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Posttraumatic Stress Symptoms Among Adults Caring for Orphaned Children in HIV-Endemic South Africa

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Abstract

There is growing evidence that mental health is a significant issue among families affected by AIDS-related parental deaths. The current study examined posttraumatic stress symptoms and identified risk factors among adults caring for AIDS-orphaned and other-orphaned children in an HIV-endemic South African community. A representative community sample of adults caring for children (N = 1,599) was recruited from Umlazi Township. Of the 116 participants who reported that a traumatic event was still bothering them, 19 % reported clinically significant posttraumatic stress symptoms. Of the 116 participants, caregivers of AIDS-orphaned and other-orphaned children were significantly more likely to meet threshold criteria for PTSD (28 %) compared to caregivers of non-orphaned children (10 %). Household receipt of an old age pension was identified as a possible protective factor for PTSD symptoms among caregivers of orphaned children. Services are needed to address PTSD symptoms among caregivers of orphaned children.

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References

  1. Stein D, Seedat S, Herman A, Moomal H, Heeringa S, Kessler R, et al. Lifetime prevalence of psychiatric disorders in South Africa. Br J Psychiatr. 2008;192:112–7.

    Article  Google Scholar 

  2. Martin L, Kagee A. Lifetime and HIV-related PTSD among persons recently diagnosed with HIV. AIDS Behav. 2011;15:125–31.

    Article  PubMed  Google Scholar 

  3. Olley B, Seedat S, Stein D. Persistence of psychiatric disorders in a cohort of HIV/AIDS patients in South Africa: a 6-month follow-up study. J Psychosom Res. 2006;61:479–84.

    Article  PubMed  Google Scholar 

  4. Myer L, Smit J, Le Roux L, Parker S, Stein D, Seedat S. Common mental disorders among HIV-infected individuals in South Africa: prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care STDS. 2008;22(2):147–58.

    Article  PubMed  Google Scholar 

  5. Cluver L, Gardner F, Operario D. Psychological distress amongst AIDS-orphaned children in urban South Africa. J Child Psychiatr Psychol Allied Discipl. 2007;48(8):755–63.

    Article  Google Scholar 

  6. Cluver L, Operario D, Gardner F. Parental illness, caregiving factors and psychological distress among children orphaned by acquired immune deficiency syndrome (AIDS) in South Africa. Vulnerable Child Youth Stud. 2009;4(3):185–98.

    Article  Google Scholar 

  7. UNAIDS. UN Report on the Global AIDS Epidemic. UNAIDS: Geneva. 2010.

  8. UNICEF. The state of the world’s children 2011: Adolescence an age of opportunity. UNICEF: New York. 2011.

  9. UNAIDS. Country Factsheet: South Africa. UNAIDS: Geneva. 2012.

  10. Monasch R, Boerma J. Orphanhood and childcare patterns in sub-Saharan Africa: an analysis of national surveys from 40 countries. AIDS. 2004;18(suppl 2):55–65.

    Article  Google Scholar 

  11. Oburu PO, Palmerus K. Parenting stress and self-reported discipline strategies of Kenyan caregiving grandmothers. Int J Behav Dev. 2003;27(6):505–12.

    Article  Google Scholar 

  12. Rotheram-Borus M, Leonard N, Lightfood M, Franzke L, Tottenham N, Lee S. Picking up the pieces: caregivers of adolescents bereaved by parental AIDS. Clin Child Psychol Psychiatr. 2002;1:115–24.

    Article  Google Scholar 

  13. Strug D, Burr C. Service needs of male caretakers of HIV-infected and affected children: policy and practice implications. Soc Work Health Care. 2003;38(2):73–92.

    Article  PubMed  Google Scholar 

  14. Ssengonzi R. The plight of older persons as caregivers to people infected/affected by HIV/AIDS: evidence from Uganda. J Cross Cult Gerontol. 2007;22(4):339–53.

    Article  PubMed  Google Scholar 

  15. Joslin D, Harrison R. Physical health and emotional well-being. In: Joslin D, editor. Invisible caregivers: older adults raising children in the wake of HIV/AIDS. New York: Columbia University Press; 2002. p. 90–112.

    Google Scholar 

  16. Joslin D, Mevi-Triano D, Berman J. Grandparents raising children orphaned by HIV/AIDS: Health risks and service needs. Cincinnati: The Gerontological Society of America; 1997.

