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Relationships Between Familial HIV/AIDS and Symptoms of Anxiety and Depression: The Mediating Effect of Bullying Victimization in a Prospective Sample of South African Children and Adolescents

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Abstract

South African children and adolescents living in HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms. Poverty and HIV/AIDS-related stigma are additional risk factors for these negative mental health outcomes. Community level factors, such as poverty and stigma, are difficult to change in the short term and identifying additional potentially malleable mechanisms linking familial HIV/AIDS with mental health is important from an intervention perspective. HIV/AIDS-affected children are also at increased risk of bullying victimization. This longitudinal study aimed to determine whether prospective relationships between familial HIV/AIDS and both anxiety symptoms and depressive symptoms operate indirectly via bullying victimization. Adolescents (M = 13.45 years, 56.67 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up one year later (n = 3,401, 96.70 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces, and door-to-door sampling included all households with a resident child/adolescent. Familial HIV/AIDS at baseline assessment was not directly associated with mental health outcomes 1 year later. However, significant indirect effects operating via bullying victimization were obtained for both anxiety and depression scores. Importantly, these effects were independent of poverty, HIV/AIDS-related stigma, and baseline mental health, which highlight bullying victimization as a potential target for future intervention efforts. The implementation and rigorous evaluation of bullying prevention programs in South African communities may improve mental health outcomes for HIV/AIDS-affected children and adolescents and this should be a focus of future research and intervention.

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Notes

  1. Caution is needed when transferring interventions designed and tested in the developed world into a developing world context, and efforts should be made to ensure their cultural acceptability and applicability.

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Acknowledgments

This study was funded by the UK Economic and Social Research Council, the South African National Research Foundation, the Health Economics and HIV/AIDS Research Division (HEARD) at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation. The authors wish to thank the South African fieldwork teams and all the participants and their families.

Author contributions

LC conceived the larger overall project. MB conceived the specific study. MB and LC both participated in the study design and co-ordination, analysed the data, and wrote the manuscript. Both authors read and approved the final manuscript.

Conflict of interests

Neither of the authors have any conflicts of interest to declare.

Ethical statement

Ethical approval for the study was obtained from the Universities of Oxford, Cape Town, and KwaZulu-Natal, as well as the Provincial Health and Education Departments of the Western Cape, Mpumalanga, and KwaZulu-Natal. Prior to participation voluntary informed consent was provided by participants and their caregivers. No incentive for participation was provided. Confidentiality was maintained unless participants requested assistance or were at significant risk of harm, in which case referrals to appropriate services were made.

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Authors and Affiliations

  1. Health Psychology and Behavioural Medicine Research Group, School of Psychology and Speech Pathology, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia

    Mark E. Boyes

  2. Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK

    Mark E. Boyes & Lucie D. Cluver

  3. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Lucie D. Cluver

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  1. Mark E. Boyes
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  2. Lucie D. Cluver
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Correspondence to Mark E. Boyes.

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Boyes, M.E., Cluver, L.D. Relationships Between Familial HIV/AIDS and Symptoms of Anxiety and Depression: The Mediating Effect of Bullying Victimization in a Prospective Sample of South African Children and Adolescents. J Youth Adolescence 44, 847–859 (2015). https://doi.org/10.1007/s10964-014-0146-3

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