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Silima M, Christofides N, Franchino-Olsen H, Woollett N, Wang J, Ho-Foster A, Maleke K, Meinck F. Co-occurring Intimate Partner Violence, Mental Health, Human Immunodeficiency Virus, and Parenting Among Women: A Scoping Review. TRAUMA, VIOLENCE & ABUSE 2024:15248380241268807. [PMID: 39275939 DOI: 10.1177/15248380241268807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/16/2024]
Abstract
Little research exists on the human immunodeficiency virus (HIV)-intimate partner violence (IPV)-mental health (MH) syndemic impact on parenting. The objective of this scoping review is to identify and summarize the available evidence regarding the syndemic relationship between HIV or Acquired Immune Deficiency Syndrome (AIDS), IPV, and poor MH among mothers and caregivers who identify as women. We conducted the review according to the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and meta-analyses extension for scoping reviews guidelines, a comprehensive search was conducted from 2001 to September 2023. The inclusion criteria targeted studies examining at least two of the HIV, IPV, or MH epidemics among participants and their syndemic impact on parenting. Both qualitative and quantitative studies were included. Covidence software was used to screen and extract data. Twenty-three studies were included in the analysis. Most of the studies were conducted in the United States. Furthermore, all the studies used quantitative research designs, with most being longitudinal. Most of the research was concentrated on the IPV-MH syndemic with no research found on the HIV-IPV syndemic impact on parenting. Research on the HIV-IPV-MH syndemic found that an HIV diagnosis exacerbated the negative impacts of IPV-MH on parenting. Research on IPV-MH showed that this syndemic significantly influences parenting, leading to less nurturing and more punitive behaviors. Studies did not find a direct association between IPV and harsh parenting practices, the relationship was mediated by poor MH. Studies examining the HIV-MH syndemic found that anxiety and maternal depression were the most frequent MH disorders. The review revealed that living with the different syndemics, (IPV-MH-HIV, HIV-MH, and IPV-MH) adversely affects parenting practices, resulting in harsher parenting.
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Affiliation(s)
- Mpho Silima
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Nataly Woollett
- University of the Witwatersrand, Johannesburg, South Africa
- University of Johannesburg, South Africa
| | | | - Ari Ho-Foster
- University of the Witwatersrand, Johannesburg, South Africa
- University of Botswana, Botswana
| | - Kabelo Maleke
- The SAMRC/Wits Centre for Health Economics and Decision Science (PRICELESS SA), Johannesburg, South Africa
| | - Franziska Meinck
- University of the Witwatersrand, Johannesburg, South Africa
- University of Edinburgh, UK
- North-West University, Vanderbijlpark, South Africa
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2
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Hillis S, Tucker S, Baldonado N, Taradaika E, Bryn L, Kharchenko S, Machabelii T, Taylor R, Green P, Goldman P, Awah I, Baldonado J, Gomez P, Flaxman S, Ratmann O, Lachman JM, Villaveces A, Sherr L, Cluver L. The effectiveness of Hope Groups, a mental health, parenting support, and violence prevention program for families affected by the war in Ukraine: Findings from a pre-post study. J Migr Health 2024; 10:100251. [PMID: 39175798 PMCID: PMC11340612 DOI: 10.1016/j.jmh.2024.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/23/2024] [Accepted: 07/20/2024] [Indexed: 08/24/2024] Open
Abstract
Background Nearly one in six children lived in war zones in 2023. Evidence-based psychosocial and parenting support has potential to mitigate negative impacts for parents and children co-exposed to war and displacement, especially in relation to mental health and harsh parenting reactions. In the current war in Ukraine, local mental health experts co-created and evaluated, with global experts, the effectiveness of psychosocial and parenting support groups, called 'Hope Groups' on improvements in mental health, positive parenting, and violence against children. This paper aimed to assess the effectiveness of psychosocial and parenting support groups, called 'Hope Groups,' on improvements in caregiver mental health, positive parenting, and prevention of violence against children, for families affected by the war in Ukraine, using a pre/post study design. Methods Participants (n = 577) included Ukrainian caregivers, 66% (381) of whom were parents and co-residing caregivers of children ages 0-17, while the remaining 34% were non-resident informal caregivers. Internally displaced, externally displaced, and those living at-home in war-torn regions were invited to groups by trained Ukrainian peer facilitators. Using a pre-post design, we compared individual level frequency measures at three time-points - baseline, midline, and endline, to assess changes in 4 mental health, and 9 parenting and child health outcomes. We analyzed these outcomes using paired t-tests to compare outcomes at baseline-to-midline (after 4-sessions) and baseline-to-endline (after 10-sessions), which estimated the mean changes in days per week and associated percent change, during the respective periods; we quantified uncertainties using bias-corrected and accelerated (BCa) bootstrapping with 95% uncertainty ranges for baseline-midline and baseline-endline estimates. We used this same approach for stratified analyses to assess potential effect modification by displacement status and facilitator type. We further used linear models to adjust for age and sex. Findings Compared to baseline, every mental health, parenting, and child health outcome improved significantly at midline and endline. Mental health ratings showed endline reductions in depressive symptoms of 56.8% (95% CI: -59.0,-54.3; -1.8 days/week), and increases in hopefulness, coping with grief, and self-care, ranging from 62.0% (95% CI: 53.6,71.3; 2.2 days/week) to 77.0% (95% CI: 66.3,88.3; 2.2 days/week). Significant improvements in parenting and child health outcomes included monitoring children, reinforcing positive behavior, supporting child development, protecting child, nonviolent discipline, and child verbalizing emotions. By endline, emotional violence, physical violence, and child despondency had dropped by 57.7% (95% CI: -63.0%,-51.9; -1.3 days/week), 64.0% (95% CI: -79.0,-39.5; -0.22 days/week), and 51.9% (95% CI: -45.1,-57.9; -1.2 days/week), respectively. Outcomes stratified by displacement status remained significant across all groups, as did those according to facilitator type (lay versus professional). Interpretation This study demonstrates preliminary evidence, using a brief survey and pre-post design as is appropriate for acute and early protracted emergency settings, of the feasibility and effectiveness of Hope Groups for war-affected Ukrainian caregivers, on improved mental health, positive parenting, and reduced violence against children.
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Affiliation(s)
- Susan Hillis
- Global Reference Group on Children Affected by Crisis, University of Oxford, Oxford, United Kingdom
- Department of Mathematics, Imperial College London, United Kingdom
| | - Sydney Tucker
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Mathematics, Imperial College London, United Kingdom
| | | | | | | | | | | | - Roisin Taylor
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | | | | | - Isang Awah
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
| | | | | | - Seth Flaxman
- Department of Computer Science, University of Oxford, Oxford, United Kingdom
| | - Oliver Ratmann
- Department of Mathematics, Imperial College London, United Kingdom
| | - Jamie M. Lachman
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Parenting for Lifelong Health, United Kingdom
- Centre of Social Science Research, University of Cape Town, Cape Town, South Africa
| | - Andres Villaveces
- Division of Violence Prevention, U.S. Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Lucie Cluver
- Centre for Evidence-Based Social Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Mawoyo T, Steventon Roberts KJ, Laurenzi C, Skeen S, Toit SD, Hisham R, Cluver L, Sherr L, Tomlinson M. How do new crises impact HIV risk behaviour - exploring HIV risk behaviour according to COVID-19-related orphanhood status in South Africa? AIDS Care 2024; 36:126-136. [PMID: 38709951 DOI: 10.1080/09540121.2024.2333435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 03/15/2024] [Indexed: 05/08/2024]
Abstract
The COVID-19 pandemic resulted in high death rates globally, and over 10.5 million children lost a parent or primary caregiver. Because HIV-related orphanhood has been associated with elevated HIV risk, we sought to examine HIV risk in children affected by COVID-19 orphanhood. Four hundred and twenty-one children and adolescents were interviewed, measuring seven HIV risk behaviours: condom use, age-disparate sex, transactional sex, multiple partners, sex associated with drugs/alcohol, mental health and social risks. Approximately 50% (211/421) experienced orphanhood due to COVID-19, 4.8% (20/421) reported living in an HIV-affected household, and 48.2% (203/421) did not know the HIV status of their household. The mean age of the sample was 12.7 years (SD:2.30), of whom 1.2% (5/421) were living with HIV. Eighty percent (337/421) reported at least one HIV risk behaviour. HIV sexual risk behaviours were more common among children living in HIV-affected households compared to those not living in HIV-affected households and those with unknown household status (35.0% vs. 13.6% vs.10.8%, X2 = 9.25, p = 0.01). Children living in HIV-affected households had poorer mental health and elevated substance use (70.0% vs. 48.5%, X2 = 6.21, p = 0.05; 35.0% vs. 19.9%, X2 = 4.02, p = 0.1306, respectively). HIV-affected households may require specific interventions to support the health and well-being of children and adolescents.
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Affiliation(s)
- Tatenda Mawoyo
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Christina Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- Faculty of Social and Behavioural Sciences, Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, Netherlands
| | - Stefani Du Toit
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Ramsha Hisham
- Department for Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department for Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Lorraine Sherr
- Institute for Global Health, University College London, London, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Cape Town, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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Hua Z, Wang S, Yuan X. Trends in age-standardized incidence rates of depression in adolescents aged 10-24 in 204 countries and regions from 1990 to 2019. J Affect Disord 2024; 350:831-837. [PMID: 38242215 DOI: 10.1016/j.jad.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 11/24/2023] [Accepted: 01/03/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The objective of this study was to provide a comprehensive analysis of the spatial distribution and temporal trends in the age-standardized incidence rates (ASIRs) of depression in adolescents aged 10-24 worldwide. METHODS Data from the Global Burden of Disease Study (GBD) 2019 were analyzed, adopting Sawyer's broad definition of adolescence encompassing ages 10 to 24. Estimated annual percentage changes (EAPCs) were used to assess temporal trends. RESULTS Globally, from 1990 to 2019, there was a decrease in the ASIR of depression in adolescents (EAPC = -0.23). Notably, this decrease was more pronounced in female adolescents compared to their male counterparts (EAPC = -0.12 and - 0.29, respectively). Conversely, high Sociodemographic Index (SDI) regions experienced a significant increase in the ASIR of depression among adolescents (EAPC = 0.87). Furthermore, it is worth mentioning that individuals aged 20-24 exhibited the highest incidence rate for depression followed by those aged 15-19 and then those aged 10-14. The largest increases in the ASIRs of depression occurred in High-income North America (EAPC = 1.19) and Malaysia (EAPC = 2.4), respectively. LIMITATIONS Mathematical models were used to reconstruct and adjust data of different qualities, which might have introduced bias. CONCLUSIONS The global burden of disease for depression among adolescents aged 10-24 years declined from 1990 to 2019. Special attention must be paid to older adolescents and areas with higher SDIs.
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Affiliation(s)
- Zuguang Hua
- Department of Plastic Surgery, The First Affiliated Hospital of Ningbo University, No.59, Liuting Street Haishu District, Ningbo 315010, Zhejiang, China
| | - Shuyu Wang
- Chinese Center for Disease Control and Prevention, 13 Zhengfu Street, Changping District, 102200 Beijing, China
| | - Xinhua Yuan
- Department of Orthopedics, Ningbo No.2 Hospital, No.41 Northwest Street, Haishu District, Ningbo 315099, Zhejiang, China.
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5
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Kimani M, Molyneux S, Charo A, Zakayo SM, Sanga G, Njeru R, Davies A, Kelley M, Abubakar A, Marsh V. Layered vulnerability and researchers' responsibilities: learning from research involving Kenyan adolescents living with perinatal HIV infection. BMC Med Ethics 2024; 25:21. [PMID: 38378641 PMCID: PMC10877892 DOI: 10.1186/s12910-023-00972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 10/16/2023] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND Carefully planned research is critical to developing policies and interventions that counter physical, psychological and social challenges faced by young people living with HIV/AIDS, without increasing burdens. Such studies, however, must navigate a 'vulnerability paradox', since including potentially vulnerable groups also risks unintentionally worsening their situation. Through embedded social science research, linked to a cohort study involving Adolescents Living with HIV/AIDS (ALH) in Kenya, we develop an account of researchers' responsibilities towards young people, incorporating concepts of vulnerability, resilience, and agency as 'interacting layers'. METHODS Using a qualitative, iterative approach across three linked data collection phases including interviews, group discussions, observations and a participatory workshop, we explored stakeholders' perspectives on vulnerability and resilience of young people living with HIV/AIDS, in relation to home and community, school, health care and health research participation. A total of 62 policy, provider, research, and community-based stakeholders were involved, including 27 ALH participating in a longitudinal cohort study. Data analysis drew on a Framework Analysis approach; ethical analysis adapts Luna's layered account of vulnerability. RESULTS ALH experienced forms of vulnerability and resilience in their daily lives in which socioeconomic context, institutional policies, organisational systems and interpersonal relations were key, interrelated influences. Anticipated and experienced forms of stigma and discrimination in schools, health clinics and communities were linked to actions undermining ART adherence, worsening physical and mental health, and poor educational outcomes, indicating cascading forms of vulnerability, resulting in worsened vulnerabilities. Positive inputs within and across sectors could build resilience, improve outcomes, and support positive research experiences. CONCLUSIONS The most serious forms of vulnerability faced by ALH in the cohort study were related to structural, inter-sectoral influences, unrelated to study participation and underscored by constraints to their agency. Vulnerabilities, including cascading forms, were potentially responsive to policy-based and interpersonal actions. Stakeholder engagement supported cohort design and implementation, building privacy, stakeholder understanding, interpersonal relations and ancillary care policies. Structural forms of vulnerability underscore researchers' responsibilities to work within multi-sectoral partnerships to plan and implement studies involving ALH, share findings in a timely way and contribute to policies addressing known causes of vulnerabilities.
