Predictors of Mental Health Resilience in Children who Have Been Parentally Bereaved by AIDS in Urban South Africa
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Children parentally bereaved by AIDS experience high rates of mental health problems. However, there is considerable variability in outcomes, and some show no mental health problems even when followed over time. Primary aims were to identify predictors of resilient adaptation at child, family and community levels within a group of AIDS-orphaned children, and to consider their cumulative influence. A secondary aim was to test whether predictors were of particular influence among children orphaned by AIDS relative to non-orphaned and other-orphaned children. AIDS-orphaned (n = 290), other-orphaned (n = 163) and non-orphaned (n = 202) adolescents living in informal settlements in Cape Town, South Africa were assessed on two occasions 4 years apart (mean age 13.5 years at Time 1, range = 10–19 years). Self-report mental health screens were used to operationalise resilience in AIDS-orphaned children as the absence of clinical-range symptoms of PTSD, anxiety, depression, conduct problems, and suicidality. A quarter of AIDS-orphaned children (24 %) showed no evidence of mental health problems at either wave. Child physical health, better caregiving quality, food security, better peer relationship quality, and lower exposure to community violence, bullying or stigma at baseline predicted sustained resilience. There were cumulative influences across predictors. Associations with mental health showed little variation by child age or gender, or between orphaned and non-orphaned children. Mental health resilience is associated with multiple processes across child, family and community levels of influence. Caution is needed in making causal inferences.
KeywordsResilience Orphan Depression Psychopathology Longitudinal HIV
The study was supported by a grant from the Nuffield Foundation (grant number: 35198). We are grateful for support from the Waterloo Foundation to Stephan Collishaw, and from the Economic and Social Research Council to Lucie Cluver. The authors wish to thank our fieldwork team: Somaya Latief, Naema Latief, Joy Nikelo, Julia Limba, Nomhle Panyana, Daphne Makasi and Thembela Molwana. We would also like to thank Cape Town Child Welfare, the Western Cape Education Department, Pollsmoor Prison, The Homestead Shelter and South African Airways. Most importantly, we thank all the participants, and their families, for taking part in the study.
Ethical Approval and Informed Consent
Ethical approval was obtained from the University of Oxford, the University of Cape Town and the Western Cape Education Department. Participants and caregivers provided informed consent. Confidentiality was maintained except where children were at risk of significant harm or requested assistance.
Conflict of Interest
The authors declare that they have no conflict of interest.
- Achenbach, T. M. (1991). Manual for the Child Behavior Checklist/4–18 and 1991 profiles. Burlington:Department of Psychiatry, University of Vermont.Google Scholar
- Betancourt, T. S., Meyers-Ohki, S. E., Charrow, A., & Hansen, N. (2013). Annual research review: mental health and resilience in HIV/AIDS-affected children – a review of the literature and recommendations for future research. Journal of Child Psychology and Psychiatry, 54, 423–444.CrossRefPubMedPubMedCentralGoogle Scholar
- Collishaw, S., Hammerton, G., Mahedy, L., Sellers, R., Owen, M. J., Craddock, N., et al. (2015). Mental health resilience in at-risk adolescents. Lancet Psychiatry (in press).Google Scholar
- Garmezy, N. (1991). Resilience in children's adaptation to negative life events and stressed environments. Pediatrics, 20, 459–466.Google Scholar
- Han, C. K., Ssewamala, F. M., & Wang, J. S. (2013). Family economic empowerment and mental health among AIDS-affected children living in AIDS-impacted communities: evidence from a randomised evaluation in southwestern Uganda. Journal of Epidemiology and Community Health, 67, 225–230.CrossRefPubMedPubMedCentralGoogle Scholar
- Kovacs, M. (1992). Children’s depression inventory. Niagra Falls, NY:Multi-health Systems.Google Scholar
- Maughan, B., & Collishaw, S. (2015). Development and psychopathology: a life course perspective. In A. Thapar, D. Pine, J. L. Leckman, S. Scott, M. J. Snowling, & E. Taylor (Eds.), Rutter’s Child and Adolescent Psychiatry (Sixth ed.). Chichester: Wiley Blackwell.Google Scholar
- National Research Council and Institute of Medicine (2009). Preventing mental, emotional and behavioural disorders among young people: Progress and possibilities. Washington:National Academies Press.Google Scholar
- Ruchkin, V., Schwab-Stone, M., & Vermeiren, R. (2004). Social and Health Assessment (SAHA) psychometric development summary. New Haven:Yale University.Google Scholar
- Rutter, M. (2006). Implications of resilience concepts for scientific understanding. In B. Lester, A. Masten, & B. McEwen (Eds.), Resilience in children: Annals of the New York Academy of Sciences (vol. 1094, pp. 1–12). London: Blackwell.Google Scholar
- Snider, L., & Dawes, A. (2006). Psychosocial vulnerability and resilience measures for national level monitoring of orphans and other vulnerable children: recommendations for revision of the UNICEF Psychological Indicator. Cape Town:UNICEF.Google Scholar
- United Nations Children’s Fund (2013). Towards an AIDS-Free Generation – Children and AIDS: Sixth Stocktaking Report, 2013. New York:UNICEF.Google Scholar
- Van der Merwe, A., & Dawes, A. (2000). Prosocial and antisocial tendencies in children exposed to community violence. Journal of Child and Adolescent Mental Health, 12, 19–37.Google Scholar
- Weisz, J. R., Chorpita, B. F., Palinkas, L. A., et al. (2012). Testing standard and modular designs for psychotherapy treating depression, anxiety, and conduct problems in youth. JAMA Psychiatry, 69, 274–282.Google Scholar
- Werner, E. E., & Smith, R. S. (1992). Overcoming the odds: High risk children from birth to adulthood. Ithaca, NY:Cornell University Press.Google Scholar