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.

Keywords: Refugee adolescents and youth; Refugee settlements; Refugee youth living with HIV; Social determinants of mental health.

© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

尽管冲突影响人口中的精神疾病患病率较高，但社会决定因素如何影响生活在乌干达的受艾滋病影响的难民青少年和青年的精神健康的研究还不充分。本研究旨在探讨社会决定因素如何影响生活在乌干达的受艾滋病影响的难民青少年和青年（RAYLHIV）的精神健康。我们分析了为期两年的集群随机对照试验（RCT）中的基线数据，这些参与者年龄在13至30岁之间，并于2023年7月至12月期间从三个难民营的20个卫生中心招募而来。为了研究选定的社会决定因素与精神健康结果之间的关联，我们分别为抑郁、绝望感和创伤后应激障碍（PTSD）构建了混合效应线性回归模型。

研究发现：

• 艾滋病相关污名（β = 0.04, 0.01-0.07; p = 0.012）和 PTSD（β = 0.29, 0.16-0.43; p < 0.001）与抑郁症状增加有关。
• 失业（β = 2.39, 0.65-4.13; p 0.007）、艾滋病相关污名（β = 0.20, 0.09-0.31; 0.001）和 PTSD（β = 1.55, 0.84-2.26; p < 0.001）与绝望感有关。
• 良好的身体健康状况（β = -0.53, -1.00-0.06; p = 0.028）和学校注册情况（β = -0.94, -1.3-0.50; p < 0.001）与 PTSD 症状较低有关。

本研究发现，包括学校注册、双重孤儿身份、艾滋病相关污名、身体健康状况不佳以及失业等贫困因素在内的社会决定因素是 RAYLHIV 精神健康不良的重要预测指标，强调了采取多层次方法应对这些问题的重要性。临床试验注册号：NCT01790373。

关键词： 难民青少年和青年；难民营；受艾滋病影响的难民青少年和青年；精神健康的社会决定因素。