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Affiliation(s)
- Mary Kimani
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Sassy Molyneux
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya.
- Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Anderson Charo
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Scholastica M Zakayo
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Gladys Sanga
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
| | - Rita Njeru
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alun Davies
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Health Systems Collaborative, Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Maureen Kelley
- Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Amina Abubakar
- Aga Khan University, Institute for Human Development, Nairobi, Kenya
| | - Vicki Marsh
- Kenya Medical Research Institute Wellcome Trust Research Programme, Kilifi, Kenya
- Centre for Global Health Research, Nuffield Department of Medicine, University of Oxford, Peter Medawar Building for Pathogen Biology, 3 South Parks Road, Oxford, OX13SY, UK
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Brewer SK, Talge N, Holzman C, Sikorskii A, Ezeamama A. Perinatal HIV exposure and infection and caregiver depressive symptoms. AIDS Care 2024; 36:280-290. [PMID: 37352547 DOI: 10.1080/09540121.2023.2214865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/11/2023] [Indexed: 06/25/2023]
Abstract
Survival is possible for children perinatally exposed to or infected by HIV in the post-combined antiretroviral therapy era and identifying factors affecting children's ability to thrive has public health significance. Caregiver mental health is one such factor to consider given its impact on child development, but previous work has not included a full complement of HIV exposure/infection groups within HIV-endemic settings. We compared depressive symptoms among caregivers of 3 groups of 6-10-year-olds in Uganda: children with perinatally acquired HIV infection (CPHIV, n = 102), children with perinatal HIV exposure, but no infection (CPHEU, n = 101), and children without perinatal HIV exposure or infection (CHUU, n = 103). The Hopkins Symptom Checklist was used to assess caregiver depressive symptoms. Generalized linear models were used to estimate group mean differences. Adjusted models included caregiver demographics, social support, and lifetime trauma. Depression symptoms were higher among CPHEU compared to CPHIV caregivers (model coefficient [B] = -3.5, 95%CI -5.3, -1.8). This finding was minimally attenuated following adjustment for covariates (B = -2.2, 95%CI -4.1, -0.4) and among biological mothers. At lower levels of social support and wealth, CPHEU caregivers reported higher levels of depression symptoms than CPHIV caregivers. Our findings point to unmet mental health needs among CPHEU caregivers.
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Affiliation(s)
- Sarah K Brewer
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Nicole Talge
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Claudia Holzman
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, USA
| | - Alla Sikorskii
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
| | - Amara Ezeamama
- Department of Psychiatry, Michigan State University, East Lansing, MI, USA
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Sherr L, Macedo A, Tomlinson M, Skeen S, Hensels IS, Steventon Roberts KJ. Parenting in Adversity: Effects of Older Caregivers, Biological Carers and Troubled Carers on Child Outcomes in High HIV-Affected Communities. J Cross Cult Gerontol 2023:10.1007/s10823-023-09482-6. [PMID: 37243786 DOI: 10.1007/s10823-023-09482-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 05/29/2023]
Abstract
Caregiving by older adults is a common phenomenon, enhanced in the era of HIV infection. This longitudinal study was set up to examine the effect of caregiver age, relationship and mental wellbeing on child (4-13 years) outcomes (psychosocial and cognitive) in a sample of 808 caregiver- child dyads in South Africa and Malawi. Respondents were drawn from consecutive attenders at Community Based Organisations (CBOs) and interviewed with standardised inventories at baseline and followed up 12-15 months later. Analysis focused on three separate aspects of the caregiver; age, relationship to the child, and mental wellbeing, results are stratified with regard to these factors. Results showed that compared to younger caregivers, over 50 years were carrying a heavy load of childcare, but caregiver age for the most part was not associated with child outcomes. Being biologically related to the child (such as biological grandparenting) was also not a significant factor in child outcomes measured. However, irrespective of age and relationship, caregiver mental health was associated with differences in child outcome - those children of caregivers with a greater mental health burden were found to report experiencing more physical and psychologically violent discipline. Over time, the use of violent discipline was found to reduce. These data suggest that older caregivers and grandparents are providing comparable care to younger caregivers, for young children in the face of the HIV epidemic and that interventions should focus on mental health support for all caregivers, irrespective of age or relationship to the child.
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Affiliation(s)
- Lorraine Sherr
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK.
| | - Ana Macedo
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, Netherlands
| | - Imca S Hensels
- Department of Psychology, University of Manchester, Manchester, UK
| | - Kathryn J Steventon Roberts
- Institute for Global Health, University College London, Rowland Hill Street, London, NW3 2PF, UK
- Department for Social Policy and Intervention, University of Oxford, Oxford, UK
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Asiimwe R, Dwanyen L, Subramaniam S, Kasujja R, Blow AJ. Training of interventionists and cultural adaptation procedures: A systematic review of culturally adapted evidence-based parenting programs in Africa. FAMILY PROCESS 2023; 62:160-181. [PMID: 35570371 DOI: 10.1111/famp.12780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 06/15/2023]
Abstract
There has been an increase in the implementation of evidence-based parenting programs from high-income countries to several African countries. In this review, we systematically evaluated intervention studies of culturally adapted parenting programs in nine African countries with the objective of examining the quality of training for interventionists and cultural adaptation procedures. A total of 18 studies, obtained from an electronic search of 6 databases, met the inclusion criteria and were evaluated following PRISMA guidelines. The Ecological Validity Model was adopted to organize data on cultural adaptation procedures. Sixteen of the 18 studies reported information regarding the clinical training of interventionists and the cultural adaptations undertaken. Live and interactive workshops were the most common format used to train interventionists in the focal intervention. Overall, cultural adaptations in most studies included translation of intervention protocols into the local language. However, studies varied in the way cultural adaptation procedures were reported with some studies failing to report on cultural adaptation procedures. Concurring with previous literature, attending to issues of culture, power, privilege, access, sustainability, and other relevant concepts to increase the cultural relevance is highly encouraged in parent intervention studies in Africa. This review provides a baseline upon which future training and adaptation procedures can be built.
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Affiliation(s)
- Ronald Asiimwe
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Lekie Dwanyen
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Saila Subramaniam
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
| | - Rosco Kasujja
- Department of Mental Health, School of Psychology, Makerere University, Kampala, Uganda
| | - Adrian J Blow
- Department of Human Development and Family Studies, Michigan State University, East Lansing, Michigan, USA
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Malo VF, Ritchwood TD, Hart LJ, Atujuna M. A qualitative analysis of family support for adolescent HIV care in South Africa. AIDS Care 2023; 35:425-430. [PMID: 36120906 PMCID: PMC10020124 DOI: 10.1080/09540121.2022.2121956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Compared to other age groups, South African adolescents living with HIV (ALWH) have the lowest rates of retention in HIV care and medication adherence. While previous research suggests that familial social support may improve treatment retention and adherence within this population, we know little about the influence of differential types of social support on HIV-related outcomes. Thus, the purpose of this study is to qualitatively characterize the influence of type of familial social support on treatment retention and adherence among ALWH. We interviewed adolescents living with perinatally-acquired HIV (n = 20), their caregivers (n = 19), and community stakeholders (n = 20) in Cape Town, South Africa. Data were coded using deductive and inductive approaches to content analysis. We identified four types of familial social support: instrumental, appraisal, emotional, and informational support. Families provided instrumental support through logistical assistance, including transportation to appointments and pill reminders. Families also provided both emotional support and appraisal support, encouraging ALWH to adhere to their medication regimens by reflecting upon its importance to their futures. For informational support, families often educated ALWH about their HIV status and strategies for disease self-management. In characterizing familial social support, our findings highlight potential targets of future interventions to improve HIV-related outcomes among ALWH.
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Affiliation(s)
| | - Tiarney D. Ritchwood
- Duke Global Health Institute, Duke University, Durham, NC, US
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, US
| | - Lauren J. Hart
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, US
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Mensi M, Ahishakiye A, Journeay K, Baiocco R, Betancourt TS, Paganotti GM. HIV-Exposed Uninfected Children: A Systematic Review on Psychological Well-Being and Association with School Performances in Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2499. [PMID: 36767866 PMCID: PMC9916290 DOI: 10.3390/ijerph20032499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
There is a growing number of children affected by HIV in Africa. Research on HIV-exposed uninfected children (HEU) is also growing. This systematic review focuses on the psychological well-being of HEU and its association with school intervention, outcomes, and enrollment in the African context, which is where the rate of HIV reaches its highest levels. Research on public databases was conducted according to PRISMA standards. Only studies on HEU primary school children in Africa, both quantitative and qualitative, were included. Out of 1510 papers retrieved, 50 met the inclusion criteria. These studies demonstrate that HEU children are more likely to perform worse in school compared to their counterparts who were not exposed to HIV and to show poorer concentration in the classroom. Children with parents suffering from AIDS are worried for them and have to take household responsibility, resulting in school dropouts, juvenile work, and risky behaviors. Few interventions have been conducted in the school environment with some of them being successful; therefore, future research should involve schools to create an inclusive environment where HEU children could enhance their potential and improve their psychological health.
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Affiliation(s)
- Marina Mensi
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | - Alain Ahishakiye
- Capacity Building Team, Mental Health Centre, University of Rwanda, Kigali P.O. Box 4285, Rwanda
- Section of Epidemiology, Department of Public Health, Institut de Santé et de Développement, Cheikh Anta Diop University, Dakar 10700, Senegal
- Department of Social Medicine, Harvard University, Boston, MA 02115, USA
| | - Katharine Journeay
- Research Program on Children and Adversity, School of Social Work, Boston College, Boston, MA 02467, USA
| | - Roberto Baiocco
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy
| | | | - Giacomo M. Paganotti
- Botswana-University of Pennsylvania Partnership, P.O. Box 45498, Riverwalk, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Biomedical Sciences, University of Botswana, Private Bag UB 0022, Gaborone, Botswana
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11
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Carries S, Mkhwanazi Z, Sigwadhi L, Moshabela M, Nyirenda M, Goudge J, Govindasamy D. An economic incentive package to support the wellbeing of caregivers of adolescents living with HIV during the COVID-19 pandemic in South Africa: a feasibility study protocol for a pilot randomised trial. Pilot Feasibility Stud 2023; 9:3. [PMID: 36624520 PMCID: PMC9827020 DOI: 10.1186/s40814-023-01237-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 01/02/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The mental and financial strain linked to unpaid caregiving has been amplified during the COVID-19 pandemic. In sub-Saharan Africa, carers of adolescents living with HIV (ALHIV) are critical for maintenance of optimum HIV treatment outcomes. However, the ability of caregivers to provide quality care to ALHIV is undermined by their ability to maintain their own wellbeing due to multiple factors (viz. poverty, stigma, lack of access to social support services) which have been exacerbated by the COVID-19 pandemic. Economic incentives, such as cash incentives combined with SMS reminders, have been shown to improve wellbeing. However, there is a lack of preliminary evidence on the potential of economic incentives to promote caregiver wellbeing in this setting, particularly in the context of a pandemic. This protocol outlines the design of a parallel-group pilot randomised trial comparing the feasibility and preliminary effectiveness of an economic incentive package versus a control for improving caregiver wellbeing. METHODS Caregivers of ALHIV will be recruited from public-sector HIV clinics in the south of the eThekwini municipality, KwaZulu-Natal, South Africa. Participants will be randomly assigned to one of the following groups: (i) the intervention group (n = 50) will receive three cash payments (of ZAR 350, approximately 23 USD), coupled with a positive wellbeing message over a 3-month period; (ii) the control group (n = 50) will receive a standard message encouraging linkage to health services. Participants will be interviewed at baseline and at endline (12 weeks) to collect socio-demographic, food insecurity, health status, mental health (stigma, depressive symptoms) and wellbeing data. The primary outcome measure, caregiver wellbeing, will be measured using the CarerQoL instrument. A qualitative study will be conducted alongside the main trial to understand participant views on participation in the trial and their feedback on study activities. DISCUSSION This study will provide scientific direction for the design of a larger randomised controlled trial exploring the effects of an economic incentive for improving caregiver wellbeing. The feasibility of conducting study activities and delivering the intervention remotely in the context of a pandemic will also be provided. TRIAL REGISTRATION PACTR202203585402090. Registry name: Pan African Clinical Trials Registry (PACTR); URL: https://pactr.samrc.ac.za/ ; Registration. date: 24 March 2022 (retrospectively registered); Date first participant enrolled: 03 November 2021.
