Maternal and Child Health Journal

, Volume 18, Issue 1, pp 191–199 | Cite as

Mental Health Disorders Among Caregivers of Preschool Children in the Asenze Study in KwaZulu-Natal, South Africa

  • Meera K. ChhaganEmail author
  • Claude A. Mellins
  • Shuaib Kauchali
  • Murray H. Craib
  • Myra Taylor
  • Jane D. Kvalsvig
  • Leslie L. Davidson


Given the existing evidence linking parental depression with infant and early child development, our aim was to describe the burden of mental health disorders among caregivers of young children aged 4–6 years living in an environment of poverty and high HIV seroprevalence. We analyzed baseline data from an epidemiologic study of the health and psychosocial needs of preschool-aged children. Primary caregivers of index children recruited from a household survey were screened for common mental disorders using the Client Diagnostic Questionnaire (CDQ). Sociodemographic, HIV and general health surveys were also conducted. Many caregivers (449/1,434; 31.3 %) screened positive for at least one psychiatric disorder on the CDQ, with post-traumatic-stress-disorder being the most common. Caregivers who screened positive for any disorder were more likely to be older, to have no individual sources of income and to have less formal education. Presence of a disorder was also significantly associated with lower employment levels within the household and death of a young child within the household. Known HIV-infected caregivers were more likely to have any mood disorder than caregivers who previously tested negative. The data support the need for mental health treatment interventions in South Africa, particularly interventions directed at PTSD and depression, and that take into account the high burden of poverty, HIV and childhood mortality. Given the limited formal mental health structure in South Africa to address these highly prevalent disorders; community-based mental health supports, available through decentralized health systems many be critical to delivering accessible interventions.


Caregivers Mental health Depression Post-traumatic-stress-disorder HIV 



We thank the community for their participation, and the local health authorities, community leaders and study staff. This research was funded by NIDA and Fogarty International Center Brain Disorders in Developing Countries Program under Award R01-DA023697. Opinions presented here are the sole responsibility of the authors and do not necessarily represent the official views of the NIH.


