{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:42:03Z","timestamp":1792777323232,"version":"4.5.0"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"10","license":[{"start":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T00:00:00Z","timestamp":1792713600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosmentalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Ment Health"],"abstract":"<jats:p>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\u2009&lt;\u20090.05. 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\u2009\u00b1\u20098.44) 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\u2009=\u20091.53; 95% CI: 1.06 \u20132.22), and low social support (AOR\u2009=\u20092.32; 95% CI: 1.11\u20135.07) were risk factors while low income (AOR\u2009=\u20090.42; 95% CI: 0.21\u20130.85), and low perceived stress (AOR\u2009=\u20090.05; 95% CI: 0.02\u20130.15) were protective of depression. Low perceived stress was protective of anxiety (AOR\u2009=\u20090.07; 95% CI: 0.02\u20130.22). 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.<\/jats:p>","DOI":"10.1371\/journal.pmen.0000764","type":"journal-article","created":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:35:13Z","timestamp":1792776913000},"page":"e0000764","update-policy":"https:\/\/doi.org\/10.1371\/journal.pmen.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cCarrying the burden silently\u201d: A mixed-methods analysis of common mental health disorders among women caregivers living with HIV in Enugu, Nigeria"],"prefix":"10.1371","volume":"3","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3819-3699","authenticated-orcid":true,"given":"Ugochukwu Uzoechina","family":"Nwokoro","sequence":"first","affiliation":[{"name":"Federal Teaching Hospital","place":["Owerri, Imo State, Nigeria"],"department":["Department of Community Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5235-292X","authenticated-orcid":true,"given":"Ifeyinwa Lilian","family":"Ezenwosu","sequence":"additional","affiliation":[{"name":"University of Nigeria Teaching Hospital","place":["Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9218-2726","authenticated-orcid":true,"given":"Elias Chikee","family":"Aniwada","sequence":"additional","affiliation":[{"name":"University of Nigeria Teaching Hospital","place":["Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]},{"name":"University of Nigeria Enugu Campus","place":["Enugu, Enugu, State, Nigeria"],"department":["Department of Community Medicine, Faculty of Medical Sciences, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Izuchukwu Frank","family":"Obi","sequence":"additional","affiliation":[{"name":"University of Nigeria Teaching Hospital","place":["Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-3089-0181","authenticated-orcid":true,"given":"Justus Uchenna","family":"Onu","sequence":"additional","affiliation":[{"name":"Nnamdi Azikiwe University","place":["Awka, Anambra State, Nigeria"],"department":["Department of Mental Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chidiebere Clifford","family":"Aniagboso","sequence":"additional","affiliation":[{"name":"University of Nigeria Teaching Hospital","place":["Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8289-0442","authenticated-orcid":true,"given":"Eunice","family":"Enabulele","sequence":"additional","affiliation":[{"name":"University of Nigeria Teaching Hospital","place":["Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4583-4714","authenticated-orcid":true,"given":"Chinyere Nkiruka","family":"Okafor","sequence":"additional","affiliation":[{"name":"University of Nigeria Enugu Campus","place":["Enugu, Enugu, State, Nigeria"],"department":["Department of Community Medicine, Faculty of Medical Sciences, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chijioke Thaddeus","family":"Asogwa","sequence":"additional","affiliation":[{"name":"Enugu State University College of Medicine","place":["Parklane, Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John Olajide","family":"Olawepo","sequence":"additional","affiliation":[{"name":"Northeastern University","place":["Boston, Massachusetts, United States of America"],"department":["Department of Public Health and Health Sciences, Bouve College of Health Sciences"]},{"name":"University of Nigeria, Old UNTH","place":["Enugu, Nigeria"],"department":["IVAN Research Institute"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika N.","family":"Onwasigwe","sequence":"additional","affiliation":[{"name":"University of Nigeria Teaching Hospital","place":["Enugu, Enugu State, Nigeria"],"department":["Department of Community Medicine"]},{"name":"University of Nigeria Enugu Campus","place":["Enugu, Enugu, State, Nigeria"],"department":["Department