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Affiliation(s)
- Stanley Carries
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Zibuyisile Mkhwanazi
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Lovemore Sigwadhi
- grid.11956.3a0000 0001 2214 904XBiostatistics Unit, Stellenbosch University, Stellenbosch, South Africa
| | - Mosa Moshabela
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Makandwe Nyirenda
- grid.16463.360000 0001 0723 4123School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa ,grid.415021.30000 0000 9155 0024Burden of Disease Unit, South African Medical Research Council, Cape Town, South Africa
| | - Jane Goudge
- grid.11951.3d0000 0004 1937 1135Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Darshini Govindasamy
- grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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12
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Doku PN. Child maltreatment and associated sociodemographic factors among children affected by HIV/AIDS in Ghana: a multi-informant perspective. AIDS Care 2023; 35:106-113. [PMID: 35465790 DOI: 10.1080/09540121.2022.2067310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
ABSTRACTChild maltreatment is considered a major public health concern among children because they can cause significant physical and psychological problems. Child maltreatment is widespread but often underestimated. Surprisingly, there is hardly any data on child maltreatment and any associated sociodemographic factors children affected by HIV/AIDS in low-income countries. This study employed cross-sectional, quantitative survey that involved 291 children aged 10-17 years and their caregivers in the Lower Manya Krobo District, Ghana and examined their exposure to and experience of child maltreatment. The results show that at least one form of maltreatment was reported by approximately 90% of the children, and it was significantly higher among orphans and vulnerable children (OVC) as compared with comparison children. Older age, frequent changes in residence, non-schooling and living with many siblings are associated with child maltreatment. The results demonstrate that maltreatment among children affected by HIV/AIDS are not rare, and that the dysfunction family conditions that they find themselves bear systemic risks for maltreatment. It is important that culturally appropriate and evidence-based interventions are implemented to address the maltreatment.
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Affiliation(s)
- Paul Narh Doku
- Department of Mental Health Nursing, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
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13
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Tredoux A, Phillander N, Williams H, Ward CL, Schrieff-Brown L. Investigating parenting factors, traumatic brain injury and callous and unemotional traits among high school students in a South African setting. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221135256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aggressogenic parenting styles are associated with increased rates of callous and unemotional traits, and in turn, with antisocial behaviours. Traumatic brain injury is also associated with antisocial behaviour, but not callous and unemotional traits specifically. No study has previously investigated these three variables, aggressogenic parenting, traumatic brain injury, and callous and unemotional traits, in a single study. The study setting was Cape Town, South Africa. The sample included high school boys ( N = 54), aged 13–21 years in an observational, descriptive study. We hypothesised that boys who reported that they had sustained a traumatic brain injury and who had been exposed to aggressogenic parenting would display increased levels of callous and unemotional traits, and that those with traumatic brain injury but had experienced positive parenting would display lower levels of such traits. The main measures included the Comprehensive Health Assessment Tool, the Inventory of Callous/Unemotional traits, and the Alabama Parenting Questionnaire. Results show that almost 41% (22/54) of participants reported sustaining a traumatic brain injury. Aggressogenic parenting significantly moderated callous and unemotional traits only in participants with traumatic brain injury, F(1.46) = 4.76, p = .03, while positive parenting and substance use did not. In conclusion, traumatic brain injury in the presence of aggressogenic parenting is associated with greater callous and unemotional traits in this sample of adolescent boys.
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Affiliation(s)
- Aimee Tredoux
- Department of Psychology, ACSENT Laboratory, University of Cape Town, South Africa
| | - Nathan Phillander
- Department of Psychology, ACSENT Laboratory, University of Cape Town, South Africa
| | - Huw Williams
- Centre for Clinical Neuropsychology Research, University of Exeter, UK
| | | | - Leigh Schrieff-Brown
- Department of Psychology, ACSENT Laboratory, University of Cape Town, South Africa
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14
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Gumede D, Meyer-Weitz A, Edwards A, Seeley J. Understanding older peoples' chronic disease self-management practices and challenges in the context of grandchildren caregiving: A qualitative study in rural KwaZulu-Natal, South Africa. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000895. [PMID: 36962615 PMCID: PMC10021571 DOI: 10.1371/journal.pgph.0000895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 08/23/2022] [Indexed: 11/19/2022]
Abstract
While chronic diseases are amongst the major health burdens of older South Africans, the responsibilities of caring for grandchildren, by mostly grandmothers, may further affect older people's health and well-being. There is a paucity of information about chronic disease self-management for older people in the context of grandchildren caregiving in sub-Saharan Africa. Guided by the Self-Management Framework, the purpose of this qualitative methods study was to explore the chronic disease self-management practices and challenges of grandparent caregivers in rural KwaZulu-Natal, South Africa. Eighteen repeat in-depth interviews were carried out with six grandparent caregivers aged 56 to 80 years over 12 months. Thematic analysis was conducted based on the Self-Management Framework. Pathways into self-management of chronic illnesses were identified: living with a chronic illness, focusing on illness needs, and activating resources. Self-perceptions of caregiving dictated that grandmothers, as women, have the responsibility of caring for grandchildren when they themselves needed care, lived in poverty, and with chronic illnesses that require self-management. However, despite the hardship, the gendered role of caring for grandchildren brought meaning to the grandmothers' lives and supported self-management due to the reciprocal relationship with grandchildren, although chronic illness self-management was complicated where relationships between grandmothers and grandchildren were estranged. The study findings demonstrate that grandchildren caregiving and self-management of chronic conditions are inextricably linked. Optimal self-management of chronic diseases must be seen within a larger context that simultaneously addresses chronic diseases, while paying attention to the intersection of socio-cultural factors with self-management.
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Affiliation(s)
- Dumile Gumede
- Centre for General Education, Durban University of Technology, Durban, South Africa
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Anna Meyer-Weitz
- School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Anita Edwards
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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15
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Goodrum NM, Carroll J, Dubrow I, Armistead LP, Masyn K, Schulte M, Murphy DA. Parenting stress predicts longitudinal change in parental involvement among mothers living with HIV. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2022; 36:725-735. [PMID: 34472939 PMCID: PMC8888772 DOI: 10.1037/fam0000909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Mothers living with HIV (MLH) face unique challenges that may compound parenting stress and impede effective parenting practices. Among the general population, research has demonstrated bidirectional longitudinal relations between parenting stress and parenting practices; yet, despite the additional stressors faced by MLH, these processes have not been examined longitudinally in this population. Utilizing the process model of parenting, the present study examined the longitudinal relations between parenting stress and parental involvement among a sample of MLH with children aged 6-14 years (N = 174). MLH completed self-report measures on their parenting stress and parental involvement at four timepoints spanning 15 months. Latent change score modeling was employed to examine how changes in parenting stress and changes in parental involvement were related across time. Results revealed that increases in parenting stress-specifically distress within the parental role-predicted subsequent decreases in parental involvement. The effects were unidirectional; parental involvement did not predict subsequent changes in parenting stress. Other aspects of parenting stress (perceptions of dysfunctional parent-child interactions and perceptions of the child's temperament as difficult) did not have significant longitudinal associations with changes in parental involvement. Results highlight the central role of parenting stress for MLH as a potential driving factor of parenting quality. Beyond supporting the use of effective parenting skills, clinical prevention and intervention efforts with families affected by HIV should also incorporate stress reduction techniques to increase MLH's capacity for active parental involvement and thereby support positive outcomes for their children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Nada M. Goodrum
- Department of Psychology, University of South Carolina
- National Crime Victims Research and Treatment Center, Medical University of South Carolina
| | | | - Isabella Dubrow
- National Crime Victims Research and Treatment Center, Medical University of South Carolina
| | | | | | - Marya Schulte
- Department of Psychiatry, University of California, Los Angeles
| | - Debra A. Murphy
- Department of Psychiatry, University of California, Los Angeles
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16
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Jiang Y, Li X, Harrison SE, Zhang J, Qiao S, Zhao J, Zhao G. Effects of a Multilevel Resilience-Based Intervention on Mental Health for Children Affected by Parental HIV: A Cluster Randomized Controlled Trial. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 31:1094-1105. [PMID: 36875685 PMCID: PMC9979773 DOI: 10.1007/s10826-022-02236-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 06/18/2023]
Abstract
The present study aimed to examine the efficacy of the Child-Caregiver-Advocacy Resilience (ChildCARE) intervention, a multilevel resilience-based psychosocial intervention, on mental health outcomes, including depressive symptoms, school anxiety, and loneliness, among children affected by parental HIV in central China. Seven hundred and ninety children (51.6% boys, 6-17 years of age) affected by parental HIV were randomly assigned by cluster to a control group or one of three intervention groups designed to test the three conditions of the ChildCARE intervention (child-only, child + caregiver, child + caregiver + community). Linear mixed-effects modeling was performed to test the intervention effect at 6, 12, and 18 months. The intervention did not yield significant changes in mental health outcomes in the child-only group at any follow-ups, whereas significant reductions in depressive symptoms and loneliness were observed in the child + caregiver group at 12 months. The observed intervention effects were not sustained at 18 months. Also, children who received the additional community component that, was implemented after 12 months did not show larger improvements in mental health outcomes than the control group at 18 months. Lastly, older children (i.e., ≥12 years) were found to benefit more from the intervention than their younger counterparts (i.e., <12 years). Overall, the findings provide some support for the promise of multilevel resilience-based interventions in improving mental health of children affected by parental HIV, but more research is needed to further determine whether multilevel resilience-based interventions can yield sustained effects on mental health.
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Affiliation(s)
- Yanping Jiang
- Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
- Department of Family Medicine and Community Health, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
| | - Xiaoming Li
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | | | - JiaJia Zhang
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Shan Qiao
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, USA
| | - Junfeng Zhao
- Institute of Behavior and Psychology, Henan University, Kaifeng, Henan, China
| | - Guoxiang Zhao
- Department of Psychology, Henan Normal University, Xinxiang, Henan, China
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17
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Shangase N, Edwards J, Pence B, Aiello A, Hussong A, Gómez-Olivé X, Kahn K, Stoner M, Pettifor A. Effect of Quality of Caregiver-Adolescent Relationship on Sexual Debut, Transactional Sex, and on Age-Disparate Relationships Among Young Women in Rural South Africa Enrolled in HPTN 068. J Acquir Immune Defic Syndr 2022; 89:366-373. [PMID: 35202045 PMCID: PMC8887792 DOI: 10.1097/qai.0000000000002890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Adolescent girls and young women (AGYW) remain burdened by the HIV epidemic. Positive caregiver-child relationships are associated with safe sexual behaviors in young people; yet, this literature often highlights the role of parent-child communication and parental monitoring, neglecting the importance of emotional relationships between a caregiver and adolescent. SETTING We used longitudinal data from HIV Prevention Trial Network 068-conducted among 2533 AGYW (13-20 years) over a period of 5 years in Agincourt, South Africa. METHOD Kaplan-Meier and Cox models were used to estimate the effect of quality of caregiver-adolescent relationships (caring and closeness) on sexual debut, and log-binomial models with generalized estimating equations were used to examine the relationship between our exposures and transactional sex and age-disparate relationships. RESULTS Sexual debut was delayed among those who reported high levels of caregiver caring [hazard ratio: 0.80, 95% confidence interval (CI): 0.69 to 0.93] and caregiver closeness (hazard ratio: 0.80, 95% CI: 0.68 to 0.95). AGYW who reported high quality caregiver-adolescent relationships had a lower risk of transactional sex [caring: risk ratio (RR): 0.67, 95% CI: 0.58 to 0.78; closeness: RR: 0.58; 95% CI: 0.50 to 0.67]. Similarly, those with high-quality caregiver-adolescent relationships were less likely to be in an age-disparate relationship (caring: RR: 0.68, 95% CI: 0.58 to 0.79; closeness: RR: 0.77, 95% CI: 0.66 to 0.90). CONCLUSIONS Findings indicate high-quality caregiver-adolescent relationships are associated with delayed sexual debut, a lower risk of transactional sex, and having an older partner. Family-centered interventions are needed to improve relationships between AGYW and caregivers.
