Background
Methods
Study design, population and setting
Study procedures
Measures
Statistical analysis for the depression manuscript
Variable | Mean (SD, N)/N (%) | Unadjusted Beta Coef (95 % CI) | Unadjusted p-value | Adjusted Beta Coef(95 % CI) | Adjusted p-value | |
---|---|---|---|---|---|---|
Socio-demographic factors | ||||||
School Grade | ||||||
Not in school or Junior Primary School | 176 (31.3) | 2.37 [0.68-4.06] | 0.02 | 5.25 [3.23-7.26] | <0.0001 | |
Senior Primary School | 229 (40.7) | 1.62 [0.02-3.22] | 3.5 [1.78-5.22] | |||
Secondary School or Tertiary | 157 (27.9) | Reference | Reference | |||
Family’s estimated combined income | ||||||
Less than 14,000 MK per month | 171 (31.8) | 0.36 [−1.29-2.02] | 0.61 | 0.38 [−1.26-2.02] | 0.64 | |
14,000 -49,999 MK per month | 117 (21.8) | −0.85 [−2.69-0.99] | −0.79 [−2.61-1.03] | |||
More than 50,000 per month | 71 (13.2) | −0.48 [−2.65-1.68] | −0.37 [−2.52-1.77] | |||
I do not know | 178 (33.1) | Reference | Reference | |||
Location of home | ||||||
In the city | 369 (65.7) | −1.24 [−2.98-0.50] | 0.06 | −1.49 [−3.22-0.25] | 0.06 | |
Just outside the city | 93 (16.5) | 0.74 [−1.48-2.97] | 0.3 [−1.92-2.52] | |||
Rural area | 100 (17.8) | Reference | Reference | |||
Time it takes to get to the clinic from home | ||||||
0-30minutes | 71 (12.7) | −0.88 [−2.96-1.20] | 0.71 | −0.92 [−2.98-1.15] | 0.67 | |
31-60 minutes | 229 (40.8) | −0.15 [−1.56-1.25] | −0.36 [−1.76-1.04] | |||
>60 minutes | 261 (46.5) | Reference | Reference | |||
Primary caregiver type | ||||||
Father/Mother | 178 (31.7) | −1.63 [−3.39-0.13] | 0.01 | −1.36 [−3.12-0.39] | 0.02 | |
Both parents | 112 (19.9) | −3.39 [−5.36--1.42] | −3.09 [−5.06--1.12] | |||
Uncle/Aunt | 138 (24.6) | −1.5 [−3.37-0.37] | −1.32 [−3.18-0.54] | |||
Other/Grandparent | 134 (23.8) | Reference | Reference | |||
Past-traumatic events/stressors | ||||||
Maternal death or employment status | ||||||
Not working | 106 (18.9) | −0.95 [−2.71-0.80] | 0.01 | −0.8 [−2.55-0.95] | 0.03 | |
Self-employed | 103 (18.3) | −1.51 [−3.29-0.26] | −1.37 [−3.14-0.40] | |||
Employed by someone else | 73 (13) | −3.22 [−5.24--1.19] | −2.97 [−4.99--0.95] | |||
Died | 280 (49.8) | Reference | Reference | |||
Change in caregiver | ||||||
No change in caregiver | 422 (75.2) | −1.59 [−3.10--0.08] | 0.04 | −1.59 [−3.09--0.09] | 0.04 | |
Caregiver has changed once or more | 139 (24.8) | Reference | Reference | |||
Experience of family/household deaths | ||||||
Nobody in my family has died | 149 (26.5) | −2.42 [−3.89--0.95] | 0.001 | −2.51 [−3.97--1.05] | 0.0008 | |
One or more people have died | 413 (73.5) | Reference | Reference | |||
Failed school term/class | ||||||
No | 327 (58.9) | −1.64 [−2.97--0.31] | 0.02 | −1.73 [−3.05--0.41] | 0.01 | |
Yes | 228 (41.1) | Reference | Reference | |||
Experience of forced sex, physical abuse, or witnessed physical violence in the home | ||||||
No | 477 (84.9) | −3.16 [−4.97--1.35] | 0.0006 | −2.97 [−4.79--1.15] | 0.001 | |
Yes | 85 (15.1) | Reference | Reference | |||
