Mental Health of Black & Latinx Youth and Emerging Adults Living with HIV: Examining Social Ecological Risk Factors and Their Association with Depression, Post-Traumatic Stress Disorder (PTSD), and Comorbid Depression/PTSD

Background and Purpose: The mental health of minoritized youth is affected by multiple risk factors in their social ecology. This paper examines rates of depression, post-traumatic stress disorder (PTSD), and comorbid depression/PTSD among diverse Black and Latinx youth and emerging adults (YEA) living with HIV recruited in the community. With a focus on foreign-born persons, we incorporated a social-ecological framework to examine how individual, interpersonal, community, and societal risk factors are associated with depression, PTSD, and comorbid depression/PTSD. Insight into risk factors can play a vital role in determining potential levers for prevention.

Methods: We used a hybrid recruitment strategy (social media, classified and public transportation ads, dating apps, and peer-to-peer) and surveyed 271 Black & Latinx YEA living with HIV in urban areas in the Eastern United States. Descriptive statistics and well-established clinical cut-off scores were used to examine the presence of significant depression (PHQ-8), PTSD (PC-PTSD), and comorbid depression/PTSD. We used multivariable logistic regression and hypothesized that individual risk factors (foreign born, older age, non-Hispanic black/multiracial, transgender, unsuppressed viral load, greater number of adverse childhood experiences [ACEs], moderate/high substance use), interpersonal risk factors (history of IPV victimization, greater social support), and community and societal risk factors (unemployed, history of being jailed, greater discrimination), would be positively associated with depression, PTSD, and comorbid depression/PTSD.

Results: Participants mean age was 25.2 years (SD=2.4), 95.6% male sex, 58.7% Hispanic/Latino, 49.1% foreign-born, and mean age of first HIV diagnosis 21.3 years (SD=2.9). Participants experienced elevated rates of significant mental distress; 33.9% met the cut-off score for depression, 33.9% for PTSD, and, importantly, 19.3% for comorbid depression/PTSD. Contrary to our hypothesis, U.S. born participants had significantly higher rates of depression (20.9%), PTSD (20.3%), and comorbid depression/PTSD (12.6%) compared to foreign-born participants; depression (13.0%), PTSD (13.7%), and comorbid depression/PTSD (6.7%).

At the individual-level, foreign-born status was associated with lower odds of comorbid depression/PTSD (OR:0.28, 95% CI:[0.09, 0.85]), greater number of ACEs was associated with PTSD (OR:1.10, 95% CI:[1.03, 1.17]) and comorbid depression/PTSD (OR:1.11, 95% CI:[1.01, 1.23]), while moderate/high substance use was associated with depression (OR:2.90, 95% CI:[1.18, 7.14]). At the interpersonal-level, lower social support was associated with higher odds of depression (OR:0.98, 95% CI:[0.97, 1.00]), PTSD (OR:0.98, 95% CI:[0.97, 0.99]), and comorbid depression/PTSD (OR:0.97, 95% CI:[0.95, 0.99]). At the community/societal-level, greater discrimination was associated with higher odds of depression (OR:1.05, 95% CI:[1.02, 1.08]) and comorbid depression/PTSD (OR:1.06, 95% CI:[1.02, 1.11]).

Conclusion and Implications: Specific social-ecological risk factors were associated with various mental health outcomes among Black and Latinx YEA living with HIV, an understudied and underserved population. Across analyses, we found greater number of ACEs, lower social support, and discrimination were associated with multiple negative mental health outcomes. This suggests future research aiming to improve lives of Black and Latinx YEA living with HIV consider interventions that enhance social support, reduce discrimination, and mitigate impact of ACEs. As foreign-born youth had significantly lower rates of depression compared to U.S. born youth, future studies should compare social-ecological risk factors among these two populations separately.