Browsing by Author "Willis, Nicola"

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    The subjective experiences and perceptions of care among depressed adolescents living with HIV attending a community adolescent HIV programme in Harare, Zimbabwe
    (Stellenbosch : Stellenbosch University, 2016-12) Willis, Nicola; Kagee, Ashraf; Mavhu, Webster; Stellenbosch University. Faculty of Arts and Social Sciences. Dept. of Psychology.
    Introduction: Studies in Zimbabwe and elsewhere have found that adolescents with HIV are at risk of depression. Depression has a disabling effect on adolescents’ quality of life, increases suicide risk and impacts on their adult lives. There is also evidence from Zimbabwe that depression affects HIV positive adolescents’ adherence to antiretroviral medicines (ARVs). Sub-optimal adherence to ARVs results in virological replication and subsequent treatment failure. There are limited alternative treatment regimens available. High viral loads also increase the risk of HIV transmission to sexual partners and children. As HIV-related mortality rates rise in adolescents worldwide, evidence-based, adolescent-focused interventions which prevent and manage depression are urgently needed. If these services are to effectively meet adolescents’ needs, it is necessary to understand their own experiences of depression and their perceptions of the care that they have received and need. Methods: In-depth interviews were conducted with twenty-one HIV positive adolescents, 13-19 years old, diagnosed with major depressive disorder using DSM-V criteria. All participants were attending ‘Zvandiri’, a community programme for adolescents with HIV in Zimbabwe. The interviews were structured around a body mapping session, a creative arts technique. Participants were asked to create a painted map of their body to assist them in externalizing their somatic and emotional experiences. Verbal and visual data were collected from the interviews and body maps, then analysed thematically. Results:Participants described a relational model of depression, attributing their experiences of depression to their relationships and interactions with significant people in their lives, primarily family members and peers. A sense of being different from others was common, both due to their HIV status and the impact HIV has had on their life circumstances. Participants described a longing to be important or to matter to the people in their lives. A sense of isolation and rejection was common, as well as grief and loss, including ambiguous and anticipated loss. Participants’ idioms of distress included ‘thinking deeply’ (‘kufungisisa’), ‘pain’, darkness, ‘stress’ or a lack of hope and ambiguity for the future. Suicidal ideation was described, including slow suicide through poor adherence. Supportive factors were also relational, including the importance of supportive relatives and peers, clinic staff and psychosocial support programmes. Educational assistance and skills training for employment were also important. The results of this study suggest an ecological systems theoretical model for depression in adolescents with HIV, where characteristics at the microsystem level have the greatest influence on young person as they develop through childhood and adolescence. Body mapping was an effective, acceptable methodology for engaging adolescents in an exploration of their own narratives around depression. Participants described feeling relieved having shared experiences, emotions, life events and needs which they had not shared before. Conclusions and Recommendations: An understanding of HIV positive adolescents’ own narratives around depression can help to inform the development and integration of appropriate mental health interventions within HIV care and treatment programmes. Research is needed to validate culturally-sensitive diagnostic tools for depression in young people with HIV. An ecological systems framework should be adopted and utilised to strengthen community, family and peer-based interventions for the prevention and management of depression in adolescents with HIV. However, studies are needed to evaluate the effectiveness, acceptability and feasibility of such family and peer-led mental health interventions in preventing and managing depression and improving adherence to ARVs. This evidence must be disseminated to inform national and international policy and guidelines for adolescent HIV treatment and care.
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    Understanding the experience and manifestation of depression in adolescents living with HIV in Harare, Zimbabwe
    (Public Library of Science, 2018-01-03) Willis, Nicola; Mavhu, Webster; Wogrin, Carol; Mutsinze, Abigail; Kagee, Ashraf
    Background Studies have found that adolescents living with HIV are at risk of depression, which in turn affects adherence to medication. This study explored the experience and manifestation of depression in adolescents living with HIV in Zimbabwe in order to inform intervention development. Methods We conducted a body mapping exercise with 21 HIV positive 15–19 years olds who had been diagnosed with major depressive disorder. Participants created a painted map of their body to assist them in expressing their somatic and emotional experiences in qualitative interviews. The interviews were transcribed and thematically coded using NVivo 10. Results Participants attributed their experiences of depression to their relationships and interactions with significant people in their lives, primarily family members and peers. A sense of being different from others was common among participants, both due to their HIV status and the impact HIV has had on their life circumstances. Participants described a longing to be important or to matter to the people in their lives. A sense of isolation and rejection was common, as well as grief and loss, including ambiguous and anticipated loss. Participants’ idioms of distress included ‘thinking deeply’ (‘kufungisisa’), ‘pain’, darkness, ‘stress’ or a lack of hope and ambiguity for the future. Suicidal ideation was described, including slow suicide through poor adherence. Supportive factors were also relational, including the importance of supportive relatives and peers, clinic staff and psychosocial support programmes. Conclusions An understanding of HIV positive adolescents’ own narratives around depression can inform the development and integration of appropriate mental health interventions within HIV care and treatment programmes. Study findings suggest that family and peer-led interventions are potentially useful in the prevention and management of depression in adolescents living with HIV.