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Direct and Indirect Effects of Caregiver Social Support on Adolescent Psychological Outcomes in Two South African AIDS-Affected Communities


Caregiver social support has been shown to be protective for caregiver mental health, parenting and child psychosocial outcomes. This is the first known analysis to quantitatively investigate the relationship between caregiver social support and adolescent psychosocial outcomes in HIV-endemic, resource–scarce Southern African communities. A cross-sectional household survey was conducted over 2009–2010 with 2,477 South African adolescents aged 10–17 and their adult caregivers (18 years or older) in one urban and one rural community in South Africa’s KwaZulu-Natal province. Adolescent adjustment was assessed using adult caregiver reports of the Strengths and Difficulties questionnaire (SDQ), which measures peer problems, hyperactivity, conduct problems, emotional symptoms and child prosocial behavior. Hierarchical linear regressions and multiple mediation analyses, using bootstrapping procedures, were conducted to assess for: (a) direct effects of more caregiver social support on better adolescent psychosocial wellbeing; and (b) indirect effects mediated by better parenting and caregiver mental health. Direct associations (p < .001), and indirect associations mediated through better parenting, were found for all adolescent outcomes. Findings reinforce the importance of social support components within parenting interventions but also point to scope for positive intervention on adolescent psychosocial wellbeing through the broader family social network.

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Fig. 1


  1. Three versions of the SDQ exist to respectively collect child self-reports, carer reports and teacher reports of child behavior.

  2. We refer to ‘hierarchical logistic regression,’ to indicate the practice of building successive regression models, adding more predictors to each model.

  3. This software is available at:

  4. This refers to social support mechanisms mirroring social norms and expectations related to appropriate forms of behavior, which may be experienced directly by the child through exposure to the caregiver’s support providers (Belsky 1984).


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The Young Carers study was funded by the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal (SA), the Economic and Social Research Council (UK), the National Research Foundation (SA), the National Department of Social Development (SA), the Claude Leon Foundation and the John Fell Fund. The study in the KwaZulu-Natal provincial site was generously funded by HEARD. We would like to acknowledge the important contribution of our entire Young Carers KwaZulu-Natal research team and our local NGO partner in the rural site, Tholulwazi Uzivikele, to this research. We would also like to thank the children and their families who welcomed us into their homes. Additional support was provided to C. Kuo for analysis and writing by the US National Institute of Mental Health grant awards K01 MH096646 and L30 MH098313 and National Institute of Child Health and Human Development grant award R24 HD077976. The research leading to these results has also received funding from the European Research Council under the European Union’s Seventh Framework Programme (FP7/2007-2013)/ERC grant agreement n°313421.

Ethical Standard

This study was approved by the relevant social science research ethics committees of the University of Oxford, UK, and the University of KwaZulu-Natal, South Africa. It has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and other amendments and is compliant with APA ethical principles in the treatment of individual participants.

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Correspondence to Marisa Casale.

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Casale, M., Cluver, L., Crankshaw, T. et al. Direct and Indirect Effects of Caregiver Social Support on Adolescent Psychological Outcomes in Two South African AIDS-Affected Communities. Am J Community Psychol 55, 336–346 (2015).

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  • Caregiver social support
  • Parenting
  • Caregiver mental health
  • Child mental health
  • Child behavior
  • South Africa