Abstract
Although the prevalence of mental disorders is high among conflict-affected populations, the extent to which social determinants impact the mental health of conflict-affected youth living with HIV is not well studied. The goal of this study was to investigate how social determinants impact the mental health of refugee adolescents and youth living with HIV in Uganda (RAYLHIV). We analyzed baseline data from a two-year cluster randomized clinical trial (RCT) among RAYLHIV (ages 13-30). The participants were recruited between July and December 2023 from 20 health centers in three refugee settlements. To examine the association between selected social determinants of mental health (SDoMH) and the mental health outcomes, we fitted a separate mixed-effects linear regression model for each outcome including depression, hopelessness, and PTSD. HIV-related stigma (β = 0.04, 0.01-0.07; p = 0.012) and PTSD (β = 0.29, 0.16-0.43; p = < 0.001) were associated with increased depressive symptoms. Similarly, unemployment (β = 2.39, 0.65-4.13; p 0.007), HIV-related stigma (β = 0.20, 0.09-0.31; 0.001) and PTSD (β = 1.55, 0.84-2.26; p < 0.001) were associated with hopelessness. Good physical health (β = -0.53, -1.00-0.06; p = 0.028) and school enrollment (β = -0.94, -1.3-0.50; p < 0.001) were associated with lower PTSD symptoms. This study found that social determinants including school enrollment, double orphanhood, HIV-related stigma, poor physical health, and poverty related factors like unemployment are important predictors of poor mental health among RAYLHIV, underscoring the need for multilevel approaches to address these challenges.Trial registration: NCT01790373.