Adolescents, Young Adults With HIV at Increased Risk of Mental Health Issues

Young adults and adolescents with HIV have increased risk of developing either a sleep disorder or a mental health issue, according to a new review published in BMJ Open.¹ This finding emphasizes the need for interventions in this population to address gaps in care.

People living with HIV have consistently been shown to have a higher risk of developing mental health disorders,² including anxiety, depression, and psychological stress. These mental health issues can arise from a variety of sources, including adverse effects of medication and living with HIV in general. In general, adolescence and young adulthood is a time when mental health disorders often develop. This review aimed to gather data on the prevalence of mental health disorders and sleep disorders in adolescents and young adults (AYA) aged 10 to 40 years who are living with HIV.¹

Adolescents and young adults with HIV had higher rates of sleep and mental health disorders | Image credit: ViDi Studio - stock.adobe.com

The researchers used PubMed, Embase, Web of Science, and PsycINFO to search for studies that were relevant for this review. Observational studies published in English that included participants aged 10 to 40 years and included study results on the prevalence of depression, anxiety, posttraumatic stress disorder (PTSD), and sleep disorder were included in the study. All data regarding the study population, including the size of the sample and demographic data, were extracted from each study.

There were 56 articles that were included in the review. The prevalence of depression was reported in 51 studies containing 21,735 AYA, the prevalence of anxiety was reported in 21 studies with 8021 AYA, the prevalence of PTSD was reported in 9 studies with 3691 AYA, and the prevalence of sleep disorders was reported in 4 studies with 1909 AYA. Most of the studies were cross-sectional and conducted in Africa.

There was a pooled prevalence of 28% (95% CI, 24%-32%) for depression, 22% (95% CI, 17%-27%) for anxiety, 12% (95% CI, 8%-17%) for PTSD, and 51% (95% CI, 31%-70%) for sleep disorders. There was significant heterogeneity that ranged from 95.60% to 98.64% in all studies.

Higher risks of depression (OR, 2.67; 95% CI, 1.63-5.90), anxiety (OR, 1.89; 95% CI, 1.32-2.69), sleep disorder (OR, 2.11; 95% CI, 1.51-2.95), and PTSD (OR, 1.58; 95% CI, 1.23-2.04) were found in AYA with HIV when compared with AYA without HIV.

The researchers found that case-control studies had lower pooled prevalence of depression. A higher prevalence of depression was found in studies that used the Beck Depression Inventory-Second Edition, Center for Epidemiologic Studies Depression Scale, and the Patient Health Questionnaire-9 compared with those using the Children’s Depression Inventory, Patient Health Questionnaire-Adolescent, and the Mini-International Neuropsychiatric Interview for Children and Adolescents. Studies from Asia had a lower prevalence of depression (21.7% vs 29.6%) and anxiety (14.7% vs 21.9%) compared with studies from Africa, whereas studies from Africa displayed a lower prevalence of PTSD compared with North America (7.7% vs 24.4%).

There were some limitations to this study. There was high heterogeneity between the studies, which could limit applicability. There was also publication bias due to some studies not being published. The certainty of evidence measurements were low due to study design and publication bias.

The researchers concluded that AYA with HIV were at increased risk of both mental health disorders and sleep disorders compared with those without HIV in the same age group. Although the differences in the studies need to be considered due to high heterogeneity, the researchers concluded that “more sensitive screening strategies and more comprehensive intervention methods are needed” for AYA with HIV.

References

1. Tan Y, Ma Z, Cao Q, Gao S, Xiong Y. Prevalence of common mental disorders and sleep disorder among adolescents and young adults with HIV: a systematic review and meta-analysis. BMJ Open. 2025;15:e093320. doi:10.1136/bmjopen-2024-093320

2. HIV mental health treatment issues: HIV and clinical depression. American Psychiatric Association Office of HIV Psychiatry. 2012. Accessed May 19, 2025. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/Professional-Topics/HIV-Psychiatry/FactSheet-Depression-2012.pdf