| Chapter 2: | Background |
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Therefore, maturation becomes associated with sickness and death, rather than aspirations and the excitement of possibility in an adult world.
Adolescence, more then any other stage in human development, generates vulnerability to depression. The strife associated with normal adolescence compounded by the anxiety of a life-threatening and stigmatizing disease leads to significant escalation of psychological distress in adolescence (Rabkin & Chesney, 1999). In fact, recent literature indicates that the risk for childhood depression is 3 times greater if an early loss is combined with a child’s own life-threatening occurrences, long term troubles, or problematic personal relationships (Greenberg, Cicchetti, & Cummings, 1990).
Adolescents with HIV infection are at great risk of depression, a known catalyst for poor adherence (Hosek et al., 2002; Rabkin & Chesney, 1999; Starace et al., 2002). Depression is a significant predictor of medication nonadherence in HIV infected adolescents (Hosek et al.). Half of the HIV-infected adolescents studied in the United States are poorly adherent to their prescribed medications, with complexity of the regimen and depression playing substantial roles in noncompliance (Murphy et al., 2003).
Adolescents with HIV infection may have limited or ineffective family support as they struggle with achieving the goal of full medication adherence. Family histories of substance abuse and psychiatric illness are common among adolescents with HIV infection (Mellins, BrackisCott, Dolezal, & MeyerBahlburg, 2005) and may significantly impact the quality and consistency of care giving and guidance regarding medication management, and the child’s risk for depression.