Experience of being bullied for one’s physical appearance | ||||||
No | 427 (76.1) | −3.11 [−4.62--1.59] | 0.0001 | −2.78 [−4.31--1.25] | 0.0004 | |
Yes | 134 (23.9) | Reference | Reference | |||
Experience of being bullied for taking medicines | ||||||
No | 459 (88.4) | −5.7 [−7.75--3.64] | <0.0001 | −5.3 [−7.40--3.19] | <0.0001 | |
Yes | 60 (11.6) | Reference | Reference | |||
Hospital admissions in the past year | ||||||
No | 510 (90.7) | −2.08 [−4.34-0.17] | 0.07 | −2.13 [−4.36-0.10] | 0.06 | |
Yes | 52 (9.3) | Reference | Reference | |||
Behavioral factors/social support | ||||||
Experience of being in a romantic relationship that did not involve sex | ||||||
Never had a boyfriend/girlfriend | 479 (85.4) | −3.52 [−5.35--1.69] | 0.0002 | −2.96 [−4.96--0.96] | 0.004 | |
Yes, in the past or current | 82 (14.6) | Reference | Reference | |||
Satisfaction with the way I look (physical appearance) | ||||||
I am very happy with the way I look | 460 (82) | −4.65 [−6.31--2.99] | <0.0001 | −4.34 [−6.00--2.68] | <0.0001 | |
I am somewhat/ not at all satisfied with the way I look | 101 (18) | Reference | Reference | |||
Use of alcohol in the past 30 days | ||||||
Never | 547 (97.3) | −7.76 [−11.77--3.74] | 0.0002 | −7.35 [−11.35--3.36] | 0.0003 | |
Once a month or more | 15 (2.7) | Reference | Reference | |||
HIV disclosure status* | ||||||
Disclosed and have shared with someone | 273 (48.6) | 0.19 [−1.59-1.97] | 0.09 | 0.98 [−2.86-0.97] | 0.02 | |
Disclosed, have not shared with anyone | 184 (32.7) | 1.68 [−0.21-3.57] | 0.98 [−0.74-3.12] | |||
Not disclosed | 105 (18.7) | Reference | Reference | |||
Age at disclosure | 12.35 (1.63, 457) | 0.55 [0.10-1.00] | 0.02 | 0.42 [−0.09-0.92] | 0.11 | |
Bio-clinical parameters | ||||||
Child on ART | ||||||
No | 36 (6.4) | 0.83 [−1.84-3.50] | 0.54 | 0.99 [−1.66-3.64] | 0.46 | |
Yes | 526 (93.6) | Reference | Reference | |||
Efavirenz based ART regimen | ||||||
No | 526 (93.6) | −0.71 [−3.38-1.96] | 0.60 | −0.71 [−3.36-1.95] | 0.60 | |
Yes | 36 (6.4) | Reference | Reference | |||
Second line ART regimen | ||||||
No | 491 (87.4) | 0.68 [−1.29-2.65] | 0.50 | 0.65 [−1.33-2.63] | 0.52 | |
Yes | 71 (12.6) | Reference | Reference | |||
History of TB treatment | ||||||
No | 309 (55) | 0.77 [−0.54-2.09] | 0.25 | 0.75 [−0.55-2.06] | 0.26 | |
Yes | 253 (45) | Reference | Reference | |||
Initial WHO stage | ||||||
WHO stage 1-2 | 160 (28.7) | −0.12 [−1.57-1.34] | 0.87 | 0.03 [−1.42-1.47] | 0.97 | |
WHO Stage 3-4 | 398 (71.3) | Reference | Reference | |||
Most recent CD4 count | 516 (307, 509) | 0 [−0.01--0.00] | 0.009 | 0 [−0.00--0.00] | 0.02 | |
HIV immunological classification (based on CD4) | ||||||
None or not significant | 235 (46.2) | −2.34 [−4.18--0.49] | 0.03 | −2.26 [−4.09--0.43] | 0.05 | |
Mild | 112 (22) | −0.94 [−3.05-1.18] | −1 [−3.09-1.09] | |||
Advanced | 68 (13.4) | −0.16 [−2.56-2.25] | −0.15 [−2.53-2.22] | |||
Severe | 94 (18.5) | Reference | Reference | |||
Current nutritional status | ||||||