of Community Medicine, Faculty of Medical Sciences, College of Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,10,23]]},"reference":[{"key":"pmen.0000764.ref001","author":"UNAIDS"},{"key":"pmen.0000764.ref002","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.puhe.2020.01.014","article-title":"The effect of gender inequality on HIV incidence in Sub-Saharan Africa","volume":"182","author":"D Sia","year":"2020","journal-title":"Public Health"},{"issue":"6","key":"pmen.0000764.ref003","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s11904-021-00583-w","article-title":"Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV","volume":"18","author":"J Hoare","year":"2021","journal-title":"Curr HIV\/AIDS Rep"},{"key":"pmen.0000764.ref004","doi-asserted-by":"crossref","first-page":"2325958220985665","DOI":"10.1177\/2325958220985665","article-title":"Mental health in women living with HIV: the unique and unmet needs","volume":"20","author":"EM Waldron","year":"2021","journal-title":"J Int Assoc Provid AIDS Care"},{"issue":"11","key":"pmen.0000764.ref005","doi-asserted-by":"crossref","first-page":"6879","DOI":"10.3390\/ijerph19116879","article-title":"Mental Health Challenges and the Associated Factors in Women Living with HIV Who Have Children Living with HIV in Indonesia: A Qualitative Study","volume":"19","author":"NK Fauk","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"2","key":"pmen.0000764.ref006","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0002767","article-title":"Mental health burden among females living with HIV and AIDS in sub-Saharan Africa: A systematic review","volume":"4","author":"DS Boakye","year":"2024","journal-title":"PLOS Glob Public Health"},{"issue":"3","key":"pmen.0000764.ref007","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1177\/0361684314525579","article-title":"Gender roles and mental health in women with and at risk for HIV","volume":"38","author":"LR Brody","year":"2014","journal-title":"Psychological Women Quarterly"},{"key":"pmen.0000764.ref008","doi-asserted-by":"crossref","first-page":"1113587","DOI":"10.3389\/fpsyt.2023.1113587","article-title":"Women involvement in the informal caregiving field: A perspective review","volume":"14","author":"S Rexhaj","year":"2023","journal-title":"Front Psychiatry"},{"key":"pmen.0000764.ref009","doi-asserted-by":"crossref","first-page":"20289","DOI":"10.7448\/IAS.18.6.20289","article-title":"How does living with HIV impact on women\u2019s mental health? Voices from a global survey","volume":"18","author":"L Orza","year":"2015","journal-title":"J Int AIDS Soc"},{"issue":"5","key":"pmen.0000764.ref010","first-page":"68","article-title":"Caregiver burden, quality of life and coping mechanisms among caregivers of children living with HIV in Lagos, Nigeria","volume":"33","author":"OYO Adedoyin","year":"2023","journal-title":"Afr J Health Sci"},{"issue":"2","key":"pmen.0000764.ref011","doi-asserted-by":"crossref","first-page":"49","DOI":"10.5539\/gjhs.v5n2p49","article-title":"The impact of fear, secrecy, and stigma on parental disclosure of HIV status to children: a qualitative exploration with HIV positive parents attending an ART clinic in South Africa","volume":"5","author":"S Madiba","year":"2012","journal-title":"Glob J Health Sci"},{"key":"pmen.0000764.ref012","doi-asserted-by":"crossref","first-page":"59","DOI":"10.2174\/1745017902016010059","article-title":"Anxiety and Depression Among Women Living with HIV: Prevalence and Correlations","volume":"16","author":"A Yousuf","year":"2020","journal-title":"Clin Pract Epidemiol Ment Health"},{"key":"pmen.0000764.ref013","volume-title":"Consolidated guidelines on HIV prevention, testing, treatment, service delivery and monitoring: recommendations for a public health approach","author":"World Health Organization","year":"2021"},{"key":"pmen.0000764.ref014","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1016\/j.jad.2006.05.021","article-title":"Validity of the patient health questionnaire (PHQ-9) as a screening tool for depression amongst Nigerian university students","volume":"96","author":"AO Adewuya","year":"2006","journal-title":"J Affect Disord"},{"key":"pmen.0000764.ref015","doi-asserted-by":"crossref","DOI":"10.1192\/bjo.2023.224","article-title":"Psychometric Properties of the 7-Item Generalized Anxiety Disorder (Gad-7) in Nigerian Pregnant Women Attending Primary Health Care","volume":"9","author":"O Olaluwoye","year":"2023","journal-title":"BJPsych open"},{"issue":"3","key":"pmen.0000764.ref016","doi-asserted-by":"crossref","first-page":"19","DOI":"10.9734\/jesbs\/2022\/v35i330410","article-title":"Validation of the Multidimensional Scale of Perceived Social Support