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Affiliation(s)
- Nosipho Shangase
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Jess Edwards
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Brian Pence
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Allison Aiello
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Andrea Hussong
- Department of Psychology, University of North Carolina, Chapel Hill, NC
| | - Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Marie Stoner
- Women’s Global Health Imperative, RTI International, San Francisco, California, USA
| | - Audrey Pettifor
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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18
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Mathias K, Nayak P, Singh P, Pillai P, Goicolea I. Is the Parwarish parenting intervention feasible and relevant for young people and parents in diverse settings in India? A mixed methods process evaluation. BMJ Open 2022; 12:e054553. [PMID: 35177452 PMCID: PMC8860057 DOI: 10.1136/bmjopen-2021-054553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To assess the feasibility, acceptability and relevance of the Parwarish, a positive parenting intervention (adapted from PLH-Teens) in three diverse settings in India. DESIGN This mixed methods study used the Medical Research Council framework for process evaluations of complex interventions. SETTING This study was set in disadvantaged communities in urban Agra, rural Uttar Pradesh and tribal Jharkhand in India. PARTICIPANTS Data were collected from 86 facilitators, implementers, parents and teens who participated in the Parwarish intervention among 239 families. INTERVENTION Couples from target communities facilitated groups of parents and teens over the 14-module structured, interactive Parwarish intervention which focused on building communication, reducing harsh parenting and building family budgeting skills. OUTCOME MEASURES We assessed relevance, acceptability and feasibility of the intervention using mixed methods. Qualitative data collected included semistructured interviews and focus group discussions with implementers, facilitators, parents and young people who were transcribed, translated and thematically analysed to develop themes inherent in the data. Quantitative data which assessed attendance, fidelity to the intervention and facilitator training and coaching were analysed descriptively. RESULTS Findings were grouped under the three domains of facilitation, community engagement and programme support with the following seven themes: (1) community-based facilitators increased contextual validity of the intervention; (2) gender relations were not only influenced by Parwarish implementation but were also influenced and transformed by Parwarish; (3) facilitator responsiveness to group concerns increased participation; (4) participation gathered momentum; (5) Parwarish's strong core and porous periphery allowed adaptations to local contexts; (6) technology that included Skype and WhatsApp enhanced implementation and (7) critical reflection with community trained coaches strengthened facilitation quality and programme fidelity. CONCLUSION This study found Parwarish engaging, feasible and acceptable in three diverse, low-income communities, although constrained by patriarchal gender relations. It paves the way for larger-scale implementation in other South Asian settings.
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Affiliation(s)
- Kaaren Mathias
- Global Health and Epidemiology, Umea University, Umea, Sweden
- Community Health and Development, Emmanuel Hospital Association, New Delhi, Delhi, India
| | - Prabhudutt Nayak
- Chhatarpur Christian Hospital, Community Health and Development Programme, Emmanuel Hospital Association, Chhatarpur, Madhya Pradesh, India
| | - Pratibha Singh
- Community Health and Development, Emmanuel Hospital Association, New Delhi, Delhi, India
| | - Pooja Pillai
- Burans, Herbertpur Christian Hospital, Emmanuel Hospital Association, Dehradun, Uttarakhand, India
| | - Isabel Goicolea
- Global Health and Epidemiology, Umea University, Umea, Sweden
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Song Y, Wang H, Yin Y, Nie A, Yang H, Liu Y, Tao L, Zhong H, Zhang L, Chen H. Caregiver Burden Among Informal Caregivers of Persons Living with HIV/AIDS in Liangshan Prefecture, China. Patient Prefer Adherence 2022; 16:1027-1035. [PMID: 35444411 PMCID: PMC9013673 DOI: 10.2147/ppa.s357580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/27/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Previous studies revealed that informal caregivers for persons living with HIV/AIDS (PLWHA) experience perceived caregiver burden. Although Liangshan prefecture is one of the areas with the fastest growing HIV/AIDS epidemics in China, little is known about burden of informal caregivers for PLWHA. This study aimed to evaluate caregiver burden and these predictors among informal caregivers of PLWHA in Liangshan prefecture, China. METHODS This was a cross-sectional study conducted from August to December 2017. We used convenience sampling to recruit informal caregivers of PLWHA. A total of 222 participants completed questionnaires including demographic information, caregiving-related information, and caregiver burden (measured by Zarit Burden Interview, ZBI). SPSS software was used to analyze the data. Independent student's t-test, one-way analysis of variance (one-way ANOVA), Spearman rank correlation, and multiple linear regression analysis were performed. RESULTS The mean ZBI score was 40.61 (SD = 14.47), and 199 (89.6%) informal caregivers had a mild or above caregiver burden. Multiple linear regression analysis revealed that older age (P=0.003), caregivers with poor health (P=0.002), parent-caregivers (P=0.001), poorer ability in 'balancing caregiving needs and their own needs' (P<0.001), and 'managing emotional needs' (P=0.014) were significantly associated with higher level of caregiver burden. CONCLUSION The majority of informal caregivers had perceived caregiver burden in Liangshan prefecture of China. Findings emphasize that health-care providers, medical institutions and government should develop educational programs and policy to improve caregiver's ability to cope with caregiving for PLWHA, and take more attention to caregivers with health problem, at older age, parent-caregivers. These may contribute to reducing caregiver burden among informal caregivers of PLWHA.
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Affiliation(s)
- Yuqing Song
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Huan Wang
- Department of Nursing, the Third Hospital of Mianyang, Sichuan Mental Health Centre, Mianyang, Sichuan Province, 621000, People's Republic of China
| | - Yao Yin
- Department of Neurology/Evidence-Based Nursing Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Anliu Nie
- Emergency Department, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, 510120, People's Republic of China
| | - Hui Yang
- Nursing Department, the First Affiliated Hospital of Harbin Medical University, Harbin, 150001, Heilongjiang, People's Republic of China
| | - Ying Liu
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Lin Tao
- Department of Breast Surgery, West China Hospital /West China School of Nursing, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Hua Zhong
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Liao Zhang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
| | - Hong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, Sichuan Province, 610041, People's Republic of China
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Natukunda HPM, Mubiri P, Cluver LD, Ddumba-Nyanzi I, Bukenya B, Walakira EJ. Which Factors Are Associated With Adolescent Reports of Experiencing Various Forms of Abuse at the Family Level in Post-Conflict Northern Uganda? JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP12067-NP12096. [PMID: 31789094 DOI: 10.1177/0886260519888526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Research assessing familial violence against adolescents, using caregiver-adolescent dyads, is limited in post-conflict settings. This study aimed to determine the prevalence and factors associated with adolescent-reported familial abuse in post-conflict northern Uganda. It also assessed the relationship between abuse subtypes and (a) beliefs supporting aggression and (b) adolescent well-being and life satisfaction. A randomly selected community-based sample of 10- to 17-year-old adolescents (54% girls) and their caregivers (N = 427 dyads) in two northern Uganda districts was used. Abuse outcomes were adolescent reported. All measures used standardized tools that have been adapted for research in resource-limited settings. Analyses used multivariable linear regressions in Stata 14/IC. Overall, physical, emotional, and sexual abuse rates were 70% (confidence interval [CI] = [65.7, 74.4]), 72% (CI = [67.4, 76.0]), and 18.0% (CI = [14.0, 21.2]), respectively. Polyvictimization was 61% (CI = [55.4, 64.7]). There were no gender differences regarding adolescent reports of physical and emotional abuse, but adolescent girls were more likely to report sexual abuse and polyvictimization than adolescent boys. All forms of adolescent-reported abuse (except sexual abuse) were associated with caregiver reports of harsh disciplinary practices. In addition, emotional abuse was associated with physical and sexual abuse. Physical abuse was associated with being an orphan and emotional abuse. Sexual abuse was associated with being a girl, older adolescent age, living in a larger household, and emotional abuse. Polyvictimization was positively associated with being an orphan, younger caregiver age, caregiver-reported poor monitoring and supervision, and higher household socioeconomic status, but negatively associated with lower parental role satisfaction. Physical and emotional (but not sexual) abuse and polyvictimization were associated with beliefs supporting aggression among adolescents. All abuse subtypes were associated with lower levels of perceived well-being and life satisfaction among adolescents in this study. Child abuse prevention programs have the potential to improve adolescent-caregiver interaction and interrupt the violence transmission cycle in this setting.
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Affiliation(s)
- Helen P M Natukunda
- Makerere University, Kampala, Uganda
- MRC Harwell Institute, UK Research and Innovation, Oxfordshire, UK
- University of Oxford, UK
| | | | - Lucie D Cluver
- University of Oxford, UK
- University of Cape Town, South Africa
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21
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Thomas T, Tan M, Ahmed Y, Grigorenko EL. A Systematic Review and Meta-Analysis of Interventions for Orphans and Vulnerable Children Affected by HIV/AIDS Worldwide. Ann Behav Med 2021; 54:853-866. [PMID: 32525205 DOI: 10.1093/abm/kaaa022] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Worldwide, there are more than 13.3 million orphans and vulnerable children affected by Human immunodeficiency virus infection and acquired immune deficiency syndrome (HIV/AIDS) (HIV OVC), defined as individuals below the age of 18 who have lost one or both parents to HIV/AIDS or have been made vulnerable by HIV/AIDS; they are at risk for negative psychosocial and cognitive outcomes. PURPOSE This meta-analysis aimed to examine the scientific literature on available interventions for HIV OVC, with a focus on community-based interventions (CBI). METHODS Systematic electronic searches were conducted from four databases between October 2016 and April 2017 to identify articles investigating the effectiveness of interventions for HIV OVC. Effect sizes were calculated for each article which provided enough information and data points for analyses. RESULTS Seventy-four articles were reviewed, including psychosocial interventions (d = 0.30), cognitive interventions (d = 0.14), social protection interventions (d = 0.36), and community-based interventions (CBI; d = 0.36). Study-specific effect sizes varied widely, ranging from -1.09 to 2.26, that is, from a negative effect to an impressively large positive one, but the majority of studies registered small to medium effects (the overall effect size for all studies was 0.32, SE = 0.03, 95% CI: 0.26-0.37). Social protection interventions had the highest positive outcomes whereas CBI tended to have the fewest significant positive outcomes, with some outcomes worsening instead of improving. CONCLUSIONS Overall, interventions provided to OVC have potential for improving cognitive, psychosocial, and risk-behavior outcomes. Social protection interventions and CBI had the highest effect sizes, but CBI had positive effects on fewer outcomes and demonstrated some negative effects. CBI warrant scrutiny for improvement, as they represent an important form of culturally embedded services with potentially long-term benefits to OVC, yet appear to be differentially effective. Successful components of other types of intervention were identified, including cash grants, mentorship, and family therapy. In addition, more research is needed that attends to which interventions may be more effective for specific populations, or that studies cost-effectiveness.
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Affiliation(s)
- Tina Thomas
- Department of Psychology, University of Houston, Houston, TX
| | - Mei Tan
- Department of Psychology, University of Houston, Houston, TX
| | - Yusra Ahmed
- Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX
| | - Elena L Grigorenko
- Department of Psychology, University of Houston, Houston, TX.,Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX.,Molecular and Human Genetics, Baylor College of Medicine, Houston, TX.,Moscow State University for Psychology and Education, Moscow, Russian Federation
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22
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Goldschmidt T, Petersen L, Booley S, Roman NV. Perspectives of nurturance within the parent-child relationship in resource-constrained families. Child Care Health Dev 2021; 47:494-500. [PMID: 33638196 DOI: 10.1111/cch.12861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nurturing parents raise children in an engaged, flexible, emotionally expressive and supportive manner, which is associated with positive outcomes for children. While parenting research within the South African context is increasing, there is a lack of focus on nurturance within the parent-child relationship. Thus, this study sought to explore how parents nurture their children in resource-constrained environments in South Africa. METHOD A qualitative approach with an exploratory research design was used. Participants were purposively recruited via non-governmental institutions and key informants in the communities. A sample of 77 semi-structured interviews was conducted with participants from two rural areas, Calvinia and Lamberts Bay, in South Africa. RESULTS A thematic analysis of the data revealed two themes. The first theme is nurturance approaches, which encapsulate how parents nurture their children physically and emotionally. The second theme focuses on factors contributing to nurturance within the parent-child relationship with regard to parenting practices and external factors. CONCLUSION Although parents are nurturing children physically and emotionally, parenting capacity needs to be improved in the South African context.
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Affiliation(s)
- Tessa Goldschmidt
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
| | - Lisa Petersen
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
| | - Shakierah Booley
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
| | - Nicolette V Roman
- Centre for Interdisciplinary Studies of Children, Families and Society, University of the Western Cape, Cape Town, South Africa
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23
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Laurenzi CA, Hunt X, Skeen S, Sundin P, Weiss RE, Kosi V, Rotheram-Borus MJ, Tomlinson M. Associations between caregiver mental health and young children's behaviour in a rural Kenyan sample. Glob Health Action 2021; 14:1861909. [PMID: 33397222 PMCID: PMC7801103 DOI: 10.1080/16549716.2020.1861909] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Research shows that caregiver mental health problems have direct, significant effects on child behaviour. While these risks are amplified in low-resource settings, limited evidence exists from these places, especially sub-Saharan Africa. Objective: We measured associations between caregiver mental health and child behaviour in a rural Kenyan sample, hypothesizing that higher rates of caregiver mental health would be associated with increased child behavioural problems. We also sought to provide an overview of caregiver mental health symptoms in our sample. Method: Cross-sectional data were collected from caregivers of children ages 4–5 years old enrolled in a community-based early child development programme in western Kenya. 465 caregivers were recruited and assessed at baseline, and answered questions about child behaviour, mental health symptoms (depression, anxiety, stress), and help-seeking. A multivariate linear regression model was used to assess significance of each mental health factor. Results: Caregiver anxiety (p = 0.01) and parenting stress (p < 0.001) were significantly associated with child behavioural problems. 245 caregivers (52.9%) had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored above the cut-off for both of these scales. A high proportion of our sample (60.6%) reported seeking some formal or informal psychosocial support services; however, less than one-third of these caregivers were symptomatic (30.9%). Conclusion: Anxiety and stress were associated with poorer child behavioural outcomes. Our sample reflected a higher prevalence of caregiving adults with mental health symptomology than previous estimates from Kenya, with few high-symptom caregivers seeking support. We discuss further implications for programming and health services delivery.