    Google Scholar 

  17. Hirschowitz R, Orkin M. Trauma and mental health in South Africa. Soc Indic Res. 1997;41(1/3):169–82.

    Article  Google Scholar 

  18. Kagee A. Symptoms of distress and posttraumatic stress among South African former political detainees. Ethnic Health. 2005;10:169–79.

    Article  Google Scholar 

  19. Halvorsen J, Kagee A. Predictors of psychological sequelae of torture among South African former political prisoners. J Interpers Viol. 2010;25(6):989–1005.

    Article  Google Scholar 

  20. Kaminer D, Stein D, Mbanga I, Zungu-Dirwayi N. The truth and reconciliation commission in South Africa: relation to psychiatric status and forgiveness among survivors of human rights abuses. Br J Psychiatr. 2001;178:373–7.

    Article  CAS  Google Scholar 

  21. South African Department of Health. National Antenatal Sentinel HIV and Syphilis Prevalence Survey in South Africa, 2009. South African National Department of Health: Pretoria. 2010.

  22. South African Police Services (SAPS). Annual report 2008/2009: SAPS Strategic Management. SAPS: Pretoria. 2009.

  23. Statistics South Africa. Profile of children living in South Africa. http://www.statssa.gov.za/PublicationsHTML/Report-03-19-002009/html/Report-03-19-002009_13.html. Accessed 20 Jul 2011.

  24. Census 2001: Census in brief. http://www.statssa.gov.za/census01/html/CInBrief/CIB2001.pdf. Accessed 15 Jun 2006.

  25. Lopman B, Barnabas R, Boerma JT, Chawira G, Gaitskell K, Harrop T, et al. Creating and validating an algorithm to measure AIDS mortality in the adult population using verbal autopsy. PLoS Med. 2006;3(8):1273–81.

    Article  Google Scholar 

  26. Lopman B, Cook A, Smith J, Chawira G, Urassa M, Kumogola Y, et al. Verbal autopsy can consistently measure AIDS mortality: a validation study in Tanzania and Zimbabwe. J Epidemiol Commun Health. 2010;64:330–4.

    Article  CAS  Google Scholar 

  27. Gray M, Litz B, Hsu J, Lombardo T. The psychometric properties of the Life Events Checklist. Assessment. 2004;11:330–41.

    Article  PubMed  Google Scholar 

  28. Mollica R, Caspi-Yavin Y, Bollini P, Truong T, Tor S, Lavelle J. The Harvard Trauma Questionnaire. Validating a cross-cultural instrument for measuring torture, trauma and posttraumatic stress disorder in Indochinese refugees. J Nerv Ment Disord. 1992;180:111–6.

    Article  CAS  Google Scholar 

  29. Ward C, Flisher A, Zissis C, Muller M, Lombard C. Exposure to violence and its relationship to psychopathology in adolescents. Inj Prev. 2001;7:297–301.

    Article  PubMed  CAS  Google Scholar 

  30. Smit J, Myer L, Middelkoop K, Seedat S, Wood R, Bekker L, et al. Mental health and sexual behaviours in a South African township: a community-based cross-sectional study. Public Health. 2006;120:534–42.

    Article  PubMed  CAS  Google Scholar 

  31. Mollica R, McInnes K, Sarajlic N. Disability associated with psychiatric comorbidity and health status in Bosnian refugees living in Croatia. J Am Med Assoc. 1999;282(2):433–9.

    Article  CAS  Google Scholar 

  32. Miyazaki T, Dewaraja R, Kawamura N. Reliability and validity of the scales related to post traumatic stress disorder of Sri Lankan version. Int Congr Ser. 2006;1287:82–5.

    Article  Google Scholar 

  33. Smit J, van der Berg C, Bekker L, Seedat S, Stein D. Translation and cross-cultural adaptation of a mental health battery in an African setting. Afr Health Sci. 2006;6(4):215–22.

    PubMed  CAS  Google Scholar 

  34. Patel L, Triegaardt J, editors. South Africa: social security, poverty alleviation and development. New York: Palgrave Macmillan; 2008.

    Google Scholar 

  35. Plagerson S, Patel V, Harpham T, Kielmann K, Mathee A. Does money matter for mental health? Evidence from the child support grants in Johannesburg, South Africa. Glob Public Health. 2010;11:1–17.

    Google Scholar 

  36. Zimet G, Dahlem N, Zimet S, Farley G. The multidimensional scale of perceived social support. J Pers Assess. 1988;52:30–41.

    Article  Google Scholar 

  37. Zimet G, Powell S, Farley G, Werkman S, Berkoff K. Psychometric properties of the multidimensional scale of perceived social support. J Pers Assess. 1990;55:610–7.

