Drivers of chronic depressive and harmful alcohol use symptoms among adults living with HIV in Lesotho: pathways for integrated interventions

IF 4.1 Q1 PSYCHIATRY
Grace H. Yoon , Natalie E. Johnson , Irene Falgas-Bague , Mahlatsi Palesa , Moleboheng Mokebe , Nadine Tschumi , Malebanye Lerotholi , Alastair van Heerden , Niklaus D. Labhardt , Jennifer M. Belus
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Abstract

Introduction

Mental health problems are prevalent among people with HIV (PWH) in Southern Africa. However, mental health problems are substantially under-diagnosed and under-treated in this setting. This study explores the drivers, explanatory factors, and coping mechanisms of mental health problems among PWH in Lesotho who have lived experience with depressive symptoms and/or alcohol use problems and attempts to contextualize the findings to local realities and norms.

Methods

Semi-structured interviews were conducted in Butha Buthe (peri-urban) and Mokhotlong (rural) districts in Lesotho at district- and village-level health facilities with 28 PWH recruited based on past year's record of depressive symptoms (n = 22), harmful alcohol consumption (n = 4), or both (n = 2). Thematic analysis identified overarching themes, which were synthesized into a conceptual model.

Results

Economic and interpersonal challenges were perceived as drivers of mental health problems. Perceived lack of tangible resources and agency to alleviate these problems led participants to feel helpless and experience chronic depressive symptoms. Participants described coping with these symptoms through harmful alcohol use, which is often unaddressed due to local norms surrounding alcohol consumption. Chronic depressive symptoms and harmful alcohol use reduced individuals’ cognitive capacity to resolve their economic and interpersonal problems, reinforcing the cycle between these problems and corollary mental health problems. Participants suggested three intervention areas to target this cycle in their community: economic empowerment, social engagement in the form of group activities, and public education coupled with professional counseling to raise awareness and support for mental health problems.

Conclusions

Findings reveal that PWH in Lesotho view economic and interpersonal problems as the main drivers of chronic depressive symptoms and harmful alcohol use, which only serve to reinforce the underlying problems. Addressing these drivers alongside HIV care may be effective in reducing the depression and alcohol use burden experienced by this population.
莱索托成年艾滋病毒感染者慢性抑郁和有害酒精使用症状的驱动因素:综合干预措施的途径
在南部非洲,精神健康问题在艾滋病毒感染者(PWH)中很普遍。然而,在这种情况下,心理健康问题基本上没有得到充分诊断和治疗。本研究探讨了莱索托有抑郁症状和/或酒精使用问题的PWH的心理健康问题的驱动因素、解释因素和应对机制,并试图将研究结果与当地现实和规范联系起来。方法在莱索托Butha Buthe(近城区)和Mokhotlong(农村)地区的区级和村级卫生机构进行半结构化访谈,根据过去一年的抑郁症状(n = 22)、有害酒精消费(n = 4)或两者(n = 2)的记录招募28名PWH。专题分析确定了总体主题,这些主题被综合成一个概念模型。结果经济和人际挑战被认为是心理健康问题的驱动因素。由于缺乏切实的资源和机构来缓解这些问题,参与者感到无助,并经历慢性抑郁症状。与会者描述了通过有害使用酒精来应对这些症状的情况,由于当地对酒精消费的规范,这一问题往往得不到解决。慢性抑郁症状和有害的酒精使用降低了个人解决经济和人际问题的认知能力,加强了这些问题与必然的心理健康问题之间的循环。与会者建议在其社区针对这一周期采取三个干预领域:增强经济权能、以团体活动的形式进行社会参与,以及结合专业咨询的公共教育,以提高对心理健康问题的认识和支持。结论莱索托的PWH认为经济和人际关系问题是慢性抑郁症状和有害酒精使用的主要驱动因素,这只会加剧潜在的问题。在艾滋病毒护理的同时解决这些驱动因素可能有效地减轻这一人群所经历的抑郁和酒精使用负担。
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来源期刊
SSM. Mental health
SSM. Mental health Social Psychology, Health
CiteScore
2.30
自引率
0.00%
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审稿时长
118 days
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