Queen Balina

Maternal Mental Health and Outcomes of Referral for Mental Health Care Among Women Living with and without HIV in the Botswana-Based FLOURISH Study

Queen M. Balina1,3, Gosego M. Masasa RN2, Samuel W. Kgole RN2, Sara R. Schenkel MPH3, Kathleen M. Powis MD, MPH2,4,5

1Harvard College, Cambridge, MA, USA; 2Botswana Harvard Health Institute, Gaborone, Botswana,3Division of Pediatric Global Health, Massachusetts General Hospital, Boston, MA, USA; 4Departments of Internal Medicine and Pediatrics, Massachusetts General Hospital, Boston, MA, USA, 5Department of Immunology and Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA, USA.

Poor mental health among women living with HIV can impact care engagement, treatment adherence, and parenting. We sought to quantify prevalence of depression and anxiety among mothers participating in the Botswana-based FLOURISH study, an ongoing longitudinal observational study following maternal-child pairs, including mothers living with and without HIV and their children, ranging in age from birth to 17 years.

Maternal participants are administered the PHQ-9 and GAD-7 standardized instruments at enrollment to screen for depression and anxiety, respectively. Prevalence of screening positive was compared by HIV status. Unadjusted and adjusted logistic regression models were fit to identify risk factors associated with screening positive.

1087 mothers, including 819 (75.3%) mothers living with HIV (MLHIV), were screened at FLOURISH study entry. Compared to mothers without HIV, MLHIV were older (38.9 years versus 30.9 years; p<0.0001), had lower academic attainment (p<0.0001), lower income (p<0.0001) and reported higher prevalence of severe food insecurity (p=0.001). A total of 104 (9.6%) mothers screened positive for depression including 90 (11.0%) MLHIV and 14 (5.1%) without HIV (p=0.06), including 52 (6.3%) MLHIV and 10 (3.7%) without HIV who screened positive for moderate to severe depression versus mild depression. Prevalence of screening positive for anxiety was 4.8% among MLHIV compared to 6.6% among mothers without HIV (p=0.20). In unadjusted analyses, living with HIV [Odds Ratio (OR) 1.8 (95% Confidence Interval (CI) 1.1, 3.1) p=0.02] and severe household food insecurity [OR 2.3 (95% CI 1.4, 3.9) p=0.002) were significantly associated with screening positive, but no association was noted between maternal age, education level, or household income. In adjusted analysis, severe household food insecurity remained significantly associated with screening positive of depression or anxiety [OR 2.4 (95% CI 1.4, 4.2) p=0.001] but the association between living with HIV and a positive screen was no longer significant after adjusting for age.

In this large cohort, mothers living with HIV were more likely to screen positive for depression, but not anxiety. Food insecurity was significantly associated with a positive screening score, highlighting the need for a comprehensive psychosocial support package of care in high burden HIV settings.