    PubMed  CAS  Google Scholar 

  38. Myint T, Mash B. Coping strategies and social support after receiving HIV-positive results at a South African district hospital. S Afr Med J. 2008;98:276–8.

    PubMed  Google Scholar 

  39. Bruwer B, Emsley R, Kidd M, Lochner C, Seedat S. Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth. Compr Psychiatr. 2008;49(2):195–201.

    Article  Google Scholar 

  40. Cecil H, Stanley M, Carrion P, Swann A. Psychometric properties of the MSPSS and NOS in psychiatric outpatients. J Clin Psychol. 1995;51:593–602.

    Article  PubMed  CAS  Google Scholar 

  41. Stanley M, Beck J, Zebb B. Psychometric properties of the MSPSS in older adults. Aging Ment Health. 1998;2:186–93.

    Article  Google Scholar 

  42. Eker D, Arkar H. Perceived social support, psychometric properties of the MSPSS in normal and pathological groups in a developing country. Soc Psychiatr Psychiatr Epidemiol. 1995;30:121–6.

    Article  CAS  Google Scholar 

  43. Statistics South Africa. Census 2001 Questionnaire. http://www.statssa.gov.za/additional_services/questionnaires/Questionnaire%20C.pdf. Accessed 2 Oct 2007.

  44. Statistics South Africa. General Household Survey. http://www.statssa.gov.za/Publications/statsdownload.asp?ppn=P0318&SCH=3655. 2 Accessed Oct 2007.

  45. Medical Research Council of South Africa. South African Demographic and Health Survey. www.mrc.ac.za/bod/sadhs.htm. Accessed 2 Oct 2007.

  46. May J. KwaZulu–Natal Income Dynamics Study (KIDS) 1993–1998: A Longitudinal Household Data Set for South African Policy Analysis. Durban: School of Development Studies, University of KwaZulu Natal; 1999.

    Google Scholar 

  47. Baron R, Kenny D. The moderator-mediator variable distinction in social psychological research: conceptual, strategic and statistical considerations. J Pers Soc Psychol. 1986;51:1173–82.

    Article  PubMed  CAS  Google Scholar 

  48. Williams S, Williams D, Stein D, Seedat S, Jackson P, Moomal H. Multiple traumatic events and psychological distress: the South African stress and health study. J Trauma Stress. 2007;20(5):845–55.

    Article  PubMed  Google Scholar 

  49. Haglund K. Parenting a second time around: an ethnography of African American grandmothers parenting grandchildren due to parental cocaine abuse. J Fam Nurs. 2000;6(2):120–35.

    Article  Google Scholar 

  50. Minkler M, Fuller-Thompson E, Miller D, Driver D. Grandparent caregiving and depression. In: Hayslip B, Goldberg-Glen R, editors. Grandparents raising grandchildren: Theoretical, empirical, and clinical perspectives. New York: Springer; 2000. p. 207–19.

    Google Scholar 

  51. Fuller-Thomson E, Minkler M. African American grandparents raising grandchildren: a national profile of demographic and health characteristics. Health Soc Work. 2000;25(2):109–18.

    Article  PubMed  CAS  Google Scholar 

  52. Minkler M, Fuller-Thomson E, Miller D, Driver D. Depression in Grandparents Raising Grandchildren. Arch Fam Med. 1997;6:445–52.

    Article  PubMed  CAS  Google Scholar 

  53. Roe K, Minkler M, Thompson R, Saunders F. Health of grandmothers raising children of the crack cocaine epidemic. Med Care. 1996;34:744–51.

    Article  Google Scholar 

  54. Cluver L, Fincham D, Seedat S. Posttraumatic stress in AIDS-orphaned children exposed to high levels of trauma: the protective role of perceived social support. of traumatic stress. J Trauma Stress. 2009;22(2):106–12.

    Article  PubMed  Google Scholar 

  55. South Africa Government Services. Older persons grant. http://www.services.gov.za/services/content/Home/ServicesForPeople/Socialbenefits/oldagegrant/en_ZA. 3 Accessed Nov 2011.

  56. Bertrand M, Sendhil M, Miller D. Public policy and extended families: evidence from pensions in South Africa. World Bank Econ Rev. 2003;17(1):27–50.

    Article  Google Scholar 

  57. Case A, Deaton A. Large cash transfers to the elderly in South Africa. Econ J. 1998;108(450):1330–61.

    Article  Google Scholar 

  58. Lund C, Breen A, Flisher A, Kakuma R, Corrigall J, Joska J, et al. Poverty and common mental disorders in low and middle income countries: a systematic review. Soc Sci Med. 2010;71(3):517–28.