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Affiliation(s)
- Christina A Laurenzi
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Sarah Skeen
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa
| | - Phillip Sundin
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Robert E Weiss
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | | | - Mary Jane Rotheram-Borus
- Department of Biostatistics, Fielding School of Public Health, University of California , Los Angeles, CA, USA
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University , Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University , Belfast, UK
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24
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The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. PLoS One 2021; 16:e0251689. [PMID: 33989357 PMCID: PMC8121357 DOI: 10.1371/journal.pone.0251689] [Citation(s) in RCA: 77] [Impact Index Per Article: 25.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/01/2021] [Indexed: 12/11/2022] Open
Abstract
Background and purpose Most research regarding child and adolescent mental health prevention and promotion in low-and middle-income countries is undertaken in high-income countries. This systematic review set out to synthesise findings from epidemiological studies, published between 2008 and 2020, documenting the prevalence of mental health problems in adolescents from across sub-Saharan Africa. Methods A systematic search of multiple databases (MEDLINE, PsycINFO, Scopus) and Google Scholar was conducted guided by the Joanna Briggs Institute (JBI) Reviewer’s manual for systematic reviews of observational epidemiological studies. Studies included reported prevalence outcomes for adolescents aged 10–19 using either clinical interviews or standardized questionnaires to assess psychopathology. Clinical samples were excluded. Results The search yielded 1 549 records of which 316 studies were assessed for eligibility and 51 met the inclusion criteria. We present a qualitative synthesis of 37 of these 51 included articles. The other 14 studies reporting prevalence rates for adolescents living with HIV are published elsewhere. The prevalence of depression, anxiety disorders, emotional and behavioural difficulties, posttraumatic stress and suicidal behaviour in the general adolescent population and selected at-risk groups in 16 sub-Saharan countries (with a total population of 97 616 adolescents) are reported.
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25
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Goodrum NM, Armistead LP, Masyn K, Schulte M, Murphy DA. Longitudinal Bidirectional Relations among Parenting Quality, Parenting Stress, and Child Functioning in HIV-affected Families. J Youth Adolesc 2021; 50:1663-1678. [PMID: 33982190 DOI: 10.1007/s10964-021-01444-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
Mothers living with HIV (MLH) face unique stressors impacting parenting, parenting stress, and child psychosocial functioning, but longitudinal, bidirectional relations among family processes have not been examined in this population. This study examined relations among parenting quality, parenting stress, and child functioning in 174 MLH-child dyads (aged 6-14, Mage = 9.65, SD = 2.49; 51% female; 57% Black/African American; 35% Latinx). Families completed self-report questionnaires over four waves spanning 15 months. Cross-lagged panel analysis revealed unidirectional and bidirectional relations between parenting stress and child functioning; parenting quality and child functioning; and parenting quality and parenting stress. The findings suggest that prevention and intervention efforts with HIV-affected families should target both parent factors (e.g., communication skills) and child factors (e.g., emotion regulation), emphasizing parenting stress reduction in order to bolster family outcomes.
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Affiliation(s)
- Nada M Goodrum
- Department of Psychology, University of South Carolina, Columbia, SC, USA. .,National Crime Victims Research and Treatment Center, Medical University of South Carolina, Charleston, SC, USA.
| | - Lisa P Armistead
- Department of Psychology, Georgia State University, Atlanta, GA, USA
| | - Katherine Masyn
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Marya Schulte
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
| | - Debra A Murphy
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, CA, USA
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26
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Goodrum NM, Masyn KE, Armistead LP, Avina I, Schulte M, Marelich W, Murphy DA. A Mixed-Methods Longitudinal Investigation of Mothers' Disclosure of HIV to Their Children. Child Dev 2021; 92:1403-1420. [PMID: 33410522 DOI: 10.1111/cdev.13493] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Mothers living with HIV (MLH) must navigate disclosing their serostatus to their children, but the longitudinal impact on families remains unknown. This study examined HIV disclosure, parenting, parenting stress, and child adjustment among 174 MLH-child dyads (aged 6-14; 35% Latinx; 57% Black/African American). Quantitative data were collected over four waves spanning 15 months. Qualitative data were collected with 14 families in which disclosure had occurred. Latent change score modeling revealed that disclosure led to improvements in parenting stress, communication, and relationship quality. Disclosure did not predict child adjustment. Qualitative themes contextualized these findings, revealing stability and improvements in family functioning. MLH should be supported in disclosing their serostatus to their children to minimize parenting stress and bolster parenting skills.
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27
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Moshoeshoe M, Madiba S. Parenting the child with HIV in limited resource communities in South Africa: mothers with HIV's emotional vulnerability and hope for the future. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211058565. [PMID: 34775847 PMCID: PMC8593292 DOI: 10.1177/17455065211058565] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction: A diagnosis of HIV does not affect the well-being of mothers alone but also affects how they care for their children. The aim of this study was to explore how mothers who were diagnosed with HIV when pregnant or when their children became ill experience raising children living with HIV. The purpose was to understand how a diagnosis of HIV impacts mothering their children at different points on the mothering journey. Methods: Using descriptive phenomenological enquiry, interviews were conducted with 28 mothers recruited via purposeful sampling from clinics in health district in South Africa. The interviews were audiotaped, transcribed verbatim, and analysed following the thematic approach. Results: The mothers found mothering a child living with HIV stressful and associated with constant thoughts of death. The burden of mothering was increased for mothers who had to confront emotions of self-blame and guilt for unintentionally infecting the child. They used secrecy to protect their children from the social consequences of a diagnosis of HIV. The thought of living with HIV weighed on them every day and they expressed their experience of intense feelings of chronic worry, anxiety, and sadness. The findings identified high levels of stress, with the mothers expressing emotions suggestive of depression. With time, they accepted living with HIV and embraced motherhood, and became better mothers. Conclusion: The negative coping strategies used to deal with the child’s HIV diagnosis and high levels of stress and anxiety identified in the study underscore the need to address the psychosocial needs of mothers living with HIV. There is need to provide psychosocial support and continuous counselling for these mothers post diagnosis and upon a positive HIV diagnosis of the child to women enrolled in the prevention of mother to child transmission of HIV programme.
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Affiliation(s)
- Malerato Moshoeshoe
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Sphiwe Madiba
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Pretoria, South Africa
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28
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Asrat B, Lund C, Ambaw F, Garman EC, Schneider M. Major depressive disorder and its association with adherence to antiretroviral therapy and quality of life: cross-sectional survey of people living with HIV/AIDS in Northwest Ethiopia. BMC Psychiatry 2020; 20:462. [PMID: 32972394 PMCID: PMC7513286 DOI: 10.1186/s12888-020-02865-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 09/10/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Major depression is believed to affect treatment adherence and overall quality of life (QoL) of people living with HIV/AIDS (PLWHA). Comorbid major depression contributes to a two-fold higher risk of mortality among PLWHA. Understanding the relationships of major depression, adherence to antiretroviral therapy (ART) and QoL is important to identify areas for intervention. The aim of this study is to examine relationship of major depressive disorder (MDD) and adherence to ART with QoL, and to investigate socio-demographic and clinical factors associated with MDD, adherence and QoL among PLWHA in Northwest Ethiopia. METHOD A cross-sectional study was conducted in the ART clinic of Felege-Hiwot referral hospital in Northwest Ethiopia from July to October 2019. Adult PLWHA were selected using a systematic random sampling technique. Data were collected using interview administered questionnaires and chart reviews. Mini International Neuropsychiatric Interview and WHOQOL-HIV-BREF-Eth instruments were used to measure MDD and QoL respectively. Adherence to ART was assessed using pill count data from patients' adherence monitoring chart. Univariate and multivariate Poisson regressions were used to assess associations of socio-demographic and clinical factors with MDD and adherence to ART. A multivariate linear regression was used to examine the associations of both MDD and adherence with overall QoL. RESULT Of the total of 393 invited participants, 391 (99.5%) completed the interviews. MDD was negatively associated with overall QoL: participants with MDD had a lower QoL score of 0.17 points compared to those with no MDD. MDD was associated with reduced adherence to ART when functional disability was controlled (RR = 1.43; 95%CI = 1.05, 1.96; p = 0.025). However, there was no statistical association between adherence to ART and overall QoL. Functional disability was associated with both MDD (RR = 5.07; 95%CI = 3.27,7.86; p < 0.001) and overall QoL (β = 0.29; 95%CI = 0.21,0.36; p < 0.001). CONCLUSION The relationship between MDD and QoL indicates the need for feasible, acceptable and evidence-based mental health interventions to reduce depression and improve overall QoL of PLWHA. We recommend future studies investigate causal relationships of MDD, adherence to ART and QoL of PLWHA to better understand priority areas for intervention.
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Affiliation(s)
- Biksegn Asrat
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
| | - Crick Lund
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
- Centre for Global Mental Health, Department of Health Services and Population Research, King's Global Health Institute, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Fentie Ambaw
- School of Public Health, College of medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Emily Claire Garman
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Marguerite Schneider
- Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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29
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Shenderovich Y, Cluver L, Eisner M, Murray AL. Moderators of treatment effects in a child maltreatment prevention programme in South Africa. CHILD ABUSE & NEGLECT 2020; 106:104519. [PMID: 32485323 DOI: 10.1016/j.chiabu.2020.104519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 02/29/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous research has found mixed results on whether the most disadvantaged families benefit as much as less disadvantaged families from parenting interventions designed to reduce child maltreatment, and little in known in low-income settings. OBJECTIVE In this study, we test the effects of child, caregiver, household, and community characteristics as treatment moderators of intervention outcomes - child maltreatment and parenting practices. We test characteristics previously examined elsewhere as well as factors relevant to the South African context. PARTICIPANTS AND SETTING This analysis includes adolescents (ages 10-18) and their caregivers (N = 552 pairs) who participated in a randomised trial of a parenting programme in the Eastern Cape Province of South Africa. METHODS Data from the caregiver and adolescent standardised questionnaires collected at baseline, post-test (1-month post-intervention), and follow-up (5-9 months) were analysed using longitudinal multilevel analyses. We tested seven hypothesised moderators for each of the primary outcomes through interactions of treatment effect with baseline moderators. RESULTS No moderator effects were statistically significant after correcting for multiple comparisons testing. Hence, in line with several recent studies examining moderation effects in parenting programmes, our study suggests that parenting interventions aiming to reduce child maltreatment and promote parenting skills in low- and middle-income countries may be similarly effective for families facing various levels of economic, social, and health risk factors. CONCLUSIONS It may be useful to explicitly power trials for testing moderator effects, study different types of moderators and use person-centred analyses to further understand variations in treatment effects.
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Affiliation(s)
- Yulia Shenderovich
- Department of Social Policy and Intervention, Centre for Evidence-Based Intervention, University of Oxford, Barnett House, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom; Institute of Criminology, University of Cambridge, Sidgwick Avenue, CB3 9DA, Cambridge, United Kingdom.
| | - Lucie Cluver
- Department of Social Policy and Intervention, Centre for Evidence-Based Intervention, University of Oxford, Barnett House, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, 7925, Cape Town, South Africa.
| | - Manuel Eisner
- Institute of Criminology, University of Cambridge, Sidgwick Avenue, CB3 9DA, Cambridge, United Kingdom; Jacobs Center for Productive Youth Development, University of Zurich, Andreasstrasse 15, 8050, Zürich, Switzerland.
| | - Aja Louise Murray
- Institute of Criminology, University of Cambridge, Sidgwick Avenue, CB3 9DA, Cambridge, United Kingdom; Department of Psychology, University of Edinburgh, Room F16, Psychology Building, 7 George Square, Edinburgh, EH8 9JZ, United Kingdom.
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30
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Goin DE, Pearson RM, Craske MG, Stein A, Pettifor A, Lippman SA, Kahn K, Neilands TB, Hamilton EL, Selin A, MacPhail C, Wagner RG, Gomez-Olive FX, Twine R, Hughes JP, Agyei Y, Laeyendecker O, Tollman S, Ahern J. Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors. Am J Epidemiol 2020; 189:422-432. [PMID: 31667490 PMCID: PMC7306677 DOI: 10.1093/aje/kwz238] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 10/03/2019] [Accepted: 10/07/2019] [Indexed: 12/31/2022] Open
Abstract
The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.
