Childhood trauma, major depressive disorder, suicidality, and the modifying role of social support among adolescents living with HIV in rural Uganda

Abstract

Background: Childhood trauma is associated with mental health problems among adolescents living with HIV (ALHIV) in sub-Saharan Africa, but little is known about potential moderating factors. Methods: We enrolled 224 ALHIV aged 13–17 years and collected information on childhood trauma, major depressive disorder, and suicidality. We used modified multivariable Poisson regression to estimate the association between the mental health outcome variables and childhood trauma, and to assess for effect modification by social support. Results: Major depressive disorder had a statistically significant association with emotional abuse (adjusted relative risk [ARR] 2.57; 95% CI 1.31–5.04; P = 0.006) and physical abuse (ARR 2.16; 95% CI 1.19–3.89; P = 0.01). The estimated association between any abuse and major depressive disorder was statistically significant among those with a low level of social support (ARR 4.30; 95% CI 1.64–11.25; P = 0.003) but not among those with a high level of social support (ARR 1.30; 95% CI 0.57–2.98; P = 0.52). Suicidality also had a statistically significant association with emotional abuse (ARR 2.03; 95% CI 1.05–3.920; P = 0.03) and physical abuse (ARR 3.17; 95% CI 1.60–6.25.; P = 0.001), but no differences by social support were noted. Limitations: Corporal punishment is used widely in schools and homes as a form of discipline in Uganda; this cultural practice could have biased reporting about physical abuse. Conclusions: Childhood trauma is associated with poor mental health among ALHIV, but its effects may be moderated by social support. More research is needed to develop social support interventions for ALHIV with adverse childhood experiences for improved mental health outcomes.

Keywords

• Adolescents
• Adverse childhood experiences
• HIV
• Mental health
• Sub-Saharan Africa
• Uganda