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Predictors of Mental Health Resilience in Children who Have Been Parentally Bereaved by AIDS in Urban South Africa

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ABSTRACT

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. Child and Adolescent Psychiatry, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK

    Stephan Collishaw

  2. Department of Social Policy and Intervention, University of Oxford, Oxford, UK

    Frances Gardner & Lucie Cluver

  3. Steinhardt School of Culture, Education and Human Development, New York University, New York, NY, USA

    J. Lawrence Aber

  4. University of Cape Town, Cape Town, South Africa

    Lucie Cluver

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  1. Stephan Collishaw
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  2. Frances Gardner
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  4. Lucie Cluver
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Correspondence to Stephan Collishaw.

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Collishaw, S., Gardner, F., Lawrence Aber, J. et al. Predictors of Mental Health Resilience in Children who Have Been Parentally Bereaved by AIDS in Urban South Africa. J Abnorm Child Psychol 44, 719–730 (2016). https://doi.org/10.1007/s10802-015-0068-x

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