  1. 1.
    Bloom, D. E., Cafiero, E. T., Jané-Llopis, E., Abrahams-Gessel, S., Bloom, L. R., Fathima, S., et al. (2011). The global economic burden of non-communicable diseases. Geneva: World Economic Forum.Google Scholar
  2. 2.
    Lopez, A. D., Mathers, C. D., Ezzati, M., Jamison, D. T., & Murray, C. J. L. (2006). Global burden of disease and risk factors. Washington: The World Bank and Oxford University Press.CrossRefGoogle Scholar
  3. 3.
    World Health Organization, editor. (2008). Mental health gap action programme. Scaling up care for mental, neurological, and substance use disorders.Google Scholar
  4. 4.
    Williams, D. R., Herman, A., Stein, D. J., Heeringa, S. G., Jackson, P. B., Moomal, H., et al. (2008). Twelve-month mental disorders in South Africa: Prevalence, service use and demographic correlates in the population-based South African Stress and Health Study. Psychological Medicine, 38, 211–220.CrossRefGoogle Scholar
  5. 5.
    Myer, L., Seedat, S., Stein, D. J., Moomal, H., & Williams, D. R. (2009). The mental health impact of AIDS-related mortality in South Africa: A national study. Journal of Epidemiology and Community Health, 63, 293–298.CrossRefGoogle Scholar
  6. 6.
    Myer, L., Smit, J., Roux, L. L., Parker, S., Stein, D. J., & Seedat, S. (2008). Common mental disorders among HIV-infected individuals in South Africa: Prevalence, predictors, and validation of brief psychiatric rating scales. AIDS Patient Care and STDs, 22, 147–158. doi: 10.1089/apc.2007.0102.CrossRefGoogle Scholar
  7. 7.
    Freeman, M., & Kelly, K. (2008). Mental disorder in people living with HIV/Aids in South Africa. South African Journal of Psychology, 38, 489–500.CrossRefGoogle Scholar
  8. 8.
    Remien, R., & Mellins, C. (2007). Long-term psychosocial challenges for people living with HIV: Let’s not forget the individual in our global response to the pandemic. AIDS, 21, S55–S63.CrossRefGoogle Scholar
  9. 9.
    Harpham, T., Huttly, S., De Silva, M. J., & Abramsky, T. (2005). Maternal mental health and child nutritional status in four developing countries. Journal of Epidemiology and Community Health, 59, 1060–1064.CrossRefGoogle Scholar
  10. 10.
    Lung, F.-W., Shu, B.-C., Chiang, T.-L., & Lin, S.-J. (2009). Parental mental health, education, age at childbirth and child development from six to 18 months. Acta Paediatrica, 98, 834–941. doi: 10.1111/j.1651-2227.2008.01166.x.CrossRefGoogle Scholar
  11. 11.
    Rahman, A., Harrington, R., Bunn, J. (2002) Can maternal depression increase infant risk of illness and growth impairment in developing countries? Child: Care, Health and Development, 28, 51–56.Google Scholar
  12. 12.
    Walker, S. P., Wachs, T. D., Gardner, J. M., Lozoff, B., Wasserman, G. A., Pollitt, E., et al. (2007). Child development: Risk factors for adverse outcomes in developing countries. Lancet, 369, 145–157. doi: 10.1016/S0140-6736(07)60076-2.CrossRefGoogle Scholar
  13. 13.
    World Health Organization. (2004). The importance of caregiver-child interactions for the survival and healthy development of young children: A review. Geneva: Department of Child and Adolescent Health and Development.Google Scholar
  14. 14.
    Cooper, P. J., Tomlinson, M., Swartz, L., Landman, M., Molteno, C., Stein, A., et al. (2009). Improving quality of mother–infant relationship and infant attachment in socioeconomically deprived community in South Africa: Randomised controlled trial. British Medical Journal, 338, b974.CrossRefGoogle Scholar
  15. 15.
    Surkan, P. J., Kennedy, C. E., Hurley, K. M., & Black, M. M. (2011). Maternal depression and early childhood growth in developing countries: Systematic review and meta-analysis. Bulletin of the World Health Organization, 89, 608–615E.CrossRefGoogle Scholar
  16. 16.
    Tomlinson, M., Cooper, P. J., Stein, A., Swartz, L., & Molteno, C. (2006). Post-partum depression and infant growth in a South African peri-urban settlement. Child: Care, Health and Development, 32, 81–86.Google Scholar
  17. 17.
    Miranda, J. J., & Patel, V. (2005). Achieving the millennium development goals: Does Mental Health Play a Role? PLoS Medicine, 2, e291.CrossRefGoogle Scholar
  18. 18.
    Skeen, S., Lund, C., Kleintjes, S., & Flisher, A. (2010). Meeting the millennium development goals in Sub-saharan Africa: What about mental health? International Review of Psychiatry, 22, 624–631.CrossRefGoogle Scholar
  19. 19.
    Kaminer, D., Grimsrud, A., Myer, L., Stein, D. J., & Williams, D. R. (2008). Risk for post-traumatic stress disorder associated with different forms of interpersonal violence in South Africa. Social Science Medicine, 67, 1589–1595.CrossRefGoogle Scholar
  20. 20.
    Leibbrandt, M., Woolard, I., Finn, A., Argent, J. (2010) Trends in South African income distribution and poverty since the fall of apartheid. OECD Social, employment and migration working papers, No. 101, OECD Publishing. Available from:
  21. 21.
    South Africa National Department of Health. (2010) The 2010 national antenatal sentinel HIV and Syphilis Prevalence survey in South Africa. Pretoria.Google Scholar
  22. 22.