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Affiliation(s)
- Dana E Goin
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Rebecca M Pearson
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, Bristol University, Bristol, United Kingdom
- Bristol Biomedical Research Centre, National Institute for Health Research, Bristol, United Kingdom
| | - Michelle G Craske
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California
| | - Alan Stein
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Audrey Pettifor
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Sheri A Lippman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen Kahn
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Torsten B Neilands
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Erica L Hamilton
- HIV Prevention Trials Network Leadership and Operations Center, Science Facilitation Department, FHI 360, Durham, North Carolina
| | - Amanda Selin
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Carolina Population Center, University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Catherine MacPhail
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
- Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
- School of Health and Society, University of Wollongong, Wollongong, New South Wales, Australia
| | - Ryan G Wagner
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - F Xavier Gomez-Olive
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Rhian Twine
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - James P Hughes
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington
| | - Yaw Agyei
- Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Oliver Laeyendecker
- Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
- Division of Infectious Diseases, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Department of Epidemiology, School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Stephen Tollman
- Medical Research Council/Wits University Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences,
University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Ahern
- Division of Epidemiology & Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California
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Visser M, Hlungwani AJ. Maternal HIV status disclosure to young uninfected children: psychological variables of the mother. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:48-56. [PMID: 32153231 DOI: 10.2989/16085906.2019.1681481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Mothers living with HIV are faced with the dilemma of when and how to disclose their HIV-positive status to their young uninfected children. In this study, a South African sample of mothers living with HIV, with young uninfected children (6-10 years) in the city of Tshwane was studied. In the sample of 406 mothers, 11.6% reported that they disclosed their HIV status to their young uninfected children. The research compared 47 mothers who disclosed (29 full disclosure and 18 partial disclosure) and a random sample of 50 mothers who did not disclose to their children, in terms of depression symptoms, parenting stress and coping strategies. The results showed that single and widowed mothers disclosed significantly more to their uninfected young children than mothers who had partners or were married. Mothers in the three disclosure groups did not differ in their experience of depression symptoms, parental distress and coping styles. Mothers who disclosed partially reported less parent-child dysfunctional interaction. Time since disclosure did not influence level of disclosure and was not significantly related to psychological outcome of mothers. Mothers who disclosed reported significantly more emotional and instrumental support as coping strategies than mothers who did not disclose. Mothers thus mostly disclose their status to their children to gain support and family closeness. Mothers who disclosed and had not disclosed did not differ in terms of psychological variables. Some mothers perceived partial disclosure as age-appropriate for young children. It is recommended that HIV-positive mothers receive psychosocial support services to equip them to disclose their health status in an age-appropriate way to their children, as it is documented that maternal disclosure benefits both mother and child.
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Affiliation(s)
- Maretha Visser
- Department of Psychology, University of Pretoria, South Africa
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Toska E, Campeau L, Cluver L, Orkin FM, Berezin MN, Sherr L, Laurenzi CA, Bachman G. Consistent Provisions Mitigate Exposure to Sexual Risk and HIV Among Young Adolescents in South Africa. AIDS Behav 2020; 24:903-913. [PMID: 31748938 PMCID: PMC7018679 DOI: 10.1007/s10461-019-02735-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Exposure to sexual risk in early adolescence strongly predicts HIV infection, yet evidence for prevention in young adolescents is limited. We pooled data from two longitudinal South African surveys, with adolescents unexposed to sexual risk at baseline (n = 3662). Multivariable logistic regression tested associations between intermittent/consistent access to eight provisions and reduced sexual risk exposure. Participants were on average 12.8 years, 56% female at baseline. Between baseline and follow-up, 8.6% reported sexual risk exposure. Consistent access to caregiver supervision (OR 0.53 95%CI 0.35-0.80 p = 0.002), abuse-free homes (OR 0.55 95%CI 0.37-0.81 p = 0.002), school feeding (OR 0.55 95%CI 0.35-0.88 p = 0.012), and HIV prevention knowledge (OR 0.43, 95%CI 0.21-0.88 p = 0.021) was strongly associated with preventing early sexual risk exposure. While individual factors reduced the odds of sexual risk exposure, a combination of all four resulted in a greater reduction, from 12.9% (95%CI 7.2-18.7) to 1.0% (95%CI 0.2-1.8). Consistent access to provisions in early adolescence may prevent sexual risk exposure among younger adolescents.
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Affiliation(s)
- Elona Toska
- AIDS and Society Research Unit, University of Cape Town, Cape Town, South Africa.
- Department of Sociology, University of Cape Town, Cape Town, South Africa.
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
- University of Cape Town, 4.89 Leslie Social Science Building, 12 University Avenue South, Rondebosch, 7700, Cape Town, South Africa.
| | - Laurence Campeau
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Child and Adolescent Psychiatry, Cape Town, South Africa
| | - F Mark Orkin
- SAMRC Developmental Pathways for Health Research Unit, School of Clinical Medicine, University of Witwatersrand, Johannesburg, South Africa
| | - McKenzie N Berezin
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
- Department of Applied Psychology, New York University, New York, NY, USA
| | - Lorraine Sherr
- Institute of Global Health, University College London, London, UK
| | - Christina A Laurenzi
- Institute for Life Course Health Research, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Gretchen Bachman
- Office of HIV/AIDS, United States Agency for International Development, Arlington, VA, USA
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Desmond C, Labuschagne P, Cluver L, Tomlinson M, Richter L, Hunt X, Marlow M, Welte A. Modelling the impact of maternal HIV on uninfected children: correcting current estimates. AIDS Care 2020; 32:1406-1414. [PMID: 32048517 DOI: 10.1080/09540121.2020.1720587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
A mathematical model, populated primarily with data from South Africa, was developed to model the numbers of children affected by maternal HIV, and the number who will experience long-term negative developmental consequences. A micro-simulation model generated two scenarios. The first simulated a cohort of women whose HIV status mimicked that of a target population, and mother-child dyads by way of age- and disease-specific fertility rates. Factors defining risk were used to characterize the simulated environment. The second scenario simulated mother-child dyads without maternal HIV. In the first scenario an estimated 26% of children are orphaned, compared to 10% in the absence of HIV. And a further 19% of children whose mother is alive when they turn 18 are affected by maternal HIV. School drop-out among all children increased by 4 percentage points because of maternal HIV, similarly population level estimates of abuse and negative mental health outcomes are elevated. Relative to HIV unaffected children, HIV affected have elevated risk of poor outcomes, however not all will suffer long-term negative consequences. Interventions to protect children should target the proportion of children at risk, while interventions to mitigate harm should target the smaller proportion of children who experience long-term negative outcomes..
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Affiliation(s)
- Chris Desmond
- Centre for Rural Health, University of KwaZulu Natal, Durban, South Africa
| | - Phillip Labuschagne
- The South African DST- NRF Centre of Excellence in Epidemiological Modelling and Analysis (SACEMA), Stellenbosch University, Stellenbosch, South Africa.,South African Medical Research Council Bioinformatics Unit, South African National Bioinformatics Institute, University of the Western Cape, Cape Town, South Africa.,Fred Hutchinson Cancer Research Centre, Vaccine and Infectious Disease Division, Seattle, WA, UAS
| | - Lucie Cluver
- Centre for Evidence-Based Social Intervention in the Department of Social Policy and Intervention, Oxford University, Oxford, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.,School of Nursing and Midwifery, Queens University, Belfast, UK
| | - Linda Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Xanthe Hunt
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Marguerite Marlow
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Alex Welte
- South African Centre for Epidemiological Modelling and Analysis (SACEMA), Stellenbosch, South Africa
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Small LA, Parchment TM, Bahar OS, Osuji HL, Chomanczuk AH, Bhana A. South African adult caregivers as "protective shields": Serving as a buffer between stressful neighborhood conditions and youth risk behaviors. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1850-1864. [PMID: 31441506 PMCID: PMC7082847 DOI: 10.1002/jcop.22235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 07/15/2019] [Accepted: 07/21/2019] [Indexed: 06/10/2023]
Abstract
Low-income youths in KwaZulu-Natal, South Africa, face elevated risks to their well-being from exposure to neighborhood conditions correlated with engaging in risky behaviors. These risks can be mitigated through adult caregivers who serve as protective shields, buffering adverse conditions. However, this protective role is dependent on the caregivers' mental health and well-being. This secondary analysis uses baseline data from 475 child-caregiver dyads in an HIV-prevention program to examine the mediating effects of caregiver mental health on the relationship between neighborhood conditions and child risk-behaviors. Multivariate analyses identify the direct and indirect effects of neighborhood stressors and caregiver mental health on child risk-behavior. Findings suggest that caregivers mitigate the impact of neighborhood conditions on their children, but caregivers' mental health is directly affected by neighborhood conditions. Therefore, caregivers' mental health and well-being must be considered key elements in developing youth risk-behavior interventions.
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Affiliation(s)
- Latoya A. Small
- Department of Social Welfare—Luskin, School of Public Affairs University of California, Los Angeles
| | | | - Ozge Sensoy Bahar
- Brown School– Washington University in St. Louis., St. Louis, Missouri
| | - Hadiza L. Osuji
- McSilver Institute for Poverty Policy and Research New York University Silver School of Social Work, New York, New York
| | | | - Arvin Bhana
- University of KwaZulu-Natal Centre for Rural Health
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Kikuchi K, Furukawa Y, Tout S, Pal K, Huot C, Yi S. "Who cares" is key: factors associated with oral health status in children living with HIV in Phnom Penh, Cambodia. AIDS Care 2019; 32:462-470. [PMID: 31159563 DOI: 10.1080/09540121.2019.1622634] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This cross-sectional study aimed to identify social, clinical, and behavioral factors associated with the oral health status of children living with HIV in Phnom Penh, focusing particularly on the effect of primary caregiver type. Data were collected through separate interviews with children and caregivers. The decayed, missing, filled permanent teeth (DMFT) index and debris index scores were assessed for each child. Associations between oral health status and caregiver type as well as with other factors were examined using multiple linear regression. Of 142 total dyads (mean child and caregiver age, 12.3 (SD 1.8) and 44.8 (SD 10.6) years, respectively) 48.6% and 29.6% of caregivers were biological parents and institutional staff, respectively. Children with institutional staff as a primary caregiver had a lower DMFT score (2.81 vs. 5.50), higher rate of ever visiting a dentist (90.5% vs. 50.7%), and better oral health status than those cared for by biological parents. Higher DMFT score was negatively associated with institutional staff as primary caregiver (β: -1.642, 95% CI: -2.925, -0.360) and positively associated with longer antiretroviral therapy period (β: 0.223, 95% CI: 0.056, 0.390). Targeted oral health care programs are needed for children living with HIV whose biological parents are their primary caregivers.
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Affiliation(s)
- Kimiyo Kikuchi
- Institute of Decision Science for a Sustainable Society, Kyushu University, Fukuoka, Japan
| | - Yusuke Furukawa
- Section of Orthodontics, Kyushu University Hospital, Fukuoka, Japan
| | - Sovannary Tout
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Khuondyla Pal
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | | | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.,Center for Global Health Research, Touro University California, Vallejo, CA, USA.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Kuo C, LoVette A, Stein DJ, Cluver LD, Brown LK, Atujuna M, Gladstone TRG, Martin J, Beardslee W. Building resilient families: Developing family interventions for preventing adolescent depression and HIV in low resource settings. Transcult Psychiatry 2019; 56:187-212. [PMID: 30289374 PMCID: PMC6391217 DOI: 10.1177/1363461518799510] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to reduce onset of depression. Involving families in promoting adolescent mental health is developmentally appropriate, but few existing interventions take a family approach to prevention of adolescent depression. We conducted a qualitative investigation from 2013-2015 to inform the development of a family intervention to prevent adolescent depression in South Africa among families infected or at risk for HIV. Using focus groups with adolescents and parents (eight groups, n = 57), and interviews (n = 25) with clinicians, researchers, and others providing mental health and related services, we identified context-specific factors related to risk for family depression, and explored family interactions around mental health more broadly as well as depression specifically. Findings indicate that HIV and poverty are important risk factors for depression. Future interventions must address linguistic complexities in describing and discussing depression, and engage with the social interpretations and meanings placed upon depression in the South African context, including bewitchment and deviations from prescribed social roles. Participants identified family meetings as a context-appropriate prevention strategy. Family meetings offer opportunities to practice family problem solving, involve other family members in communal parenting during periods of parental depression, and serve as forums for building Xhosa-specific interpretations of resilience. This study will guide the development of Our Family Our Future, a resilience-focused family intervention to prevent adolescent depression (ClinicalTrials.gov #NCT02432352).
