Research has shown that adolescents with HIV are at substantial risk for mental health problems. But too often the mental health concerns of young people with HIV are neglected, contributing to higher rates of HIV treatment adherence failure and death compared to older adults.
Dr. Warren Ng and Dr. Vitharon Boon-yasidhiTo begin addressing these gaps in mental health care for adolescents living with HIV in Southeast Asia, TREAT Asia has embarked on a new initiative to study mental health problems in adolescents and to build capacity for clinical management among pediatric HIV providers. It organized the first such training in June in Bangkok to help clinicians better diagnose and manage mental health disorders in their patients. The more than 30 participating pediatricians, psychiatrists, psychologists, social workers, nurses, counselors, and HIV program managers work with HIV-positive young people in Thailand, Cambodia, Indonesia, and Malaysia.
“Mental health issues are more prevalent in youth living with HIV compared to the general population, and suicide is the second leading cause of death in youth and young adults,” said lead trainer Dr. Warren Ng, Director of Clinical Services in the Department of Child and Adolescent Psychiatry and Associate Professor of Psychiatry at Columbia University Medical Center in New York City. “Struggling with issues related to stigma, disclosure and medication adherence, while navigating the complex developmental tasks in becoming an adult, is very daunting and challenging.”
The training reviewed the global epidemiology of adolescent mental health issues, mental health needs among youth living with HIV in Thailand, psychopharmacology, and assessing suicide risk, and provided an introduction to psychotherapy.
“What made the workshop incredibly powerful was the role playing and vignettes involving youth advocates and peers.”“Pediatricians and their HIV treatment team are in a good position to address mental health problems among children and adolescents living with HIV, particularly when mental health resources are limited,” said trainer Dr. Vitharon Boon-yasidhi, a child and adolescent psychiatrist at Siriraj Hospital, Mahidol University, in Thailand. “More training in managing common psychiatric comorbidities will improve their ability to provide holistic treatment, which includes mental health.”
Role play activities based on case studies helped participants assess mental health issues and learn to use standardized screening tools. These activities were organized in collaboration with local youth organizations and the Thai Red Cross AIDS Research Centre. Volunteer “actors” helped the providers practice their skills in interviewing patients about depression, treatment failure, and suicide.
Participants and leaders of the adolescent mental health training in Bangkok, June 2017
“What made the workshop incredibly powerful was the role playing and vignettes involving youth advocates and peers,” said Dr. Ng. “This provided an empowering opportunity for youth living with HIV to provide their perspectives to care providers regarding their experiences with HIV and mental health issues. It was a phenomenal learning opportunity for everyone involved and helped to strengthen the region’s commitment and partnerships.”
The other speakers and moderators, all based in Thailand, included Drs. Annette Sohn and Jeremy Ross from TREAT Asia; Drs. Jariya Tarugsa, Sasitorn Chantaratin, and Boonying Manaboriboon from Siriraj Hospital, Mahidol University; Drs. Pagakrong Lumbiganon and Niramol Patjanasoontorn from Srinagarind Hospital, Khon Kaen University; and Dr. Thanyawee Puthanakit from Chulalongkorn University.
“The skills taught in this training are very important,” said participant Dr. Saowaluck Silalai, a pediatrician from Pattani Hospital in Thailand. “To help adolescents grow up and become mature adults, we as caregivers need to understand and support them. I truly believe that together with the adolescents we can do many great things. There is always more for us to learn, and this session has helped us to see ourselves in a clearer perspective.”
TREAT Asia hopes to extend these trainings to other countries and to build its mental health research portfolio in order to understand the scope of these disorders among patient populations in the Asia-Pacific region.
Watch Hydeia Broadbent, one of amfAR’s Epic Voices, discuss the importance of mental health care for young people living with HIV.