Study Links Stigma and Low Support to Mental Health in Nigerian HIV Caregivers

A cross-sectional study conducted in Enugu, Nigeria, investigates the prevalence and associated factors of common mental health disorders among women living with HIV who also serve as family caregivers. The research involved 1,011 women accessing anti-retroviral therapy in four tertiary health facilities within Enugu State. The study aimed to ascertain the burden of these disorders, noting that these women face a dual challenge of managing their own health while caring for their families, which increases their vulnerability to psychological issues.

The participants had a mean age of 44.3 years, with a standard deviation of 8.44, indicating a middle-aged cohort often central to family caregiving responsibilities. The study employed a mixed-methods approach to capture both statistical prevalence and lived experiences. Quantitative data were collected through face-to-face interviews using pre-tested, validated tools to assess depression, anxiety, stigma, and other psychological characteristics.

Multivariate logistic regression was used to identify significant risk factors at a 95% confidence interval with a p-value less than 0.05. To complement the numerical data, the researchers conducted four focus group discussions involving 35 women. Qualitative data from these sessions were analyzed thematically using an inductive approach to explore the specific factors impacting the mental well-being of the participants.

The quantitative results revealed a high prevalence of mental health disorders. Specifically, 25.7% of the participants experienced depression, while 19.2% reported anxiety. Additionally, 79.0% of the women reported high levels of perceived stigma.

This pervasive sense of social exclusion was identified as a critical factor influencing their mental health status. The qualitative findings converged with these statistical results, with participants frequently citing stigma as a primary driver of their psychological distress. Statistical analysis identified specific risk and protective factors associated with these disorders.

Having only primary education was found to be a significant risk factor for depression, with an adjusted odds ratio of 1.53 and a 95% confidence interval of 1.06 to 2.22. Similarly, low social support was strongly associated with an increased risk of depression, with an adjusted odds ratio of 2.32 and a 95% confidence interval of 1.11 to 5.07. These findings suggest that women with fewer educational resources and less access to supportive social networks are particularly vulnerable to developing mental health disorders while managing HIV.

Conversely, the study identified factors that appeared to protect against these disorders. Low income was associated with a lower risk of depression, with an adjusted odds ratio of 0.42 and a 95% confidence interval of 0.21 to 0.85. More notably, low perceived stress was a strong protective factor for both depression and anxiety.

The adjusted odds ratio for low perceived stress protecting against depression was 0.05, with a 95% confidence interval of 0.02 to 0.15. For anxiety, the adjusted odds ratio for low perceived stress was 0.07, with a 95% confidence interval of 0.02 to 0.22. This suggests that women who report lower levels of perceived stress are significantly less likely to experience these common mental health disorders.

The qualitative insights provided a nuanced understanding of the stressors affecting these women. These factors, combined with the impact of stigma and poor social support, highlight the significant psychological burden on this population. The researchers emphasize that the high prevalence of depression and anxiety among this group reflects the significant impact of stigma, low social support, and stress.

The study underscores the need for targeted, multi-level psychosocial interventions that address these specific drivers. Such interventions should aim to strengthen social support networks and reduce the stigma associated with HIV, thereby alleviating the psychological burden on women caregivers. Community empowerment programs are also recommended as a strategy to improve mental health outcomes by fostering a supportive community environment.

Subject of Research: Prevalence and risk factors of mental health disorders among women caregivers living with HIV in Nigeria

Article Title: “Carrying the burden silently”: A mixed-methods analysis of common mental health disorders among women caregivers living with HIV in Enugu, Nigeria

Article References: Nwokoro, U. U., Ezenwosu, I. L., Aniwada, E. C., Obi, I. F., Onu, J. U., Aniagboso, C. C., Enabulele, E., Okafor, C. N., Asogwa, C. T., Olawepo, J. O., & Onwasigwe, C. N. (2026). “Carrying the burden silently”: A mixed-methods analysis of common mental health disorders among women caregivers living with HIV in Enugu, Nigeria. PLOS Mental Health, 3(10), e0000764. https://doi.org/10.1371/journal.pmen.0000764

Image Credits: AI Generated

DOI: 10.1371/journal.pmen.0000764

Keywords: HIV, mental health, caregivers, Nigeria, stigma, depression, anxiety, social support, cross-sectional study, public health, Carrying, burden