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Affiliation(s)
| | | | | | | | | | | | - Tracy R G Gladstone
- Wellesley College, Boston Children's Hospital and Judge Baker Children's Center
| | | | - William Beardslee
- Judge Baker Children's Center, Harvard University and Boston Children's Hospital
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A systematic review of tools used to screen and assess for externalising behaviour symptoms in low and middle income settings. Glob Ment Health (Camb) 2019; 6:e13. [PMID: 31391945 PMCID: PMC6669966 DOI: 10.1017/gmh.2019.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 05/05/2019] [Accepted: 06/01/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Mental health issues, often manifested as behavioural difficulties, in children are estimated to be high in low and middle-income countries (LMIC) settings. There is a paucity of definitive data due to a lack of well-validated tools to use across settings. This review aims to provide evidence on what tools are used and which have been adapted and validated in LMIC settings. METHODS We performed a systematic review to identify tools used to assess or screen externalising behaviour problems in children and adolescents in LMIC and assess their cultural adaptations. We searched for studies measuring externalising behaviour in children from 0 to 19 years published up to September 2018. Articles were assessed to identify tools used and analysed using the Ecological Validity Framework. RESULTS We identified 82 articles from over 50 LMICs who had studied externalising behaviour in children. Twenty-seven tools were identified, with a predominance of studies using tools from the USA and Europe. Most studies did not describe an adaptation and evaluation process, with only one study following recommended criteria. New tools were identified which both screen and assess externalising behaviour which have not yet been utilised across settings. CONCLUSIONS Although tools from the USA and Europe are often utilised to screen and assess for externalising behaviour problems in children in LMICs, the conceptual frameworks behind the use of these tools in other cultural contexts are not always carefully examined. In order to have valid data across cultures, we should aim to adapt and validate tools before use. Provision of processes to validate tools across LMIC settings would be beneficial.
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Merikukka M, Räsänen S, Hakko H, Ristikari T, Gissler M, Niemelä M. Parental hospital-treated somatic illnesses during offspring's childhood associated with later offspring use of psychotropic medication during childhood to young adult - The 1987 Finnish Birth Cohort study. Prev Med 2018; 111:254-264. [PMID: 29486217 DOI: 10.1016/j.ypmed.2018.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 02/13/2018] [Accepted: 02/18/2018] [Indexed: 11/18/2022]
Abstract
This study aimed to systematically examine whether parental hospital-treated somatic illnesses, diagnosed during an offspring's childhood (1987-1995), are associated with later use of psychotropic medication (1996-2012) by the offspring. If so, which parental somatic illnesses, in particular, increase the likelihood for later use of psychotropic medication among the offspring. The 1987 Finnish Birth Cohort study yields longitudinal nationwide follow-up data that include a complete census of children born in a single year. A total 58,551 offspring are included in this study and, of these 57,752 had a known father. Offspring who had used psychotropic medication between the ages of 9 and 24 years, more often had parents who had experienced a greater number of somatic illnesses when their child was aged under 9, compared to offspring without any use of psychotropic medication. The specific parental somatic illnesses early in life, for example disorders of female tract (OR 1.12, 95%CI 1.01-1.23), pregnancy with abortive outcome (1.18, 1.09-1.28), paternal acute infections (1.20, 1.05-1.38), and paternal symptoms, signs, and ill-defined conditions (1.21, 1.03-1.42), were found to be associated with psychotropic medication treatment using parental-related determinants; death, education, receipt of social assistance and psychiatric inpatient care as covariates. This suggests that these specific parental somatic illnesses can affect psychological well-being of the offspring. Preventive actions and support for the child, should be provided in situations where a parent with a somatic illness has limited ability to care for and rear their child.
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Affiliation(s)
- Marko Merikukka
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland; PEDEGO Research Unit, University of Oulu, Oulu, Finland.
| | - Sami Räsänen
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Helinä Hakko
- Department of Psychiatry, Oulu University Hospital, Oulu, Finland
| | - Tiina Ristikari
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland; Research Center for Child Psychiatry, University of Turku, Turku, Finland; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Mika Niemelä
- Department of Welfare, National Institute for Health and Welfare, Oulu, Finland; Department of Psychiatry, Oulu University Hospital, Oulu, Finland; Center for Life Course Health Research, University of Oulu, Oulu, Finland
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Herrero Romero R, Hall J, Cluver L, Meinck F. Can supportive parenting protect against school delay amongst violence-exposed adolescents in South Africa? CHILD ABUSE & NEGLECT 2018; 78:31-45. [PMID: 28964563 DOI: 10.1016/j.chiabu.2017.09.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/30/2017] [Accepted: 09/18/2017] [Indexed: 06/07/2023]
Abstract
Exposure to multiple forms of violence is common amongst adolescents from socioeconomically disadvantaged communities in South Africa. Adolescents' exposure to violence at home, in school and in their communities can lead to detrimental outcomes in education. In particular, adolescents who are more frequently exposed to multiple forms of violence are at risk of school delay. This paper investigates the potential for supportive parenting to protect against adolescents' school delay in this context. With this aim, this paper applies structural equation modelling to a sample of 503 adolescents exposed to multiple forms of violence from 40 socioeconomically disadvantaged communities. Adolescents' self-report data on child abuse in the family, school and community, and adolescents' perceptions of positive parenting, consistent discipline, good monitoring, parental involvement and social support were analyzed. Results showed that perceptions of more positive parenting and consistent discipline moderated the relationship between more frequent exposure to multiple forms of violence and school delay. Our findings suggest that supportive parenting has the potential to protect against school delay for poly-victimized adolescents in South Africa.
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Affiliation(s)
- Rocio Herrero Romero
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom.
| | - James Hall
- Southampton Education School University of Southampton, University Road, Southampton SO17 1BJ, United Kingdom.
| | - Lucie Cluver
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom; Department of Psychiatry and Mental Health, University of Cape Town J-Block, Groote Schuur Hospital Observatory, Cape Town, South Africa.
| | - Franziska Meinck
- Department of Social Policy and Intervention, University of Oxford, Barnett House, 32 Wellington Square, OX1 2ER, Oxford, United Kingdom; OPTENTIA, School of Behavioural Sciences, North-West University, Vanderbijlpark, 1900 Gauteng, South Africa.
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Meinck F, Fry D, Ginindza C, Wazny K, Elizalde A, Spreckelsen TF, Maternowska MC, Dunne MP. Emotional abuse of girls in Swaziland: prevalence, perpetrators, risk and protective factors and health outcomes. J Glob Health 2018; 7:010410. [PMID: 28607670 PMCID: PMC5460395 DOI: 10.7189/jogh.07.010410] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background Research on emotional child abuse in sub–Saharan Africa is scarce. Few studies thus far have examined prevalence, risk and protective factors for emotional child abuse or the associations between emotional abuse and girls’ health. Methods A nationally representative two–stage, cluster–sampled, household survey of females aged 13–24 years (n = 1244) on childhood abuse victimisation was conducted. Participants completed interviewer–assisted questionnaires. Associations between emotional abuse and putative risk, and protective factors and health outcomes were analyzed using separate logistic regression models accounting for sampling design. Marginal effects of cumulative risk factors for emotional abuse victimisation were examined. Results Lifetime prevalence of emotional abuse was 28.5% with 58.3% of these girls reporting many abusive incidents. The most common perpetrators were female (27.8%) and male (16.7%) relatives and, more rarely, biological parents. Risk factors associated with emotional abuse were frequent caregiver changes (odds ratio (OR) 1.42, 95% confidence interval (CI) 1.03–1.970, poverty (OR 1.51, 95% CI 1.12–2.03), and physical abuse (OR 1.98, 95% CI 1.45–2.71) and sexual abuse (OR 2.22, 95% CI 1.57–3.10) victimisation. Being close to one’s mother was a protective factor (OR 0.88, 95% CI 0.80–0.97). Risk for emotional abuse increased from 13% with no risk factors present to 58.4% –with all four risk factors present. Health outcomes associated with emotional child abuse were suicidal ideation (OR 1.85, 95% CI 1.30–2.63) and feeling depressed (OR 1.89, 95% CI 1.31–2.71). Conclusions Girls in Swaziland experience high levels of emotional abuse victimisation. Emotional abuse is associated with economic disadvantage, family factors, other types of abuse victimisation and poor mental health. Therefore, a holistic approach to prevention is needed, incorporating poverty reduction and programmes to improve parent–child relationships, reduce the use of harsh criticism, and change parenting social norms.
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Affiliation(s)
- Franziska Meinck
- University of Oxford, Oxford, England, UK.,OPTENTIA, School of Behavioural Sciences, North-West University, Vanderbijlpark, South Africa
| | - Deborah Fry
- Moray House School of Education, University of Edinburgh, Edinburgh, Scotland, UK
| | | | - Kerri Wazny
- Moray House School of Education, University of Edinburgh, Edinburgh, Scotland, UK
| | - Aldo Elizalde
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK
| | | | | | - Michael P Dunne
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
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Hoosen N, Davids EL, de Vries PJ, Shung-King M. The Strengths and Difficulties Questionnaire (SDQ) in Africa: a scoping review of its application and validation. Child Adolesc Psychiatry Ment Health 2018; 12:6. [PMID: 29344084 PMCID: PMC5765647 DOI: 10.1186/s13034-017-0212-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/23/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Child and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa. METHODS A comprehensive scoping review methodology was used to identify all peer-reviewed studies ever published that have used the SDQ in Africa. Data were extracted and analysed to assess the countries, languages and SDQ versions used, the purpose of the SDQ studies, psychometric properties of the SDQ, and to consider knowledge gaps for future in-country and cross-country studies. RESULTS Fifty-four studies from 12 African countries were identified, most from South Africa. Many different languages were used, but authorized SDQs in those languages were not always available on the SDQinfo website. Authors frequently commented on challenges in the translation and backtranslation of mental health terminology in African languages. The SDQ was typically used to investigate internalisation/externalization disorders in different clinical populations, and was most frequently used in the evaluation of children and adolescents affected by HIV/AIDS. Sixteen studies (29.6%) administered the SDQ to participants outside the intended age range, only 4 (7.4%) used triangulation of all versions to generate assessments, and eight studies (14.8%) used only subscales of the SDQ. Only one study conducted thorough psychometric validation of the SDQ, including examination of internal consistency and factor analysis. Where 'caseness' was defined in studies, UK cut-off scores were used in all but one of the studies. CONCLUSIONS The SDQ may be a very useful tool in an African setting, but the scoping review suggested that, where it was used in Africa researchers did not always follow instrument guidelines, and highlighted that very little is known about the psychometric properties of the SDQ in Africa. We recommend comprehensive evaluation of the psychometric properties of the SDQ in various African languages, including internal consistency, factor structure, need for local cut-off values and ensuring cultural equivalence of the instrument.
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Affiliation(s)
- Nikhat Hoosen
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
| | - Eugene Lee Davids
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Petrus J. de Vries
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
| | - Maylene Shung-King
- Adolescent Health Research Unit, Division of Child & Adolescent Psychiatry, University of Cape Town, 46 Sawkins Road, Rondebosch, Cape Town, 7700 South Africa
- Health Policy and Systems Division, University of Cape Town, Cape Town, South Africa
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Mkwanazi NB, Rochat TJ, Bland RM. The Amagugu intervention: a qualitative investigation into maternal experiences and perspectives of a maternal HIV disclosure support intervention in rural South Africa. Health Policy Plan 2017; 32:1231-1240. [PMID: 28981662 PMCID: PMC5886258 DOI: 10.1093/heapol/czx056] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2017] [Indexed: 11/14/2022] Open
Abstract
The World Health Organization recommends disclosure of parental HIV to children aged 6-12 years. The maternal HIV-disclosure intervention (Amagugu), a lay counsellor-led, home-based intervention with six sessions, was implemented. The intervention included provision of disclosure tools, training and support for mothers, a family session and health promotion clinic visit for mothers and children. Amagugu demonstrated success as a maternal disclosure support programme but less is known about the experiences of participants. A sub-sample of HIV-infected mothers (n = 20) with primary school-aged HIV-uninfected children, from Amagugu, was purposely selected. Using semi-structured interviews and interview-guide, we explored maternal perceptions of disclosure prior to participation and experiences of participating in Amagugu. Audio-recorded interviews conducted in participants' homes, in isiZulu, were transcribed, and content analysis was undertaken. The most common reasons for prior non-disclosure were concerns about children's developmental capacity to understand HIV, fear of HIV-related stigma towards mothers and their families, and lack of skills to undertake disclosure. Intervention materials, rapport with counsellors, and flexibility of the proposed disclosure process motivated mothers to participate. While expressing satisfaction with the intervention, some mothers remained concerned about their children's understanding of HIV and ability to maintain confidentiality. Mothers also requested support in discussing sex-related topics with their children. Despite prior high rates of disclosure to other adults, mothers had little awareness about the importance of disclosure to children and lacked skills to undertake this. The intervention approach, rapport with counsellors, and practicality of the materials, helped overcome child disclosure barriers. Mothers reported their children as very supportive following disclosure and stated they would advise other women to disclose to children for practical support around HIV treatment adherence. This qualitative evaluation suggests that mothers with primary school-aged children may require structured support when disclosing to children, which could be achieved through supportive home-based counselling and user-friendly materials.
