The Prevalence and Determinants of Depression and Anxiety Among Adolescents and Young Adults Living with HIV in the Nampula Province, Mozambique

Blacher, Ashlee

The Prevalence and Determinants of Depression and Anxiety Among Adolescents and Young Adults Living with HIV in the Nampula Province, Mozambique

Thesis / Dissertation

2026

Publisher

University of Cape Town

Department

Department of Public Health and Family Medicine

Faculty

Faculty of Health Sciences

Abstract

Adolescents and young adults living with HIV (AYAHIV) in Mozambique represent a uniquely vulnerable demographic, faced with considerable challenges along the HIV care continuum, which are further compounded by their elevated risk of common mental disorders (CMDs). Despite this dual burden, and the purported deleterious treatment outcomes associated with this comorbidity, research in this context remains scarce. We examined the prevalence and determinants of depressive and anxiety disorder symptoms among AYAHIV in Nampula, Mozambique. This study was informed by cross-sectional data from post-intervention surveys from the CombinADO study, a cluster randomized control trial conducted among 1,715 AYAHIV, aged 10 to 24 years, across 12 clinics in the Nampula Province, Northern Mozambique. 1,358 AYAHIV, aged 1524 years, were included for analysis. We used logistic mixed effects models to assess factors associated with depressive and anxiety disorder symptoms. Among Mozambiquan AYAHIV, 21.7% screened positive for depressive symptoms and 21.1% for anxiety symptoms, with higher rates of anxiety symptoms in females (22.33% vs 16.77%, p=0.035) and higher rates of depressive symptoms in those aged 15-19 years (24.63% vs 19.78%, p=0.034). Key risk factors for depressive symptoms included lower family social support (aOR=1.09, 95% CI: 1.01, 1.17) and higher internalized HIV stigma (aOR=1.33, 95% CI: 1.20, 1.48), while protective factors included being a high-school non-completer and below (aOR=0.32, 95% CI: 0.18, 0.57), higher ART adherence (aOR=0.98, 95% CI: 0.96, 1.00), and lower friend social support (aOR=0.87, 95% CI: 0.82, 0.92). For anxiety symptoms, risk factors included female sex (aOR=2.11, 95% CI: 1.34, 3.33), being in a non-cohabitating romantic relationship (aOR=1.73, 95% CI: 1.11, 2.71), and higher internalized HIV stigma (aOR=1.19, 95% CI: 1.08, 1.30). These findings contribute to the emerging body of evidence on the burden of CMDs among AYAHIV in SSA and Mozambique, underscoring the critical need for targeted mental health services in this setting.