Vicious Circle of Perceived Stigma, Enacted Stigma and Depressive Symptoms Among Children Affected by HIV/AIDS in China
Previous research has found a deleterious impact of stigma on the mental health of children affected by HIV/AIDS. Little is known about the longitudinal relationship of stigma and children’s mental health. This study explores the longitudinal reciprocal effects of depressive symptoms and stigma, specifically enacted stigma and perceived stigma, among children affected by HIV/AIDS aged 6–12. Longitudinal data were collected from 272 children orphaned by AIDS and 249 children of HIV-positive parents in rural China. Cross-lagged panel analysis was conducted in the study. Results showed that the autoregressive effects were stable for depressive symptoms, perceived stigma and enacted stigma suggesting the substantially stable individual differences over time. The cross-lagged effects indicated a vicious circle among the three variables in an order of enacted stigma → depressive symptom → perceived stigma → enacted stigma. The possibility of employing equal constraints on cross-lagged paths suggested that the cross-lagged effects were repeatable over time. The dynamic interplay of enacted stigma, perceived stigma and depressive symptoms suggests the need of a multilevel intervention in stigma reduction programming to promote mental health of children affected by HIV/AIDS.
KeywordsChildren HIV/AIDS Enacted stigma Perceived stigma Depressive symptoms Cross-lagged Longitudinal
This study reported in this article was supported by NIH Research Grant from the National Institute of Mental health (R01MH76488) and the National Institute of Nursing Research (R01NR13466). The content of the article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental health and the National Institute of Nursing Research. The authors wish to thank Joanne Zwemer for help in preparing the manuscript.
- 1.UNICEF. Statistics by Area/HIV/AIDS. 2013 [cited 2013 Jan 15, 2013]; Available from: http://www.childinfo.org/hiv_aids_global_trends.html.
- 3.Crocker J, Major B, Steele R. Social stigma. In: Gilbert DT, Fiske ST, Lindzey G, editors. The handbook of social psychology. New York: McGraw Hill; 1998. p. 504–33.Google Scholar
- 4.Goffman E. Stigma: notes on the management of spoiled identity. New York: Simon & Schuster Inc.; 1963.Google Scholar
- 21.Scambler G. Epilepsy. London: Routledge; 1989.Google Scholar
- 31.West A, Wedgwood K. Children affected by AIDS, orphans and impact mitigation in China. In: Kaufman J, Kleinman A, Saich T, editors. AIDS and social policy in China. Cambridge: Harvard University Asia Center; 2006. p. 243–64.Google Scholar
- 32.UNAIDS, UNICEF, USAID. Children on the brink 2004: A joint report of new orphan, estimates and a framework for Action. New York: 2004.Google Scholar
- 37.Wang X. Rating scales for mental health (Chinese Journal of Mental Health Supplement). Beijing: Chinese Association of Mental Health; 1993.Google Scholar
- 38.Muthén LK, Muthén BO. Mplus user’s guide: Fifth edition. Los angeles: Author; 2007.Google Scholar
- 42.Bronfenbrenner U. The ecology of human development: experiments by nature and design. Cambridge: Harvard University Press; 1979.Google Scholar