Prevalence and risk factors for child mental disorders in a population-based cohort of HIV-exposed and unexposed African children aged 7–11 years
Despite being home to a large population of vulnerable children there is a dearth of population-based evidence on childhood mental disorders in sub-Saharan Africa. Parent and child mental health are rarely measured concurrently, despite potential for confounding with other risk factors, including parental HIV. Using the parent-report Child Behaviour Checklist (CBCL) we assessed children’s mental health in a population-based cohort of 1536 HIV-negative children (31% HIV-exposed, 18% HIV-affected, 51% HIV-unexposed) aged 7–11 years. CBCL was scored using CBCL Rating-to-Score software. A binary indicator was determined using the clinical threshold ≥ 65. We modelled mental disorders using logistic regression, including covariates associated with the mother, child, household, and parenting. Structural equation modelling techniques also derived continuous latent variables representing the underlying mental health and parent-relationship constructs. Prevalence of conduct disorders (11.8%) was high, regardless of HIV exposure, while HIV-affected children had increased odds of affective disorders. Maternal depression increased odds of externalising disorders; maternal anxiety was associated with affective and anxiety disorders. Mother–child relationship dysfunction increased odds of all disorders, including: affective [aOR = 5.1 (2.6–9.9)]; oppositional [aOR = 7.9 (4.0–15.5)]; conduct [aOR = 4.3 (2.6–7.2)] disorders. Food insecurity and male gender increased odds of somatic disorders; breastfeeding halved odds of conduct disorders. In the latent model, associations were substantially stronger for the mother–child relationship and externalising disorders (Oppositional 0.464 p < 0.001; Conduct 0.474 p = <0.001). Conduct disorders were high for all children regardless of HIV exposure. The mother–child relationship was strongly related to all child disorders, suggesting potential for concurrent interventions targeting child behaviours and the parent–child or mother–child relationship.
KeywordsMental disorders Parenting stress HIV Africa Child
Tamsen Rochat contributed to securing funding, study design and implementation of the research; she participated in data analysis and interpretation, drafted and critically revised the manuscript. Brian Houle (joint first author) led data analysis and interpretation, drafted and critically revised the manuscript. Alan Stein contributed to securing funding, study design and participated in the interpretation of data and critically revised the manuscript. Rebecca Pearson participated in data analysis and interpretation and critically revised the manuscript. Ruth Bland contributed to securing funding, study design and implementation of the research; she participated in interpretation of data and critically revised the manuscript.
The Siyakhula Cohort was funded by Grand Challenges, Canada Saving Brains (0063-03). Grand Challenges “Saving Brains” required standardisation of core metrics across all eleven funded cohorts, including socio-demographic and economic variables and data on child cognition. The funder played no other role in the design of the study. The Africa Health Research Institute, previously called Africa Centre for Population Health, University of Kwa-Zulu Natal is funded by the Wellcome Trust (Previous Africa Centre 097410/Z/11; Current AHRI 201433/Z/16/Z). The demographic surveillance is co-funded by the South Africa Department of Science and Technology through the DST/MRC South African Population Research Infrastructure Network (SAPRIN). The original Vertical Transmission Study was funded separately by Wellcome Trust (063009/Z/00/2). Tamsen Rochat receives salary support from the Newton Advanced Fellowship Scheme (AF160108). Additional support of the DST-NRF Centre of Excellence (CoE) in Human Development (ACC2018004; OPP201600035; OPP20150015) awarded to Tamsen Rochat towards manuscript development is acknowledged. Opinions expressed and conclusions arrived at are those of the authors and are not necessarily to be attributed to the funders.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
- 6.Merikangas KR, He J (2014) Epidemiology of mental disorders in children and adolescents. From Research to Practice in Child and Adolescent Mental Health:19Google Scholar
- 13.Rochat T, Houle B, Stein A, Coovadia H, Coutsoudis A, Desmond C, Newell M-L, Bland R (2016) Exclusive breastfeeding and cognition, executive function, and behavioural disorders in primary school-aged children in rural South Africa: a cohort analysis. PLOS Med 13(6):e1002044. https://doi.org/10.1371/journal.pmed.1002044 CrossRefPubMedPubMedCentralGoogle Scholar
- 14.Tanser F, Hosegood V, Barnighausen T, Herbst K, Nyirenda M, Muhwava W, Newell C, Viljoen J, Mutevedzi T, Newell ML (2008) Cohort profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol 37(5):956–962. https://doi.org/10.1093/ije/dym211 CrossRefPubMedGoogle Scholar
- 16.Achenbach TM, Rescorla LA (2001) Manual for the ASEBA School-Age Forms & Profiles University of Vermont, Research Center for Children, Youth, & Families, BurlingtonGoogle Scholar
- 17.Seligman LD, Ollendick TH, Langley AK, Baldacci HB (2004) The utility of measures of child and adolescent anxiety: a meta-analytic review of the Revised Children’s Manifest Anxiety Scale, the State-Trait Anxiety Inventory for Children, and the Child Behavior Checklist. J Clin Child Adoles Psychol 33(3):557–565CrossRefGoogle Scholar
- 18.Kroenke K, Spitzer RL, Williams JBW, Löwe B (2010) The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry 32(4):345–359. https://doi.org/10.1016/j.genhosppsych.2010.03.006 CrossRefPubMedGoogle Scholar
- 19.Abidin R (1995) Parenting stress index professional manual, 3rd edn. Psychological Assessment Resources Incorporated Florida, United StatesGoogle Scholar
- 37.Alvarez-del Arco D, Monge S, Azcoaga A, Rio I, Hernando V, Gonzalez C, Alejos B, Caro AM, Perez-Cachafeiro S, Ramirez-Rubio O, Bolumar F, Noori T, Del Amo J (2013) HIV testing and counselling for migrant populations living in high-income countries: a systematic review. Eur J Pub Health 23(6):1039–1045. https://doi.org/10.1093/eurpub/cks130 CrossRefGoogle Scholar
- 41.Rochat T, Mitchell J, Stein A, Mkwanazi N, Bland R (2016) The Amagugu Intervention: a conceptual framework for increasing HIV disclosure and parent-led communication about health and HIV prevention among HIV-infected parents with HIV-uninfected primary school-aged children. Fron Public Health. https://doi.org/10.3389/fpubh.2016.00183 CrossRefGoogle Scholar