Exploring the mental health and wellbeing of adolescent parent families affected by HIV in South Africa
Lead Research Organisation:
University of Oxford
Department Name: Social Policy and Intervention
Abstract
Africa's adolescent population (10-19 years; WHO,2017) are the fastest growing the in world - projected to reach 435 million by 2050 (United Nations,2019). Consequently, the health of adolescents, of which mental health is a fundamental component, is becoming increasingly important to promote individual potential, and ensure the prosperity of the region, and future generations. Poor mental health within adolescence has broad negative implications for individuals and wider society (United Nations Population Fund,2014). Yet, the mental health of children and adolescents remains an overlooked global health priority. Both experiencing adolescent pregnancy and living with HIV have been found to be associated with poor mental health (Vreeman,2017; Dahmen,2019). However, there is a dearth of literature (beyond the candidate's thesis) exploring mental health when both phenomena co-occur. Adolescents and their children living with and affected by HIV are a core population in both the future prosperity of the sub-Saharan Africa region and the HIV response. However, adolescent parent families living with and affected by HIV remain understudied, and thus underserved with regard to intervention and prevention.
The HEY BABY study is a cohort study of over 1000 adolescent mothers (both living with and not living with HIV) and their children residing in the Eastern Cape province, South Africa. Four components of data are collected within the study: (i) a health and wellbeing questionnaire (including validated mental health measures), (ii) a parenting questionnaire (giving detail on parenting experience), (iii) a direct assessment of child cognitive development, and (iv) child health records. Cross-sectional analyses of these data (undertaken by the candidate) have highlighted elevated poor mental health among adolescent mothers living with HIV compared to mothers not living with HIV, lower child development scores among children born to adolescent mothers compared to adult mothers within the sub-Saharan African region, and lower developmental scores among children living with HIV and HIV exposed uninfected children compared to children unexposed to HIV. These analyses have also identified an association between maternal posttraumatic stress and lower child cognitive development scores, and low paternal engagement within the care of their children (<20%). Violence exposure and lack of social support were found to be correlates of poor mental health among adolescent mothers in the sample, however longitudinal analyses is required to further understand such findings.
The proposed fellowships aims to allow the candidate to:
1. Consolidate the works within the candidate's PhD and extending these works to include longitudinal follow-up data. These works will focus on identifying amenable factors that could be integrating into policy and programming to improve the mental health of adolescent parents (both mothers and fathers) affected by HIV, and the development of their children. These works will also on developing a greater understanding the experience of fathers of children born to adolescent mothers (an often-overlooked group)
2. Develop analyses and manuscripts for publication and dissemination
3. Attend conferences, and stakeholder meetings to allow for knowledge transition and networking
4. Develop the foundations for future possible collaborations focusing on the mental health of adolescent parent families from both sub-Saharan Africa and high-income countries with the aim of extend the application of findings from both the thesis and postdoctoral activities
5. Undertake further training to build skills relating to methodology, and to establish a career in academia
6. Develop funding applications to advance the works undertaken as part of this postdoctoral fellowship, and to further address the need for data to allow for the effective development of meaningful policy and programming to serve current and future generations
The HEY BABY study is a cohort study of over 1000 adolescent mothers (both living with and not living with HIV) and their children residing in the Eastern Cape province, South Africa. Four components of data are collected within the study: (i) a health and wellbeing questionnaire (including validated mental health measures), (ii) a parenting questionnaire (giving detail on parenting experience), (iii) a direct assessment of child cognitive development, and (iv) child health records. Cross-sectional analyses of these data (undertaken by the candidate) have highlighted elevated poor mental health among adolescent mothers living with HIV compared to mothers not living with HIV, lower child development scores among children born to adolescent mothers compared to adult mothers within the sub-Saharan African region, and lower developmental scores among children living with HIV and HIV exposed uninfected children compared to children unexposed to HIV. These analyses have also identified an association between maternal posttraumatic stress and lower child cognitive development scores, and low paternal engagement within the care of their children (<20%). Violence exposure and lack of social support were found to be correlates of poor mental health among adolescent mothers in the sample, however longitudinal analyses is required to further understand such findings.
