Evaluating Depression and Anxiety in Thai Adolescents with HIV

U.S. studies have estimated that as many as 60% of HIV-infected adolescents suffer from depression, anxiety, or attention deficit hyperactivity disorder, and it is widely thought that these conditions contribute to the high rates of poor adherence and treatment failure seen in this population. As part of TREAT Asia’s initiative to address the mental health concerns of adolescents living with HIV in Asia, a new study funded through the US National Institutes of Health IeDEA collaboration is evaluating the prevalence and clinical course of depression and anxiety in Thai adolescents with HIV.

Led by Dr. Tavitiya Sudjaritruk, a pediatrician at Chiang Mai University in Chiang Mai, Thailand, the study will compare depression and anxiety in 150 adolescents living with HIV and 150 matched controls without HIV.

“While studies in the U.S. have shown a higher rate of mental health disorders among HIV-infected adolescents compared with their non-infected peers, there has been very little research into the extent of this problem in low- and middle-income countries,” said Dr. Sudjaritruk.

The new study will take place at Chiang Mai University and at Chulalongkorn University in Bangkok. Enrollment is planned for early 2018, and participants will be screened for depression and anxiety using the PHQ-9 and GAD-7 questionnaires, which are globally recognized, standardized screening tools. Adolescents whose screening scores indicate that they are depressed and/or anxious will be referred to a psychiatrist or psychologist for further evaluation. At a one-year study follow-up visit, they will be reevaluated for changes in their depression or anxiety symptoms. For study participants living with HIV, HIV-related information including antiretroviral drugs, and immunologic and virologic status will be obtained. Participants also will provide information on their education, employment, home environments, alcohol and other drug use, and sexual behaviors, so that links to and effects of depression and anxiety on other aspects of their daily lives can be better explored. 

“Improving the mental health of adolescents with HIV is important for its own sake as well as for improving treatment adherence in this population,” said Dr. Sudjaritruk. “This study will explore the impact of mental health problems and their management among Thai adolescents, and evaluate their effect on HIV-related parameters such as treatment adherence, and immunologic and virologic status. Results of studies like this one are essential to guide programs and policies to address the mental health needs of adolescents living with HIV.”

“The National Institute of Mental Health in Bethesda, Maryland, USA, is happy to co-fund this important study addressing the mental health of adolescents living with HIV” said Dr. Pim Brouwers, Deputy Director of the Division of AIDS Research at NIMH. “Mental health issues in resource-limited settings are frequently underreported and undertreated but significantly affect HIV prevention and treatment outcomes. This study may demonstrate the feasibility of this approach and could be implemented in other resource-limited settings.”