on Nigerian Female Undergraduates","volume":"35","author":"IB Bello","year":"2022","journal-title":"J Educ Soc Behav Sci"},{"issue":"1","key":"pmen.0000764.ref017","first-page":"45","article-title":"Validation and Reliability of the 12-item Zarit Burden Interview among Informal Caregivers of Elderly Persons in Nigeria","volume":"6","author":"OO Ojifinni","year":"2018","journal-title":"Arch Basic Appl Med"},{"key":"pmen.0000764.ref018","doi-asserted-by":"crossref","first-page":"1259830","DOI":"10.3389\/fpubh.2023.1259830","article-title":"Depression and perceived stress among perinatal women living with HIV in Nigeria","volume":"11","author":"FT Akinsolu","year":"2023","journal-title":"Front Public Health"},{"issue":"3","key":"pmen.0000764.ref019","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pgph.0005253","article-title":"Establishing an empirical cut-off on the 12-item Brief Berger HIV Stigma Scale to screen psychosocial vulnerability among PLHIV in Nigeria","volume":"6","author":"KS Abdulraheem","year":"2026","journal-title":"PLOS Glob Public Health"},{"issue":"9","key":"pmen.0000764.ref020","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9: validity of a brief depression severity measure","volume":"16","author":"K Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"issue":"10","key":"pmen.0000764.ref021","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"RL Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"issue":"4","key":"pmen.0000764.ref022","doi-asserted-by":"crossref","first-page":"385","DOI":"10.2307\/2136404","article-title":"A global measure of perceived stress","volume":"24","author":"S Cohen","year":"1983","journal-title":"J Health Soc Behav"},{"issue":"1","key":"pmen.0000764.ref023","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1186\/s12955-017-0691-z","article-title":"Development of a 12-item short version of the HIV stigma scale","volume":"15","author":"M Reinius","year":"2017","journal-title":"Health Qual Life Outcomes"},{"key":"pmen.0000764.ref024","article-title":"Adaptation of the multidimensional scale of perceived social support in a Ugandan setting","author":"J Nakigudde","year":"2009","journal-title":"Afr Health Sci"},{"issue":"6","key":"pmen.0000764.ref025","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1093\/geront\/20.6.649","article-title":"Relatives of the Impaired Elderly: Correlates of Feelings of Burden","volume":"20","author":"SH Zarit","year":"1980","journal-title":"Gerontologist"},{"issue":"6","key":"pmen.0000764.ref026","doi-asserted-by":"crossref","first-page":"2377","DOI":"10.18203\/2394-6040.ijcmph20221509","article-title":"Risk factors associated with depression among HIV positive women at Mama Lucy Kibaki hospital in Nairobi County, Kenya","volume":"9","author":"E Jeruto","year":"2022","journal-title":"Int J Community Med Public Health"},{"issue":"6","key":"pmen.0000764.ref027","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1080\/09540121.2021.1944595","article-title":"Social isolation is associated with major depressive disorders among women accessing HIV\/AIDS care in Nigeria","volume":"34","author":"O Abiodun","year":"2022","journal-title":"AIDS Care"},{"key":"pmen.0000764.ref028","doi-asserted-by":"crossref","first-page":"1259290","DOI":"10.3389\/fpsyt.2024.1259290","article-title":"People who living with HIV\/AIDS also have a high prevalence of anxiety disorders: a systematic review and meta-analysis","volume":"15","author":"J Ji","year":"2024","journal-title":"Front Psychiatry"},{"issue":"2","key":"pmen.0000764.ref029","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2023.e13318","article-title":"Health related quality of life of HIV-positive women on ART follow-up in north Shewa zone public hospitals, central Ethiopia: Evidence from a cross-sectional study","volume":"9","author":"D Girma","year":"2023","journal-title":"Heliyon"},{"issue":"12","key":"pmen.0000764.ref030","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.1080\/09540121.2016.1191609","article-title":"Socio-demographic correlates of depression and anxiety among female caregivers living with HIV in rural Uganda","volume":"28","author":"I Familiar","year":"2016","journal-title":"AIDS Care"},{"issue":"1","key":"pmen.0000764.ref031","article-title":"Perceived stigma and quality of life among women living with HIV\/AIDS","volume":"4","author":"N Zarei","year":"2016","journal-title":"Women\u2019s Heal Bull"},{"issue":"12","key":"pmen.0000764.ref032","doi-asserted-by":"crossref","first-page":"29","DOI":"10.9790\/0853-131222932","article-title":"Stigma in women living with HIV in Coimbatore District of TamilNadu","volume":"13","author":"L