experiencing lack of food or water, and experiencing higher rates of trauma exposure. Conclusion This study provides evidence of exposure to traumatic events and deprivation of essential goods and services suffered by IDPs, and the resultant effect this has upon their mental health. Protection and social and psychological assistance are urgently required to help IDPs in northern Uganda re-build their lives.

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What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review.

Ashley Holman, Matthew Freeman, Vikram Patel … (2006)

The expansion of AIDS treatment initiatives in resource-poor settings provides an opportunity for integrating mental health care into these programs. This systematic review of the literature on HIV and mental illness in developing countries examines the mental health risk factors for HIV, mental health consequences of HIV, psychosocial interventions of relevance for HIV-infected and affected populations, and highlights the relevance of these data for HIV care and treatment programs. We reviewed seven studies that measured the prevalence of HIV infection among clinic and hospital-based populations of people with mental illness or assessed sexual risk behavior in these populations; 30 studies that described the mental health consequences of HIV infection; and two reports of psychosocial interventions. The review demonstrates the need for methodologically sound studies of mental health throughout the course of HIV, including factors that support good mental health, and interventions that employ identified variables (e.g. coping, family support) for efficacy in reducing symptoms of mental illness. Promising intervention findings should encourage investigators to begin to study the implementation of these interventions in HIV service settings.

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Author and article information

Contributors

Erica Koegler:

ORCID: http://orcid.org/0000-0003-3685-0835

(512) 779-0540 , koeglere@health.missouri.edu

Caitlin E. Kennedy: (443) 287-8794 , caitlinkennedy@jhu.edu

Journal

Journal ID (nlm-ta): Confl Health

Journal ID (iso-abbrev): Confl Health

Title: Conflict and Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1752-1505

Publication date (Electronic): 1 June 2018

Publication date PMC-release: 1 June 2018

Publication date Collection: 2018

Volume: 12

Electronic Location Identifier: 20

Affiliations

[1 ]ISNI 0000 0001 2162 3504, GRID grid.134936.a, Department of Health Sciences, , University of Missouri, ; 512 Clark Hall, Columbia, MO 65211 USA

[2 ]ISNI 0000 0001 2171 9311, GRID grid.21107.35, Department of International Health, , Johns Hopkins Bloomberg School of Public Health, ; 615 N. Wolfe Street Room E5547 Baltimore, Baltimore, MD 21205 USA

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Erica Koegler http://orcid.org/0000-0003-3685-0835

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Publisher ID: 156

DOI: 10.1186/s13031-018-0156-y

PMC ID: 5984364

PubMed ID: 29881448

SO-VID: c4e85dbc-6ac2-439f-ac8f-10dfc9a2dbb8

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 24 October 2016

Date accepted : 25 March 2018

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100000025, National Institute of Mental Health;

Award ID: F31MH09567

Award Recipient : Erica Koegler

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ScienceOpen disciplines: Health & Social care

Keywords: mental health,hiv,conflict settings,depression,anxiety,ptsd

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ScienceOpen disciplines: Health & Social care

Keywords: mental health, hiv, conflict settings, depression, anxiety, ptsd

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A scoping review of the associations between mental health and factors related to HIV acquisition and disease progression in conflict-affected populations

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Most cited references 47

Association of sexual violence and human rights violations with physical and mental health in territories of the Eastern Democratic Republic of the Congo.

Factors associated with post-traumatic stress disorder and depression amongst internally displaced persons in northern Uganda

What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review.

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