Normal | 544 (96.8) | −2.44 [−6.15-1.28] | 0.20 | −3.14 [−6.83-0.56] | 0.10 | |
Malnourished | 18 (3.2) | Reference | Reference | |||
BMI for age z-score | −0.88 (1.18, 561) | 0.08 [−0.48-0.63] | 0.79 | −0.19 [−0.76-0.39] | 0.52 | |
Height for age z-score | −1.79 (1.16, 561) | −0.98 [−1.54-0.42] | 0.0006 | −1.31 [−1.88-0.74] | <0.0001 |
Variable | Mean (SD, N)/N (%) | N (%) | Unadjusted OR (95 % CI) | Unadjusted p-value (overall) | Adjusted OR (95 % CI) | Adjusted p-value (overall) | |
---|---|---|---|---|---|---|---|
Socio-demographic factors | |||||||
School Grade | |||||||
Not in school/Junior Primary School | 176 (31.3) | 35 (19.9) | 1.45 [0.81-2.57] | 0.27 | 2.82 [1.39-5.73] | 0.009 | |
Senior Primary School | 229 (40.7) | 48 (21) | 1.54 [0.90-2.66] | 2.36 [1.29-4.32] | |||
Secondary School or Tertiary | 157 (27.9) | 23 (14.6) | Reference | Reference | |||
Family’s estimated combined income | |||||||
Less than 14,000 MK per month | 171 (31.8) | 36 (21.1) | 1.32 [0.77-2.25] | 0.24 | 1.33 [0.77-2.28] | 0.23 | |
14,000 -49,999 MK per month | 117 (21.8) | 16 (13.7) | 0.78 [0.40-1.51] | 0.79 [0.41-1.54] | |||
More than 50,000 per month | 71 (13.2) | 17 (23.9) | 1.55 [0.79-3.04] | 1.61 [0.82-3.16] | |||
I do not know | 178 (33.1) | 30 (16.9) | Reference | Reference | |||
Location of home | |||||||
In the city | 369 (65.7) | 67 (18.2) | 0.83 [0.48-1.45] | 0.81 | 0.78 [0.45-1.36] | 0.69 | |
Just outside the city | 93 (16.5) | 18 (19.4) | 0.9 [0.45-1.83] | 0.81 [0.40-1.65] | |||
Rural area | 100 (17.8) | 21 (21) | Reference | Reference | |||
Time it take to get to the clinic from home | |||||||
0-30minutes | 71 (12.7) | 14 (19.7) | 1.25 [0.64-2.43] | 0.38 | 1.22 [0.62-2.40] | 0.50 | |
31-60 minutes | 229 (40.8) | 49 (21.4) | 1.38 [0.88-2.17] | 1.31 [0.83-2.08] | |||
>60 minutes | 261 (46.5) | 43 (16.5) | Reference | Reference | |||
Primary caregiver type | |||||||
Father/Mother | 178 (31.7) | 33 (18.5) | 0.64 [0.38-1.10] | 0.04 | 0.68 [0.39-1.17] | 0.07 | |
Both parents | 112 (19.9) | 13 (11.6) | 0.37 [0.19-0.74] | 0.4 [0.20-0.81] | |||
Uncle/Aunt | 138 (24.6) | 25 (18.1) | 0.63 [0.35-1.12] | 0.64 [0.36-1.15] | |||
Other/Grandparent | 134 (23.8) | 35 (26.1) | Reference | Reference | |||
Past-traumatic events/stressors | |||||||
Maternal death or employment status | |||||||
Not working | 106 (18.9) | 19 (17.9) | 0.77 [0.43-1.36] | 0.21 | 0.8 [0.45-1.43] | 0.31 | |
Self-employed | 103 (18.3) | 14 (13.6) | 0.55 [0.29-1.04] | 0.58 [0.30-1.09] | |||
Employed by someone else | 73 (13) | 11 (15.1) | 0.62 [0.31-1.26] | 0.67 [0.33-1.36] | |||
Died | 280 (49.8) | 62 (22.1) | Reference | Reference | |||
Change in caregiver | |||||||
No change in caregiver | 422 (75.2) | 70 (16.6) | 0.57 [0.36-0.90] | 0.02 | 0.57 [0.36-0.90] | 0.02 | |
Caregiver has changed once or more | 139 (24.8) | 36 (25.9) | Reference | Reference | |||
Experience of family/household deaths | |||||||
Nobody in my family has died | 149 (26.5) | 22 (14.8) | 0.68 [0.41-1.13] | 0.14 | 0.67 [0.40-1.12] | 0.12 | |