    Aidala, A., Havens, J., Mellins, C. A., Dodds, S., Whetten, K., Martin, D., et al. (2004). Development and validation of the Client Diagnostic Questionnaire (CDQ): A mental health screening tool for use in HIV/AIDS service settings. Psychology Health Medicine, 9, 362–379. doi: 10.1080/13548500410001721927.CrossRefGoogle Scholar
  23. 23.
    Spitzer, R. L., Kroenke, K., & Williams, J. B. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. The Journal of the American Medical Association, 282, 1737–1744.CrossRefGoogle Scholar
  24. 24.
    Bhagwanjee, A., Parekh, A., Paruk, Z., Petersen, I., & Subedar, H. (1998). Prevalence of minor psychiatric disorders in an adult African rural community in South Africa. Psychological Medicine, 28, 1137–1147.CrossRefGoogle Scholar
  25. 25.
    Ware, J.E., Kosinski, M., Dewey, J.E. (2000) How to score version two of the SF-36 health survey. Lincoln, RI: QualityMetric, Incorporated.Google Scholar
  26. 26.
    Kuo, C., & Operario, D. (2011). Health of adults caring for orphaned children in an HIV-endemic community in South Africa. AIDS Care, 23, 1128–1135. doi: 10.1080/09540121.2011.554527.CrossRefGoogle Scholar
  27. 27.
    World Health Organization. Process of translation and adaptation of instruments. 2012. Available from:
  28. 28.
    Tomlinson, M., Grimsrud, A. T., Stein, D. J., Williams, D. R., & Myer, L. (2009). The epidemiology of major depression in South Africa: Results from the South African stress and health study. South African Medical Journal, 99, 367–373.PubMedPubMedCentralGoogle Scholar
  29. 29.
    Lund, C., Kleintjes, S., Kakuma, R., & Flisher, A. J. (2010). Public sector mental health systems in South Africa: Inter-provincial comparisons and policy implications. Social Psychiatry and Epidemiology, 45, 393–404. doi: 10.1007/s00127-009-0078-5.CrossRefGoogle Scholar
  30. 30.
    Petersen, I., Bhana, A., Campbell-Hall, V., Mjadu, S., Lund, C., Kleintjies, S., et al. (2009). Planning for district mental health services in South Africa: A situational analysis of a rural district site. Health Policy and Planning., 24, 140–150.CrossRefGoogle Scholar
  31. 31.
    Seedat, S., Stein, D. J., Jackson, P. B., Heeringa, S. G., Williams, D. R., & Myer, L. (2009). Life stress and mental disorders in the South African stress and health study. South African Medical Journal, 99, 375–382.PubMedPubMedCentralGoogle Scholar
  32. 32.
    Howgego, I. M., Owen, C., Meldrum, L., Yellowlees, P., Dark, F., & Parslow, R. (2005). Posttraumatic stress disorder: An exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health. BMC Psychiatry, 5, 21.CrossRefGoogle Scholar
  33. 33.
    Li, J., Laursen, T. M., Precht, D. H., Olsen, J., & Mortensen, P. B. (2005). Hospitalization for mental illness among parents after the death of a child. New England Journal of Medicine, 352, 1190–1196. doi: 10.1056/NEJMoa033160.CrossRefGoogle Scholar
  34. 34.
    Song, J., Floyd, F. J., Seltzer, M. M., Greenberg, J. S., & Hong, J. (2010). Long-term effects of child death on parents’ health-related quality of life: A dyadic analysis. Family Relations, 59, 269–282. doi: 10.1111/j.1741-3729.2010.00601.x.CrossRefGoogle Scholar
  35. 35.
    Costello, E. J., Compton, S. N., Keeler, G., & Angold, A. (2003). Relationships between poverty and psychopathology: A natural experiment. The Journal of The American Medical Association, 290, 2023–2029.CrossRefGoogle Scholar
  36. 36.
    Lund, C., Breen, A., Flisher, A. J., Kakuma, R., Corrigall, J., Joska, J. A., et al. (2010). Poverty and common mental disorders in low and middle income countries: A systematic review. Social Science and Medicine, 71, 517–528. doi: 10.1016/j.socscimed.2010.04.027.CrossRefGoogle Scholar
  37. 37.
    Jenkins, J.H., Kleinman, A., Good, B.J. (1991) Cross-cultural aspects of depression. In: Becker J, Kleinman A, editors. Advances in affective disorders: Theory and research: Erlbaum Press; p. 67–99.Google Scholar
  38. 38.
    Möller, P.H., Smit, R. (2004) Measuring health-related quality of life: A comparison between people living with AIDS and police on active duty. Health SA Gesondheid Journal of Interdisciplinary Health Sciences, 9, 31–42.Google Scholar
  39. 39.
    Patel, V., Goel, D. S., & Desai, R. (2009). Scaling up services for mental and neurological disorders in low-resource settings. International Health, 1, 37–44. doi: 10.1016/j.inhe.2009.02.002.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Meera K. Chhagan
    • 1
    Email author
  • Claude A. Mellins
    • 2
  • Shuaib Kauchali
    • 1
  • Murray H. Craib
    • 1
  • Myra Taylor
    • 3
  • Jane D. Kvalsvig
    • 3
  • Leslie L. Davidson
    • 4
    • 5
  1. 1.Department of Pediatrics and Child Health, Maternal and Child Health UnitUniversity of KwaZulu-NatalCongella, DurbanSouth Africa
  2. 2.Departments of Psychiatry and Sociomedical Sciences, HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute, Columbia UniversityNew YorkUSA
  3. 3.Department of Public HealthUniversity of KwaZulu-NatalDurbanSouth Africa
  4. 4.Department of Epidemiology, Mailman School of Public HealthColumbia UniversityNew YorkUSA
  5. 5.Department of Pediatrics, College of Physicians and SurgeonsColumbia UniversityNew YorkUSA

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