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Onono MA, Sheira L, Frongilio EA, Odhiambo G, Wekesa P, Conroy A, Bukusi EA, Cohen CR, Weiser SD. Effect of improving food security on parenting practices and caregiver-adolescent relationships: qualitative findings of an income-generating agricultural intervention in rural Kenya. BJPsych Open 2024; 11:e10. [PMID: 39721953 PMCID: PMC11733493 DOI: 10.1192/bjo.2024.802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2022] [Revised: 09/07/2024] [Accepted: 09/09/2024] [Indexed: 12/28/2024] Open
Abstract
BACKGROUND Despite the recognised links between food insecurity and parenting, few studies have evaluated the perceived impacts of livelihood or food security interventions on parental practices, intra-household functioning, adolescent behaviour and psychosocial outcomes in HIV-affected households in sub-Saharan Africa. AIMS The study aimed to understand the perceived effects of food security on parenting practices and how this was experienced by both adolescent girls (aged 13-19 years) and their caregivers in rural Kenya. METHOD We conducted semi-structured, individual interviews with 62 caregiver-adolescent dyads who were participants in the adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha agricultural and finance intervention trial (NCT01548599). Data were analysed following the principles of thematic analysis. RESULTS Compared to control households, the Shamba Maisha intervention households had improved food security and strengthened economic security, which, in turn, improved parenting practices. Intervention households described changes in parenting experiences, including decreased parental stress, reduced absenteeism and harsh parenting and improved caregiver- adolescent relationships. These positive caregiving practices, in turn, contributed to improved mental health and fewer behavioural problems among adolescent girls. Changes in the control households were less noticeable. CONCLUSION These findings demonstrate how an income-generating agricultural intervention may improve food security and positively affect parenting practices, intra-household dynamics and adolescent psychosocial well-being and behaviour. Further research is needed to explore how to harness the social benefits of agricultural interventions to best address the critical intersections among food insecurity, parenting practices and adolescent mental health.
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Affiliation(s)
- Maricianah A. Onono
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Lila Sheira
- Division of HIV/AIDS and Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, CA, USA
| | - Edward A. Frongilio
- Department of Health Promotion, Education, and Behavior, University of South Carolina, South Carolina, SC, USA
| | - Gladys Odhiambo
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Pauline Wekesa
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Amy Conroy
- Division of Prevention Science, Center for AIDS Prevention Studies, University of California San Francisco, CA, USA
| | - Elizabeth A. Bukusi
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California San Francisco, CA, USA
| | - Sheri D. Weiser
- Department of Medicine, Division of HIV, Infectious Diseases and Global Medicine and Center for AIDS Prevention Studies, University of California San Francisco, CA, USA
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Sevenoaks T, Fouche JP, Mtukushe B, Phillips N, Heany S, Myer L, Zar HJ, Stein DJ, Hoare J. A longitudinal and qualitative analysis of caregiver depression and quality of life in the Cape Town adolescent antiretroviral cohort. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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3
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Bhushan NL, Stockton MA, Harrington BJ, DiPrete BL, Maliwichi M, Jumbe AN, Kulisewa K, Chagomerana MB, Pence BW, Gaynes BN, Hosseinipour MC. Probable perinatal depression and social support among women enrolled in Malawi's Option B+ Program: A longitudinal analysis. J Affect Disord 2022; 306:200-207. [PMID: 35314248 PMCID: PMC9681029 DOI: 10.1016/j.jad.2022.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 11/19/2021] [Accepted: 03/10/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Malawi's PMTCT Option B+ program has expanded the reach of ART services among pregnant and breastfeeding women, but retention in lifelong HIV care remains challenging. Given that depression can undermine retention, it is important to understand how depression changes over the perinatal period, varies across treatment and retention groups, and could be buffered by social support. METHODS Data are from an observational study conducted among women enrolled in Malawi's PMTCT Option B+ program. We used multilevel generalized linear models to estimate the odds of probable depression by time, treatment and retention group, and social support. Probable depression was assessed with the Edinburgh Postnatal Depression Scale and Patient Health Questionnaire-9. RESULTS Of 468 women, 15% reported probable depression at antenatal enrollment and prevalence differed across newly diagnosed individuals, second line therapy users, and previous defaulters (18%, 21%, 5%, p = 0.001). Odds of probable perinatal depression decreased over time (OR per month: 0.87, 95% CI: 0.82-0.92) but were higher among those newly diagnosed (OR: 3.25, 95% CI: 1.59-6.65) and on second line therapy (OR: 3.39, 95% CI: 1.44-7.99) as compared to previous defaulters. Odds of probable postpartum depression were lower for participants with high social support (OR: 0.19, 95% CI: 0.09-0.39). LIMITATIONS Lack of diagnostic psychiatric evaluation precludes actual diagnosis of depression. CONCLUSIONS Probable depression varied across the perinatal period and across treatment and retention groups. Social support was protective for postpartum depression among all participants. Depression screening and provision of social support should be considered in PMTCT programs.