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Affiliation(s)
- Ntombizodumo B. Mkwanazi
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
| | - Tamsen J. Rochat
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa
- Human and Social Development Research Programme, Human Sciences Research Council, Durban, South Africa
- MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, Oxford University, Oxford, UK
| | - Ruth M. Bland
- Africa Health Research Institute, University of KwaZulu-Natal, South Africa
- School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
- Institute of Health and Wellbeing and Royal Hospital for Sick Children, University of Glasgow, Glasgow, UK
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Boydell N, Nalukenge W, Siu G, Seeley J, Wight D. How mothers in poverty explain their use of corporal punishment: A qualitative study in Kampala, Uganda. THE EUROPEAN JOURNAL OF DEVELOPMENT RESEARCH 2017; 29:999-1016. [PMID: 29213191 PMCID: PMC5714261 DOI: 10.1057/s41287-017-0104-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Corporal punishment in the early years is associated with anti-social behaviour and violence, but little is known about its social and cultural context in low income countries. This paper analyses how 12 deprived women in Kampala, Uganda, perceived corporal punishment, drawing on repeated semi-structured interviews. All thought it was sometimes necessary, for three main reasons. First, it was an important strategy to ensure good behaviour and maintain their and their child's, respectability, crucial to self-respect given severe poverty. Second, it was a means of establishing household routines and managing scarce resources. Third, it was a way to protect children from health risks. However, all mothers thought corporal punishment could be excessive, and most said it can be counter-productive, making children 'stubborn'. There appeared to be considerable variation in their degree of harsh parenting and emotional support. These findings could inform culturally appropriate interventions to reduce violence against children.
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Affiliation(s)
- Nicola Boydell
- Centre for Research on Families and Relationships, University of Edinburgh, Edinburgh, UK
| | | | - Godfrey Siu
- MRC/UVRI Uganda Research Unit On AIDS, Entebbe, Wakiso, Uganda
| | - Janet Seeley
- MRC/UVRI Uganda Research Unit On AIDS, Entebbe, Wakiso, Uganda
| | - Daniel Wight
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Goldberg RE, Short SE. What do we know about children living with HIV-infected or AIDS-ill adults in Sub-Saharan Africa? A systematic review of the literature. AIDS Care 2017; 28 Suppl 2:130-41. [PMID: 27392008 PMCID: PMC4991228 DOI: 10.1080/09540121.2016.1176684] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Millions of children in Sub-Saharan Africa live with adults, often parents, who are HIV-infected or ill due to AIDS. These children experience social, emotional, and health vulnerabilities that overlap with, but are not necessarily the same as, those of orphans or other vulnerable children. Despite their distinctive vulnerabilities, research aimed at understanding the situation of these children has been limited until very recently. This review summarizes the state of knowledge based on a systematic search of PubMed and Web of Science that identified 47 empirical research articles that examined either the population prevalence of children living with HIV-infected or AIDS-sick adults, or the consequences of adult HIV infection or AIDS illness for child well-being. This review confirms that this population of children is substantial in size, and that the vulnerabilities they experience are multi-faceted, spanning physical and emotional health and schooling. Mechanisms were examined empirically in only a small number of studies, but encompass poverty, transmission of opportunistic infections, care for unwell adults, adult distress, AIDS stigma, lack of social support, maternal breastfeeding issues, and vertical HIV transmission. Some evidence is provided that infants, adolescents, children with infected or ill mothers, and children living with severely ill adults are particularly vulnerable. Future research would benefit from more attention to causal inference and further characterization of processes and circumstances related to vulnerability and resilience. It would also benefit from further study of variation in observed associations between adult HIV/AIDS and child well-being based on characteristics such as age, sex, kinship, severity of illness, TB co-infection, disclosure, and serostatus awareness. Almost one-quarter of the studies reviewed did not investigate variation based on any of these factors. More nuanced understanding of the short- and long-term effects of adult HIV on children's needs and circumstances will be important to ongoing discussions about equity in policies and interventions.
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Affiliation(s)
- Rachel E Goldberg
- a Department of Sociology , University of California Irvine , Irvine , CA , USA
| | - Susan E Short
- b Department of Sociology and Population Studies and Training Center , Brown University , Providence , RI , USA
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Lentoor AG. Psychosocial Challenges Associated with Caregiving in the Context of Pediatric HIV in Rural Eastern Cape. Front Public Health 2017; 5:127. [PMID: 28660181 PMCID: PMC5466947 DOI: 10.3389/fpubh.2017.00127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 05/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background While survival among human immunodeficiency virus (HIV)-infected children has increased due to combination antiretroviral therapy, many children remain vulnerable to the adverse effects of poverty and family disruptions as a result of the loss of one or both biological parents to acquired immunodeficiency syndrome. The aim of this qualitative study was to develop an understanding of the psychosocial challenges experienced by caregivers caring for a child with perinatally acquired HIV. Method A series of interviews were conducted with 44 HIV-positive and -negative primary caregivers of HIV+ children. Data were analyzed through interpretative phenomenological analysis using NVivo8 software. Findings The findings suggest that caregiving is compromised by inadequate, financial resources and single-headed households where mainly grandparents assume the role of primary caregivers of HIV+ children. HIV remains a stigmatized illness that weakens support networks, as well as timeous and free accessibility to healthcare. This has a negative impact on the mental health of caregivers, with the majority of women in the study displaying symptoms of depression. Conclusion The findings highlight the contextual challenges of caregiving in the presence of HIV, which impacts negatively on social ecology of the families. The need for interventions to enhance resilience and coping in families confronted with HIV is indicated.
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Affiliation(s)
- Antonio G Lentoor
- Department of Psychiatry and Mental Health, Valkenberg Hospital, University of Cape Town, Cape Town, South Africa
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46
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Kliewer W, Pillay BJ, Borre A, Zaharakis N, Drazdowski T, Jäggi L. Community violence exposure, family management practices, and substance use in youth: a cross-cultural study. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2017; 47:246-259. [PMID: 33597789 DOI: 10.1177/0081246316667918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Associations between community violence exposure, family management practices, and substance use were compared in a sample of early adolescents in low-income communities from the United States (N = 151; M age = 12.71 years, standard deviation = 0.65; 50.3% female) and South Africa (N = 175; M age = 12.55 years, standard deviation = 0.85; 64.6% female) using home interviews with youth and their maternal caregivers. Past year victimization was associated with recent youth substance use. The moderating role of family management practices varied by type of practice (e.g., parental knowledge, control, solicitation, or child disclosure), reporter, and country. High parental knowledge reported by caregiver was protective against substance use only for South African youth. In youth reports, parental knowledge was protective across the United States and South Africa. Youth reports of their disclosure to parents were negatively associated with substance use in the United States but not South Africa. These data highlight the importance of considering both ecological context and reporter in the links between violence exposure, parenting, and substance use in youth.
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Affiliation(s)
- Wendy Kliewer
- Department of Psychology, Virginia Commonwealth University, USA.,Honorary Professor, University of KwaZulu-Natal, South Africa
| | - Basil J Pillay
- Department of Behavioural Medicine, College of Health Sciences, University of KwaZulu-Natal, South Africa
| | - Alicia Borre
- Department of Psychology, Virginia Commonwealth University, USA
| | | | - Tess Drazdowski
- Department of Psychology, Virginia Commonwealth University, USA
| | - Lena Jäggi
- Department of Psychology, Virginia Commonwealth University, USA
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47
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Mon MM, Liabsuetrakul T, Htut KM. Effectiveness of Mindfulness Intervention on Psychological Behaviors Among Adolescents With Parental HIV Infection: A Group-Randomized Controlled Trial. Asia Pac J Public Health 2017; 28:765-775. [PMID: 27920241 DOI: 10.1177/1010539516675698] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to identify the effectiveness of mindfulness intervention on the psychological behaviors of adolescents with parental HIV infection and its associated factors in Myanmar. A total of 80 adolescents from 2 intervention townships and 80 adolescents from 2 control townships were enrolled in a group randomized controlled trial with assessments at baseline and 6 months follow-up. The mindfulness intervention involved monthly group sessions for 3 consecutive months led by an experienced mindfulness trainer. Three domains of psychological behaviors-namely, emotional, conduct, and social behaviors-were assessed at baseline and compared after 6 months. Multilevel regression analysis was used to determine the effectiveness of the intervention and associated factors for psychological behaviors. The intervention significantly improved emotional and conduct behaviors at 6 months (P < .001) but had no effect on social behavior. The significant effect of the intervention existed after adjusting for gender, family type, child age, and orphan status.
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Affiliation(s)
- Myo-Myo Mon
- Department of Medical Research, Yangon, Myanmar .,Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Tippawan Liabsuetrakul
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
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48
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Rochat T, Netsi E, Redinger S, Stein A. Parenting and HIV. Curr Opin Psychol 2017; 15:155-161. [PMID: 28813256 DOI: 10.1016/j.copsyc.2017.02.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 02/15/2017] [Indexed: 10/20/2022]
Abstract
With the widespread use of antiretroviral therapy and successful prevention of mother-to-child transmission the development of HIV-negative children with HIV-positive parents has become an important focus. There is considerable evidence that children's developmental risk is heightened because a parental HIV-diagnosis is associated with a range of potential problems such as depression, stigma and financial difficulties. Up to a third of children in sub-Saharan Africa (SSA) are cared for by an HIV-positive parent or caregiver. We review the mechanisms by which HIV affects parenting including its negative effects on parental responsiveness in the early years of parenting and parental avoidant coping styles and parenting deficits in the later years. We describe low-cost parenting interventions suited for low resourced HIV endemic settings.
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Affiliation(s)
- Tamsen Rochat
- Human and Social Development, Human Sciences Research Council, Durban, South Africa; MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, South Africa; Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Elena Netsi
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK
| | - Stephanie Redinger
- Human and Social Development, Human Sciences Research Council, Durban, South Africa; DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
| | - Alan Stein
- Section of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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49
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Gamarel KE, Kuo C, Boyes ME, Cluver LD. The dyadic effects of HIV stigma on the mental health of children and their parents in South Africa. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2017; 16:351-366. [PMID: 29238272 PMCID: PMC5724576 DOI: 10.1080/15381501.2017.1320619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
HIV stigma - both 'self-stigma' towards positive individuals and 'stigma by association' towards their families - is linked with adverse mental health. This study examined how stigma was associated with the mental health of parents and children in South Africa. Parent-child dyads (n=2477 dyads) in South Africa participated in a cross-sectional survey. For both parents and children, greater stigma was associated with their own reports of greater anxious and depressive symptoms. Parents reports of stigma was associated with children's greater anxious and depressive symptoms. Children's reports of stigma was related to parents greater anxious and depressive symptoms. There was a significant interaction, such that the association between parent stigma and depression was stronger when children also reported high levels of stigma. Findings provide support the effect of HIV stigma on the mental health of families and illustrate the importance of taking a family-based approach to stigma-reduction interventions to alleviate mental health problems.
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Affiliation(s)
- Kristi E. Gamarel
- Department of Behavioral and Social Sciences, Brown University School of Public, 121 South Main Street, Providence, RI 02130
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI 02130
| | - Caroline Kuo
- Department of Behavioral and Social Sciences, Brown University School of Public, 121 South Main Street, Providence, RI 02130
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, 121 South Main Street, Providence, RI 02130
- Department of Psychiatry and Mental Health, University of Cape Town, J-Block, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Mark E. Boyes
- Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, United Kingdom
- Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom
| | - Lucie D. Cluver
- Department of Social Policy and Intervention, Barnett House, 32 Wellington Square, Oxford, OX1 2ER, United Kingdom
- School of Psychology and Speech Pathology, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, Perth, Western Australia
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50
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Li L, Liang LJ, Ji G, Lin C, Xiao Y. Perceived Bonding by Parents Living with HIV and Their Adolescent Children. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2016; 26:880-888. [PMID: 27980371 PMCID: PMC5152945 DOI: 10.1111/jora.12236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
This study examined the associations between parent and adolescent reports of bonding within families and the relationships among reported parental bonding, family conflict and adolescent stress. A total of 118 families from Anhui, China, were recruited for this study. Two family-level bonding scores were constructed: the average of and difference between parent and adolescent bonding scores. Study results indicated that the difference between parent and adolescent bonding reports was associated with higher levels of adolescent daily stress. A negative association was observed between average family-level bonding and the level of parent-reported conflict. Our findings highlight the importance of combining data from both parents and adolescents when studying issues related to family wellbeing.
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Affiliation(s)
- Li Li
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Li-Jung Liang
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Guoping Ji
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, CA, U.S.A
| | - Yongkang Xiao
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
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