One or more people have died | 413 (73.5) | 84 (20.3) | Reference | Reference | |||
Failed school term/class | |||||||
No | 327 (58.9) | 55 (16.8) | 0.78 [0.51-1.20] | 0.26 | 0.76 [0.49-1.17] | 0.21 | |
Yes | 228 (41.1) | 47 (20.6) | Reference | Reference | |||
Experience of forced sex, physical abuse, or witnessed physical violence in the home | |||||||
No | 477 (84.9) | 79 (16.6) | 0.43 [0.25-0.71] | 0.001 | 0.45 [0.26-0.76] | 0.003 | |
Yes | 85 (15.1) | 27 (31.8) | Reference | Reference | |||
Experience of being bullied for one’s physical appearance | |||||||
No | 427 (76.1) | 70 (16.4) | 0.53 [0.34-0.85] | 0.008 | 0.58 [0.36-0.93] | 0.02 | |
Yes | 134 (23.9) | 36 (26.9) | Reference | Reference | |||
Experience of being bullied for taking medicines | |||||||
No | 459 (88.4) | 73 (15.9) | 0.23 [0.13-0.41] | <0.0001 | 0.27 [0.15-0.48] | <0.0001 | |
Yes | 60 (11.6) | 27 (45) | Reference | Reference | |||
Hospital admissions in the past year | |||||||
No | 510 (90.7) | 92 (18) | 0.6 [0.31-1.15] | 0.12 | 0.58 [0.30-1.13] | 0.11 | |
Yes | 52 (9.3) | 14 (26.9) | Reference | Reference | |||
Behavioral factors/social support | |||||||
Past history of being in a romantic relationship that did not involve sex | |||||||
Never had a boyfriend/girlfriend | 479 (85.4) | 83 (17.3) | 0.54 [0.31-0.92] | 0.02 | 0.65 [0.36-1.18] | 0.16 | |
Yes, in the past or current | 82 (14.6) | 23 (28) | Reference | Reference | |||
Satisfaction with the way I look (physical appearance) | |||||||
I am very happy with the way I look | 460 (82) | 77 (16.7) | 0.5 [0.30-0.82] | 0.006 | 0.54 [0.33-0.89] | 0.02 | |
I am somewhat/ not at all satisfied with the way I look | 101 (18) | 29 (28.7) | Reference | Reference | |||
Use of alcohol in the past 30 days | |||||||
Never | 547 (97.3) | 100 (18.3) | 0.34 [0.12-0.96] | 0.04 | 0.37 [0.13-1.07] | 0.07 | |
Once a month or more | 15 (2.7) | 6 (40) | Reference | Reference | |||
HIV disclosure status* | |||||||
Disclosed and have shared with someone | 273 (48.6) | 51 (18.7) | 1.19 [0.65-2.17] | 0.64 | 0.90 [0.47-1.75] | 0.54 | |
Disclosed, have not shared with anyone | 184 (32.7) | 38 (20.7) | 1.35 [0.72-2.53] | 1.19 [0.62-2.28] | |||
Not disclosed | 105 (18.7) | 17 (16.2) | Reference | Reference | |||
Age at disclosure | 12.3 (1.6, 4.6) | 1.27 [1.11-1.47] | 0.0008 | 1.31 [1.11-1.56] | 0.002 | ||
Bio-clinical parameters | |||||||
Child on ART | |||||||
No | 36 (6.4) | 4 (11.1) | 0.52 [0.18-1.50] | 0.23 | 0.54 [0.18-1.56] | 0.25 | |
Yes | 526 (93.6) | 102 (19.4) | Reference | Reference | |||
Efavirenz based ART regimen | |||||||
No | 526 (93.6) | 103 (19.6) | 2.68 [0.81-8.90] | 0.11 | 2.75 [0.82-9.19] | 0.10 | |
Yes | 36 (6.4) | 3 (8.3) | Reference | Reference | |||
Second line ART regimen | |||||||
No | 491 (87.4) | 94 (19.1) | 1.16 [0.60-2.25] | 0.65 | 1.18 [0.60-2.31] | 0.63 | |
Yes | 71 (12.6) | 12 (16.9) | Reference | Reference | |||
History of TB treatment | |||||||
No | 309 (55) | 61 (19.7) | 1.14 [0.74-1.74] | 0.56 | 1.13 [0.74-1.75] | 0.56 | |