The proposed fellowships aims to allow the candidate to:
1. Consolidate the works within the candidate's PhD and extending these works to include longitudinal follow-up data. These works will focus on identifying amenable factors that could be integrating into policy and programming to improve the mental health of adolescent parents (both mothers and fathers) affected by HIV, and the development of their children. These works will also on developing a greater understanding the experience of fathers of children born to adolescent mothers (an often-overlooked group)
2. Develop analyses and manuscripts for publication and dissemination
3. Attend conferences, and stakeholder meetings to allow for knowledge transition and networking
4. Develop the foundations for future possible collaborations focusing on the mental health of adolescent parent families from both sub-Saharan Africa and high-income countries with the aim of extend the application of findings from both the thesis and postdoctoral activities
5. Undertake further training to build skills relating to methodology, and to establish a career in academia
6. Develop funding applications to advance the works undertaken as part of this postdoctoral fellowship, and to further address the need for data to allow for the effective development of meaningful policy and programming to serve current and future generations
Organisations
Publications
| Description | The award has produced findings from two series of analyses which will be submitted for peer review publication. 1. A study focusing on the fathers of children born to adolescent mothers living with and affected by HIV which identified low father involvement with their children (19.5%). This study identified that compared to non-involved fathers, involved fathers were more likely to be older when their child was born (21 years vs.20 years) to be in a relationship with the mother of their child (74.8% vs.47.2%), to reside with their child and their mother (14.7% vs.3.7%) and, were more likely to attend the first antenatal appointment (4.3% vs.1.5%). A quarter (25.4%) of the adolescent mothers in the sample were living with HIV. Prevalence of maternal HIV was found to be higher among adolescent mothers of children born to older fathers compared to adolescent fathers (31.7% vs.15.9%). Likewise, depressive symptoms were more prevalent among adolescent mothers of children born to older fathers compared to adolescent fathers (9.9% vs.5.3%). Adolescent mothers reporting poor mental health were less likely to be in a relationship with the father of their child (41.8% vs.54.1%), more likely to experience domestic violence perpetrated by the father of their child (8.2% vs.3.3%) and, more likely to engage in arguments about finances with the father of their child (30.0% vs.17.0%). Fathers are inherently tied to the experiences of adolescent mothers and their children. 2. Longitudinal data exploring the mental health experience of adolescent mothers living with and affected by HIV in South Africa identified an extremely high burden of poor mental health. Significant increases in poor mental health were identified on all measures of mental health symptoms post onset of the COVID-19 pandemic. Any common mental disorder symptomology rose from 13.4% pre-COVID-19 to 49.7% post-COVID-19 onset. This increase was similar for all individual mental health symptoms, including comorbid mental health conditions (scoring above the cut-off on one or more mental health scales). A half (49.7%; 350/704) of participants reported chronic or deteriorating mental health symptoms. In univariate analyses, changes in mental health prevalence over time were not found to differ by HIV status. Participants reporting resilient mental health were more likely to report no baseline experience of abuse, domestic violence, or community violence, and were more likely to be food secure. A planned third analyses has not been undertaken due to the data required to explore longitudinal child development being unavailable during the award period. As part of the award, the candidate has also applied for two fellowships to expand the works of award to focus on identifying factors associated with maternal health inequalities. If successful, these fellowships would allow the candidate to develop her own independent research profile and advance her career in academia. Additional fellowships and future funding applications are currently being developed. The candidate has also undertaken a series of training advanced statistical methods and academic leadership to enhance her skill set with a future academic career in mind. |
| Exploitation Route | Efforts to bolster father engagement with adolescent mothers and their children may have family wide benefits and the need for fathers within the inclusion of policy and programming remains. Policymakers and programme providers would be well placed to explore avenues of engaging fathers in this context. Analyses identify a critical need for mental health provision to support all adolescent mothers and identify possible factors (violence reduction and food security) to promote resilience and mental health. Further explorations of pathways to mental health risk and resilience among this group are needed to inform future policy and programming. The research undertaken raises additional queries relating to maternal health inequalities which the candidate plans to take forward in future research funding and fellowship applications. |
| Sectors | Communities and Social Services/Policy Education Healthcare |
| Description | Findings from this award are the focus of an upcoming workshop for Civil Society Organisations in South Africa working with adolescent parent families living with and affected by HIV. The aim of the workshop is to identify opportunities, challenges and obstacles to integrated working with CSOs to be be able to provide better programming and services for adolescent mothers and their children (inclusive of enhancing mental health support and mechanisms identified within this research to support mental health and child development). Integrating services among CSO will provide an economical solution to programming for adolescent parent families with the aim of alleviating mental health burden and thus the economic and societal impact of mental health burden. Findings arising from this award provide the largest exploration of longitudinal mental health among adolescent mothers and their children in the context of HIV. |
| First Year Of Impact | 2025 |
| Sector | Communities and Social Services/Policy,Healthcare |
| Impact Types | Societal Policy & public services |
| Description | Exploring the mental health and wellbeing of adolescent parent families affected by HIV in South Africa |
| Amount | £10,000 (GBP) |
| Organisation | University College London |
| Sector | Academic/University |
| Country | United Kingdom |
| Start | 08/2024 |
| End | 09/2025 |
| Description | On the Right Track: Towards Intersectoral Approaches in Health and Social Services for Adolescent Research Title Mothers in South Africa |
| Amount | £29,873 (GBP) |
| Funding ID | MRF-CPP-R1-24-105 |
| Organisation | Medical Research Council (MRC) |
| Department | Medical Research Foundation |
| Sector | Charity/Non Profit |
| Country | United Kingdom |
| Start | 02/2025 |
| End | 10/2025 |
| Description | Community Support Organisation engagement (Highlighting the needs of adolescent mothers and their families & the benefits of integrated working) |
| Form Of Engagement Activity | Participation in an activity, workshop or similar |
| Part Of Official Scheme? | No |
| Geographic Reach | International |
| Primary Audience | Professional Practitioners |
| Results and Impact | State services to support the complex health and wellbeing needs of pregnant and adolescent mothers and their children are frequently inadequate, inaccessible, or non-existent. When state services fall short, Civil Society Organisations (CSOs) - such as non-governmental organisations, community-based groups, faith-based organisations, and advocacy networks - are well placed to step in and deliver critical support for marginalised or vulnerable groups. In South Africa, CSOs have started to incorporate adolescent mothers into their agenda, but organisations operate primarily in silos, providing 'sector-specific' approaches. For instance, health-focussed CSOs may solely operate within clinics, without coordinating with educational institutions or community organisations. This approach persists despite recognition by international actors that intersectoral action can significantly enhance efficiency, improve access to resources, and promote the sharing of knowledge- and responsibilities. Intersectoral CSO services are crucial for adolescent mothers to address their diverse needs and leverage available support points optimally - this dissemination workshop provided CSOs with novel evidence on the need for and potential benefits of intersectoral workings in relation to adolescent parent families, their mental health and wellbeing. This workshop provided i) a structured dissemination of research findings and ii) an action planning forum that encourages CSOs to draw upon the evidence, and identify challenges and opportunities towards intersectoral working mechanisms to deliver comprehensive solutions for adolescent families. |
| Year(s) Of Engagement Activity | 2025 |