Chitra","year":"2014","journal-title":"IOSRJDMS"},{"issue":"5","key":"pmen.0000764.ref033","doi-asserted-by":"crossref","first-page":"884","DOI":"10.47772\/IJRISS.2025.90500073","article-title":"Stigma and discrimination faced by women living with HIV\/AIDS (WLHA)","volume":"9","author":"M Verma","year":"2025","journal-title":"Int J Res Innov Soc Sci"},{"issue":"1","key":"pmen.0000764.ref034","doi-asserted-by":"crossref","DOI":"10.4102\/phcfm.v11i1.2046","article-title":"Stress and resilience among women living with HIV in Nigeria","volume":"11","author":"A Adamu","year":"2019","journal-title":"Afr J Prim Health Care Fam Med"},{"issue":"4","key":"pmen.0000764.ref035","doi-asserted-by":"crossref","first-page":"744","DOI":"10.4103\/ijcm.IJCM_49_21","article-title":"Caregiver\u2019s Burden of Children Living with HIV on Antiretroviral Therapy at an Urban Setup","volume":"46","author":"SA Inamdar","year":"2021","journal-title":"Indian J Community Med"},{"issue":"1","key":"pmen.0000764.ref036","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0262638","article-title":"Prevalence of depression among HIV-positive pregnant women and its association with adherence to antiretroviral therapy in Addis Ababa, Ethiopia","volume":"17","author":"W Abebe","year":"2022","journal-title":"PLoS One"},{"issue":"6","key":"pmen.0000764.ref037","doi-asserted-by":"crossref","first-page":"890","DOI":"10.1111\/cch.12387","article-title":"The effects of caregiver and household HIV on child development: a community-based longitudinal study of young children","volume":"42","author":"L Sherr","year":"2016","journal-title":"Child Care Health Dev"},{"key":"pmen.0000764.ref038","doi-asserted-by":"crossref","first-page":"1163604","DOI":"10.3389\/fpubh.2023.1163604","article-title":"HIV-related stress predicts depression over five years among people living with HIV","volume":"11","author":"Z Liu","year":"2023","journal-title":"Front Public Health"},{"key":"pmen.0000764.ref039","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1016\/j.jad.2021.03.027","article-title":"The Association between HIV-Stigma and Depressive Symptoms among People Living with HIV\/AIDS: A Systematic Review of Studies Conducted in South Africa","volume":"287","author":"JR MacLean","year":"2021","journal-title":"J Affect Disord"},{"issue":"2","key":"pmen.0000764.ref040","doi-asserted-by":"crossref","first-page":"151","DOI":"10.3329\/bjms.v14i2.21864","article-title":"Correlates of perceived Stigma and depression among the women with HIV\/AIDS infection","volume":"14","author":"VR Mohite","year":"2015","journal-title":"Bangladesh J Med Sci"},{"key":"pmen.0000764.ref041","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofz360.1193","article-title":"1329. Experiences and Emotional Challenges of Antiretroviral Treatment (ART)\u2014Findings from the Positive Perspectives Study","volume":"6","author":"P De Los Rios","year":"2019","journal-title":"Open Forum Infectious Diseases"},{"issue":"1","key":"pmen.0000764.ref042","doi-asserted-by":"crossref","first-page":"1841","DOI":"10.1186\/s12889-020-09717-y","article-title":"Psychosocial support interventions for improved adherence and retention in ART care for young people living with HIV (10-24\u2009years): a scoping review","volume":"20","author":"EF Okonji","year":"2020","journal-title":"BMC Public Health"},{"issue":"3","key":"pmen.0000764.ref043","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1097\/MS9.0000000000002976","article-title":"Shaping sustainable paths for HIV\/AIDS funding: a review and reminder","volume":"87","author":"C Elendu","year":"2025","journal-title":"Ann Med Surg (Lond)"},{"key":"pmen.0000764.ref044","doi-asserted-by":"crossref","first-page":"100560","DOI":"10.1016\/j.ssmqr.2025.100560","article-title":"Living in the shadows: the persistence of secrecy in young people living with HIV on antiretroviral therapy, a qualitative study of the BREATHER Plus trial","volume":"7","author":"TC Seunanden","year":"2025","journal-title":"SSM - Qualitative Research in Health"}],"container-title":["PLOS Mental Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000764","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T17:35:21Z","timestamp":1792776921000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pmen.0000764"}},"subtitle":[],"editor":[{"given":"Anil","family":"Fastenau","sequence":"first","affiliation":[{"name":"Marie Adelaide Leprosy Center","place":["PAKISTAN"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,10,23]]},"references-count":44,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,10,23]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pmen.0000764","relation":{},"ISSN":["2837-8156"],"issn-type":[{"value":"2837-8156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,23]]}}}