Yes | 253 (45) | 45 (17.8) | Reference | Reference | |||
Initial WHO stage | |||||||
WHO stage 1-2 | 160 (28.7) | 28 (17.5) | 0.88 [0.55-1.43] | 0.61 | 0.91 [0.56-1.47] | 0.71 | |
WHO Stage 3-4 | 398 (71.3) | 77 (19.3) | Reference | Reference | |||
Most recent CD4 count | 516 (307, 509) | 1 [1.00-1.00] | 0.08 | 1 [1.00-1.00] | 0.12 | ||
HIV immunological classification | |||||||
None or not significant | 235 (46.2) | 32 (13.6) | 0.58 [0.31-1.08] | 0.04 | 0.6 [0.32-1.13] | 0.05 | |
Mild | 112 (22) | 15 (13.4) | 0.57 [0.27-1.19] | 0.57 [0.27-1.19] | |||
Advanced | 68 (13.4) | 18 (26.5) | 1.33 [0.64-2.77] | 1.35 [0.64-2.82] | |||
Severe | 94 (18.5) | 20 (21.3) | Reference | Reference | |||
Current nutritional status | |||||||
Normal | 544 (96.8) | 100 (18.4) | 0.45 [0.17-1.23] | 0.12 | 0.38 [0.13-1.05] | 0.06 | |
Malnourished | 18 (3.2) | 6 (33.3) | Reference | Reference | |||
BMI for age z-score | −0.88 (1.18, 561) | 0.96 [0.80-1.14] | 0.61 | 0.89 [0.74-1.08] | 0.24 | ||
Height for age z-score | −1.79 (1.16, 561) | 0.93 [0.78-1.12] | 0.46 | 0.87 [0.72-1.06] | 0.17 |
Ethics approvals
Results
Univariate analysis of associations between BDI-II score and other variables
Univariate analysis of associations between depression and other variables
Multivariate analysis of associations between BDI-II score and other variables
Variable | Beta Coefficient [95 % CI] | P-value |
---|---|---|
Age | 0.54 [−0.38, 1.46] | 0.25 |
Female | 2.13 [0.82, 3.43] | 0.002 |
Grade | ||
Not in school/Junior Primary School | 3.84 [1.71, 5.98] | 0.0005 |
Senior Primary School | 3.17 [1.45, 4.89] | |
Secondary School or Tertiary | Reference | |
Nobody in my family has died | −1.77 [−3.15, −0.39] | 0.01 |
Did not fail school term/class | −1.46 [−2.76, −0.17] | 0.03 |
Bullying for taking medication | 5.31 [3.19, 7.43] | <0.0001 |
Never had a boyfriend/girlfriend | −2.38 [−4.35, −0.41] | 0.02 |
Satisfaction with physical appearance- happy with the way I look | −1.06 [−3.74, 1.63] | 0.44 |
HIV disclosure status | ||
Disclosed and have shared with someone | −1.83 [−3.79, 0.13] | 0.02 |
Disclosed, have not shared with anyone | 0.23 [−1.65, 2.10] | |
Not disclosed | Reference | |
Level of immunosuppression | ||
None or not significant | −2.58 [−4.29, −0.87] | 0.0009 |
Mild | −0.10 [−2.08, 1.88] | |
Advanced | 0.23 [−2.00, 2.47] | |
Severe | Reference | |
Height for age z-score | 0.23 [−0.67, 1.12] | 0.62 |
Age* satisfaction with physical appearance interaction | −0.93 [−1.74, −0.11] | 0.03 |
Age* Height for age z-score interaction | −0.39 [−0.68, −0.11] | 0.007 |
Multivariate analysis of associations between depression and other variables
Variable | OR [95 % CI] | P-value |
---|---|---|
Age | 1.23 [1.07, 1.42] | 0.004 |
Female | 1.43 [0.89, 2.29] | 0.14 |
Grade | ||
Not in school/ Junior Primary School | 3.30 [1.54, 7.05] | 0.005 |
Senior Primary School | 2.62 [1.37, 5.03] | |
Secondary School or Tertiary | Reference | |
Bullied for taking medication | 4.20 [2.29, 7.69] | <0.0001 |