Saúde mental e revelação do diagnóstico para crianças e adolescentes vivendo com HIV

Abstract

The objective of this Master's Degree thesis was to broaden the knowledge about issues related to the process of positive HIV diagnosis disclosure to children and adolescents. The results were divided into two empirical articles. The first manuscript includes the empirical results of a research survey that aimed to identify mental health characteristics of children and adolescents with HIV, investigating associations with sociodemographic factors. The sample was comprised of 112 caregivers of children and adolescents aged 6 to 18 years (mean age = 12 years old, SD ± 3) who were being treated in two specialized care centers in Porto Alegre, RS, Brazil. A sociodemographic questionnaire and the Child Behavior Checklist (CBCL) were used. We found that 59% of the sample met the clinical criteria for mental health problems according to the CBCL. Boys were more likely to have delinquent behavior than girls; and children under 10 years of age had significantly higher scores for depression, social problems, thought problems, attention difficulties, aggressive behavior, and on the clinical category. There was also an association between aggressive behavior and depressive symptoms. Regarding diagnosis disclosure, we found that 60% of patients were aware of their diagnosis, and in 68% of cases diagnosis information was provided by the family when the patients were between 10 and 12 years old. Furthermore, failure to disclose the diagnosis was associated with increased scores on the clinical category and more social problems. Our data show the need for special attention to the mental health of children and adolescents with HIV, suggesting the implementation of psychological counseling for children, adolescents, and caregivers, in addition to encouraging diagnosis disclosure. The second empirical manuscript presents a multiple-case study. The objective of this study was to investigate some familial aspects of the process of HIV diagnosis disclosure, as well as the psychological status of adolescents who are not aware of their diagnosis. We investigated the caregivers' expectations, fears, and coping strategies related to the undisclosed diagnosis and the possibility of disclosing it. We determined the adolescents' emotional state, fantasies, and defense mechanisms related to the diagnosis. Five adolescents between 10 and 13 years old and their caregivers participated in the study. Caregivers were interviewed, whereas the House-Tree-Person and fable tests were administered to the adolescents. Data analysis suggested that caregivers tend to postpone the diagnosis disclosure because they do not feel prepared to reveal such information. With regard to the adolescents, we found that their process of emotional development was impaired, showing psychological, emotional, and cognitive consequences. Our results 15 demonstrate that psychological counseling is crucial so that caregivers can cope with their diagnosis in a more adaptive manner in order to build an individualized and gradual process of diagnosis disclosure.