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Affiliation(s)
- Nivedita L. Bhushan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | - Bethany L. DiPrete
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | | | | | | | - Brian W. Pence
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Bradley N. Gaynes
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Mina C. Hosseinipour
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA,UNC Project, Lilongwe, Malawi
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4
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Mahamid FA, Veronese G, Bdier D. Fear of coronavirus (COVID-19) and mental health outcomes in Palestine: The mediating role of social support. CURRENT PSYCHOLOGY 2021; 42:8572-8581. [PMID: 34690471 PMCID: PMC8527283 DOI: 10.1007/s12144-021-02395-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 01/05/2023]
Abstract
The current investigation was conducted to test the correlation between fear due to coronavirus (COVID-19) and mental health outcomes (stress, depression, and anxiety) and the mediating role of social support during the Covid-19 Pandemic in Palestine. Structural equation modeling (SEM) was performed to test the conceptual model, where fear of Covid-19 was considered as a predictor, social support as a mediating variable, and mental health (stress, depression, and anxiety) as outcomes. The participants involved were 370 Palestinians, 266 females, and the remaining were males. Participants were recruited through online methods; Facebook advertising, Network email, and Twitter during the COVID-19 in Palestine. Results of the study showed that fear related to COVID-19 was positively and significantly correlated with mental health outcomes (anxiety; r = .29, p < .01, depression; r = .25, p < .01, and stress; r = .36, p < .01), while negatively correlated to perceived emotional support (r = -.30, p < .01), support seeking (r = -.29, p < .01), and received support (r = -.31, p < .01). Results of SEM indicated a standardized total effect of social support on mental health outcomes (βX, M = -.57; p < .001), and an indirect but statistically significant effect (via social support, βX, M, Y = -. 286; p < .01). These results indicate that social support fully mediated the relationship between fear associated with COVID-19 and mental health distress (stress, depression, and anxiety). The current study supported previous findings demonstrating that fear related to COVID-19 positively correlated with mental health distress (depression, anxiety, and stress). In addition, social support mediated the relationship between fear of COVID19 and mental health outcomes. However, further investigations are needed to test the correlation between current study variables and other associated factors and develop intervention programs targeting affected populations during crises to enhance mental health outcomes.
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Affiliation(s)
- Fayez Azez Mahamid
- Psychology and Counseling Department, An- Najah National University, Nablus, Palestine
| | | | - Dana Bdier
- An-Najah National University, Nablus, Palestine
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5
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Xie T, Yan H, Wang G. Translation and Validation: Chinese Version of the HIV-Related Social Support Scale. Int J Gen Med 2021; 14:4025-4030. [PMID: 34349552 PMCID: PMC8326224 DOI: 10.2147/ijgm.s318766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/16/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Social support is increasingly recognized to be important in care of people living with HIV/AIDS (PLWH), we firstly translate and validate the disease-targeted social support instrument in Chinese and to explore the correlation with WHOQOL-HIV. Patients and Methods We established content validity for HIV-related social support scale (HSSS) and administered the resultant questionnaire to 310 PLWH. Descriptive statistics were generated for each of the variables of general characteristics; student t-test was used to compare the different groups. Results The HSSS demonstrated a high level of internal consistency, both within each subscale and with the total score; all Cronbach’s α values exceeded a priori threshold of ≥0.70. The HSSS cores were positively correlated with WHOQOL-HIV total scores (Pearson correlation: 0.39, P < 0.001). We also found that higher educational level, personal income, CD4 cell count, and shorter duration of antiretroviral therapy are significantly associated with a higher level of social support (P < 0.05). Conclusion Social support may improve quality of life for PLWH, Chinese version of HIV-related social support scale can be used in future clinical practice.
