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

Women caregivers living with HIV (WCLHIV) face a dual burden of managing their own health while caring for their families, increasing their vulnerability to mental health disorders. This study aimed to ascertain the prevalence and factors associated with common mental health disorders among WCLHIV in Enugu, Nigeria. A cross-sectional study employing a mixed method approach was conducted among 1,011 WCLHIV accessing anti-retroviral therapy in four tertiary health facilities in Enugu State, Nigeria. Quantitative data were obtained face-to-face using pre-tested, validated tools to assess the prevalence of depression, anxiety, stigma, and other psychological characteristics. Multivariate logistic regression identified significant risk factors of mental health disorders at a 95% confidence interval and p < 0.05. Four focus group discussions involving 35 WCLHIV explored factors impacting their mental well-being. Qualitative data were analyzed thematically using an inductive approach. Participants had a mean age of 44.3 (SD ± 8.44) years. The prevalence of depression and anxiety was 25.7% and 19.2%, respectively, while 79.0% reported high perceived stigma. Having primary education (AOR = 1.53; 95% CI: 1.06 -2.22), and low social support (AOR = 2.32; 95% CI: 1.11-5.07) were risk factors while low income (AOR = 0.42; 95% CI: 0.21-0.85), and low perceived stress (AOR = 0.05; 95% CI: 0.02-0.15) were protective of depression. Low perceived stress was protective of anxiety (AOR = 0.07; 95% CI: 0.02-0.22). Qualitative findings converged with quantitative data, highlighting the impact of stigma, poor social support, pill burden, fear of status disclosure, and financial strain on the mental health of WCLHIV.The prevalence of common mental health disorders was high among WCLHIV with a substantial proportion experiencing depression and anxiety, reflecting the significant impact of stigma, low social support, and stress. Targeted multi-level psychosocial interventions and community empowerment programs are needed to strengthen social support and reduce stigma among WCLHIV.