    Article  PubMed  Google Scholar 

  59. Breslau N, Chilcoat H, Kessler R, Davis G. Previous exposure ot trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. Am J Psychiatr. 1999;156(6):902907.

    Google Scholar 

  60. Kuo C, Operario D. Caring for AIDS-orphaned children: an exploratory study of challenges faced by carers in KwaZulu–Natal, South Africa. Vulnerable Child Youth Stud. 2010;5(4):344–52.

    Article  PubMed  Google Scholar 

  61. Cluver L, Orkin M, Boyes M, Gardner F, Meinck F. Transactional sex amongst AIDS-orphaned and AIDS-affected adolescents predicted by abuse and extreme poverty. J Acquir Immune Defic Syndr. 2011;58(3):336–43.

    Article  PubMed  Google Scholar 

  62. Cohen J. Southern Africa: AIDS-affected children face systemic discrimination in accessing education. HIV AIDS Policy Law Rev. 2005;10(3):24–5.

    PubMed  Google Scholar 

  63. Freeman M, Nkomo N. Assistance needed for the integration of orphaned and vulnerable children - views of South African family and community members. J Soc Aspects of HIV/AIDS Res Alliance. 2006;3(3):503–9.

    Article  CAS  Google Scholar 

  64. Freeman M, Nkomo N. Guardianship of orphans and vulnerable children. A survey of current and prospective South African caregivers. AIDS Care. 2006;18(4):302–10.

    Article  PubMed  CAS  Google Scholar 

  65. Jones L. Childcare in poor urban settlements in Swaziland in an era of HIV/AIDS. Afr J AIDS Res. 2006;4(3):161–71.

    Article  Google Scholar 

  66. Schroeder E-A, Nichola T. The adoption of HIV/AIDS orphans and food security in rural Ingwavuma, South Africa. Int J Technol Manag Sustain Dev. 2006;5(2):173–87.

    Article  Google Scholar 

  67. Raviola G, Becker A, Farmer P. A global scope for global health: including mental health. Lancet. 2011;378(9803):1613–5.

    Article  PubMed  Google Scholar 

  68. Sheriff R, Adams C, Tharyan P, Jayaram M, Duley L. Randomised trials relevant to mental health conducted in low and middle-income countries: a survey. BMC Psychiatr. 2008;6(1):1–6.

    Google Scholar 

  69. Kakuma R, Minas H, van Ginneken N, Dal PM, Desiraju K, Morris J, et al. Human resources for mental health care: current situation and strategies for action. Lancet. 2011;378(9803):1654–63.

    Article  PubMed  Google Scholar 

  70. Collins P, Patel V, Joestl S, March D, Insel T, Daar A. Grand challenges in global mental health: a consortium of researchers, advocates and clinicians announces here research priorities for improving the lives of people with mental illness around the world, and calls for urgent action and investment. Nature. 2011;475(7354):27–30.

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

This research was supported by Award Number F31MH081820 to Dr. Caroline Kuo from the US National Institute of Mental Health and the Leverhulme Trust Grant F08-599C to Dr. Don Operario, and the Health Economics and HIV/AIDS Research Division at University of KwaZulu Natal. Other support is derived from the US National Institute for Mental Health grant Award Number K01 MH096646-01A1 to Dr. Caroline Kuo and Award Number T32 MH078788 to Dr. Larry K. Brown. The content is solely the responsibility of the authors.

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Authors and Affiliations

  1. Department of Behavioral and Social Sciences, Brown University, 121 South Main Street, Box G-S121-Floor 4, Providence, RI, USA

    Caroline Kuo & Don Operario

  2. Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA

    Caroline Kuo & Don Operario

  3. Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University and Butler Hospital and Providence Veterans Affairs Medical Center, Providence, RI, USA

    Madhavi K. Reddy

  4. Department of Social Policy and Intervention, Oxford University, Oxford, UK

    Lucie Cluver

  5. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Lucie Cluver & Dan J. Stein

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  1. Caroline Kuo
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Correspondence to Caroline Kuo.

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Kuo, C., Reddy, M.K., Operario, D. et al. Posttraumatic Stress Symptoms Among Adults Caring for Orphaned Children in HIV-Endemic South Africa. AIDS Behav 17, 1755–1763 (2013). https://doi.org/10.1007/s10461-013-0461-9

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