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Affiliation(s)
- Tiansheng Xie
- Zhejiang Sino-German Institute of Life science and Healthcare, School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, Zhejiang, 310023, People's Republic of China.,State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, 310003, People's Republic of China
| | - Haibo Yan
- Center for Disease Prevention and Control, Shaoxing, 312030, People's Republic of China
| | - Guohua Wang
- Center for Disease Prevention and Control, Jiaxing, 314500, People's Republic of China
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6
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Spielman KL, Soler-Hampejsek E, Muula AS, Tenthani L, Hewett PC. Depressive symptoms, HIV-related stigma and ART adherence among caregivers of children in vulnerable households in rural southern Malawi. PLoS One 2021; 16:e0247974. [PMID: 33667258 PMCID: PMC7935323 DOI: 10.1371/journal.pone.0247974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 02/17/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Few studies have explored the association between depressive symptoms, HIV infection and stigma in vulnerable populations. The objective of this study is to examine factors associated with depressive symptoms among caregivers living in vulnerable households in Malawi and assess how reported depressive symptoms and other factors affect ART adherence among caregivers who report testing positive for HIV and currently on ART. METHODS We interviewed 818 adult caregivers of children aged 0-17 years living in vulnerable households in 24 health facility catchment areas in five districts in rural southern Malawi in 2016-2017. Vulnerable households had either economic and food insecurity, or chronic illness. Questions on five depressive symptoms were used. ART adherence was self-report of not forgetting to take ART medication in the last week. Perceived and anticipated measures of stigma were used. Multivariable linear and logistic regressions documented relationships between depressive symptoms, self-reported HIV status, HIV-related stigma, and ART adherence. RESULTS Most caregivers were women (86.2%); about one third had no spouse or live-in partner. Fifty-seven percent of caregivers reported having three or more depressive symptoms. Forty-one percent of caregivers reported testing positive for HIV. Self-reported HIV positive status was associated with depressive symptoms (adjusted coeff = 0.355, p-value <0.001), which were in turn associated with poorer ART adherence among caregivers (aOR 0.639, p-value = 0.023). HIV-related stigma was also associated with depressive symptoms for caregivers who reported having HIV (coeff = 0.302, p-value = 0.028) and those who reported testing negative for HIV (coeff = 0.187, p-value <0.001). Having social support was associated with lower depressive symptoms (coeff = -0.115, p = 0.007). HIV-related stigma, having social support, and other socio-demographic characteristics were not found to be associated with ART adherence. CONCLUSIONS Addressing mental health among caregivers in vulnerable households may be an important step toward achieving viral suppression among vulnerable populations living with HIV in Malawi. Integrating depression screening into HIV care and treatment protocols could be a promising intervention to improve longer-term outcomes.
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Affiliation(s)
| | | | | | | | - Paul C. Hewett
- Population Council, Washington, DC, United State of America
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Sabin LL, Nguyen VC, Harvey K, Bonawitz R, Hai LT, Van Lam N, Yen LT, Gifford AL, Haberer JE, Linh DT, DeSilva MB. Challenges to Antiretroviral Therapy Adherence and Coping Strategies to Overcome Them: Qualitative Investigations of Adolescents Living with HIV, their Caregivers, and Clinicians in Vietnam. Open AIDS J 2020. [DOI: 10.2174/1874613602014010114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Adolescents living with HIV (ALHIV) in Vietnam are known to struggle with adherence to Antiretroviral Therapy (ART).
Objective:
To examine treatment challenges and facilitators experienced by ALHIV from the perspective of adolescents, their caregivers, and providers, and to inform an adherence intervention.
Methods:
In-depth Interviews (IDIs) of adolescent/caregiver dyads and Focus Group Discussions (FGDs) with adolescents, caregivers, and clinicians were conducted in Hanoi, Vietnam. We used semi-structured guides to encourage open-ended responses. We queried the challenges adolescents experience taking ART medications and being adherent, their awareness of disease status, and facilitators to support high adherence. Audio-recorded IDIs were translated into English, and coded and analyzed in NVivo using a thematic approach.
