Lena Skovgaard Andersen: Mental health challenges of people living with chronic illness

Tell us about your research

My research journey has focused on addressing the mental health challenges faced by people living with chronic illness in resource-constrained settings, particularly in people living with HIV in South Africa. My journey began in South Africa in 2007 when I was treating depression in people living with HIV for my PhD. At this time, antiretroviral therapy had only become available a few years earlier after years of AIDS-denialism by the South African government, even when 1000 people per day were dying of the virus. There was consequently a lot of fear surrounding the virus and the treatment. Stigma, discrimination and depression were prevalent and people were wary of taking the medication they had previously, and consistently, been told was a farce created by pharmaceutical companies for profit. 

My experience of working in the primary HIV care clinics, especially during a time of significant political and social challenges, opened my eyes to the importance of understanding and addressing the psychosocial aspects of healthcare including stigma and discrimination. I moved away from specialised care after my PhD to a task-shifted intervention for depression delivered by nurses and culturally adapted to the Xhosa community in resource constrained primary HIV care settings. A pilot study was followed by a large scale randomised controlled trial with very promising outcomes. The next step is that we have applied to conduct a large-scale Type III Hybrid Implementation-Effectiveness trial in 10 primary clinics in South Africa to translate our research findings into real-world solutions. Over the years, to address the need for comprehensive mental health care, I have also expanded my involvement to research in sexual trauma and in substance use disorders in people living with HIV. Our goal is to create a sustainable and scalable model for mental health care in HIV in resource-constrained settings. This approach has the potential not only to improve individual outcomes, but also to contribute to building capacity within local healthcare systems.

Overall, my research reflects a combination of clinical expertise, cultural sensitivity, and a commitment to bridging the gap between research and practice, particularly in regions and with sub-populations facing significant health disparities.

What excites you about your work and your research?

Working towards a paradigm shift away from the traditional, specialised model of mental health treatment toward a more integrated and accessible form of care is exciting. It not only challenges existing norms, it paves the way for more inclusive and equitable healthcare practices. This shift is especially critical for marginalised and resource-constrained communities, where access to specialised mental health services are particularly limited.

Which achievements do you hope to see within your research field 10 years from now?

I stand on the shoulders of giants and I aim to inspire my students and future generations to continue to build upon the work that we are doing. Together I hope that we can transform healthcare systems and address global disparities in mental health services by, among other things, establishing a strong evidence base for a range of mental health promotion, prevention, treatment and rehabilitation initiatives for people living with chronic illness, including HIV, on a global scale.

Together I hope that we can transform healthcare systems and address global disparities in mental health services by, among other things, establishing a strong evidence base for a range of mental health promotion, prevention, treatment and rehabilitation initiatives for people living with chronic illness, including HIV, on a global scale.

What advice do you have for junior researchers in global health?

If I had to stick to two points then I would advise early career researchers to follow where the research takes them and pursue what they believe in. Don’t just follow the money. While funding is crucial, prioritise what you know is important and what you are genuinely interested in.

What is your favorite source of global health inspiration and knowledge?

I am fortunate to work in a dynamic and nurturing environment, which promotes collaboration and professional growth. While I am inspired by influential figures in the field, my global health community, including colleagues at the Global Health Section and the School of Global Health, is the most influential source of motivation.