Results:
A total of 78 individuals participated in the study. Forty individuals participated in IDIs (20 adolescents and 20 caregivers). All adolescents had acquired HIV perinatally. We conducted six FGDs: four with adolescents, and one each with caregivers and clinicians. We identified major themes regarding awareness of HIV status (most caregivers reported they had disclosed to their child, while few adolescents revealed the knowledge of their status); perceived barriers to adherence (medication-related challenges, stigma, school-associated issues, financial obstacles, system challenges, awareness of HIV status); and adherence facilitators (development of dose-taking habits, reminder systems, social support). Differences between adolescents and caregivers related to key issues were evident.
Conclusion:
Further research is needed to elucidate discrepancies in adolescent-caregiver viewpoints and develop interventions tailored to both ALHIV and their caregivers.
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8
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Nsibandze BS, Downing C, Poggenpoel M, Myburgh CP. Experiences of grandmothers caring for female adolescents living with HIV in rural Manzini, Eswatini: a caregiver stress model perspective. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2020; 19:123-134. [PMID: 32780678 DOI: 10.2989/16085906.2020.1758735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The HIV pandemic has immense effects on the Eswatini population. The burden of caregiving rests on women, typically grandmothers who are elderly and dealing with chronic diseases themselves. The purpose of this study was to explore and describe the experiences of grandmothers in Eswatini caring for female adolescents living with HIV. The study draws on phenomenological fieldwork of six case studies of grandmother-granddaughter pairs who were purposively sampled. Data were collected through in-depth individual interviews that commenced with broad questions: "How is it for you to care for a female adolescent living with HIV?" for the grandmothers, and "How is it for you to live with HIV?" for female adolescents. Data were transcribed verbatim and analysed thematically following the elements of the caregiver stress theory. Drawing on the caregiver stress model, grandmothers and female adolescents experienced input stimuli of financial difficulties related to daily provisions for food and transport fare. Control processes experienced by grandmothers and female adolescents related to feelings of loss, grief, fear, hopelessness and isolation along with suicidal ideation for female adolescents. Regarding output stimuli, grandmothers and female adolescents developed psychological unrest related to difficulty accepting the HIV diagnosis and concerns about the future. Grandmothers experienced ill health due to the demands of the caregiving role. It is recommended that family, financial and psychological support be made available for grandmothers to lighten the duty of caregiving.
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Affiliation(s)
| | | | | | - Chris Ph Myburgh
- Department of Educational Psychology, University of Johannesburg, South Africa
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9
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Toledano-Toledano F, Rodríguez-Rey R, Moral de la Rubia J, Luna D. A Sociodemographic variables questionnaire (Q-SV) for research on family caregivers of children with chronic disease. BMC Psychol 2019; 7:85. [PMID: 31864414 PMCID: PMC6925508 DOI: 10.1186/s40359-019-0350-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/11/2019] [Indexed: 12/13/2022] Open
Abstract
Background Chronic diseases in childhood can affect the physical and mental health of patients and their families. The literature on pediatric chronic diseases has found important associations between the sociodemographic variables of children and their caregivers and negative health consequences in families. Methods In this study, we aimed to design and validate a questionnaire on sociodemographic variables that would be useful for research on pediatric chronic diseases; and investigate the relationship between sociodemographic variables and psychosocial variables among family caregivers. First, we created a questionnaire that consists of 20 demographic, medical, and family-related items based on a literature review and expert evaluations. This questionnaire was then validated by 335 expert reviewers in the field of Social Work, who work daily with the families of patients with chronic diseases in 10 National Institutes of Health of Mexico. The validation was based on three empirical criteria created specifically for this study, and the reviewers evaluated the usefulness, relevance, and permanence of the items. In a second cross-sectional, correlational and comparative study, a total of 446 family caregivers of children with chronic diseases were interviewed, and they completed the Sociodemographic Variables Questionnaire for research on family caregivers of children with chronic sociodemographic diseases and four psychosocial measurement instruments for evaluating anxiety, depression, caregiver burden and quality of life. Results Based on the results of the first study, we created the Sociodemographic Variables Questionnaire (Q-SV) for research on family caregivers of children with chronic diseases, and it includes 17 items that assess demographic, medical, and family characteristics. The results of the second study showed that the 17 sociodemographic variables obtained in the validation by expert judges are useful for measuring and evaluating the relationship between psychosocial variables in families of children with chronic diseases. Conclusions Psychosocial and sociodemographic factors are relevant for the development of research processes for families that care for children with chronic diseases.
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Affiliation(s)
- Filiberto Toledano-Toledano
- Unidad de Investigación en Medicina Basada en Evidencias, Hospital Infantil de México Federico Gómez Instituto Nacional de Salud, Dr. Márquez 162, Doctores, Cuauhtémoc, 06720, México City, Mexico.
| | - Rocío Rodríguez-Rey
- Universidad Europea de Madrid. Calle Tajo, s/n, 28670 Villaviciosa de Odón, Madrid, Spain
| | - José Moral de la Rubia
- Facultad de Psicología, Universidad Autónoma de Nuevo León. Dr. Carlos Canseco, 110, Esq. Dr. Aguirre Pequeño, Col. Mitras Centro, 64460, Monterrey, Mexico
| | - David Luna
- Comisión Nacional de Arbitraje Médico, Mitla No. 250-10° Piso, esq. Eje 5 Sur (Eugenia). Col. Narvarte, 03020, Benito Juárez, Mexico City, Mexico
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10
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Boyden JY, Hill DL, Carroll KW, Morrison WE, Miller VA, Feudtner C. The Association of Perceived Social Support with Anxiety over Time in Parents of Children with Serious Illnesses. J Palliat Med 2019; 23:527-534. [PMID: 31697175 DOI: 10.1089/jpm.2019.0387] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Background: Parenting a child with a serious life-threatening illness (SLTI) may impact parents' mental health. The protective association of social support with anxiety over time following an acute medical event has not been empirically tested in a sample of parents of children with oncologic and nononcologic serious illnesses. Objective: To test the potential association of perceived social support with anxiety in parents of children with SLTIs over time. Design: Prospective cohort study. Setting/Subjects: Two hundred parents of 158 children in the Decision Making in Serious Pediatric Illness study, conducted at the Children's Hospital of Philadelphia. Measurements: Parental anxiety and perceived social support were assessed using the Hospital Anxiety and Depression Scale (HADS) and the Social Provisions Scale (SPS). We performed bivariate linear regressions to test cross-sectional and longitudinal associations between the SPS and anxiety scores at baseline, 12 months, and 24 months. Results: The average SPS total and subscale scores decreased significantly from baseline to 12 months, and increased from 12 to 24 months. The average HADS-Anxiety scores decreased significantly from baseline to 12 months, and remained stable at 24 months. Cross-sectionally, total SPS scores were negatively associated with anxiety scores at each time point. Longitudinally, SPS scores were associated with anxiety scores, although this association weakened in adjusted modeling. Conclusions: Over a two-year period, higher levels of perceived social support were associated with lower levels of anxiety in parents of seriously ill children. Clinicians and researchers should work to optimize social support for families to improve parental mental health outcomes.
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Affiliation(s)
- Jackelyn Y Boyden
- Department of Biobehavioral Health Sciences, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Douglas L Hill
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen W Carroll
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Wynne E Morrison
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Chris Feudtner
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Roomaney R, Kagee A, Knoll N. Received and perceived support subscales of the Berlin Social Support Scales in women diagnosed with breast cancer attending the breast clinic at Tygerberg hospital: structure and correlates. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2019. [DOI: 10.1177/0081246319831819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Research in the field of psycho-oncology in South Africa is increasing, and there is a need for validated measures that assess factors associated with cancer, such as social support. The Berlin Social Support Scales are a battery of instruments that measure various types and functions of social support. The measure was originally developed for use among adult cancer patients, and their partners but has also been used among other clinical populations and healthy adults. We investigated the psychometric properties of the English version of the perceived and received sub-scales, Berlin Social Support Scales. Our sample included South African women ( N = 201) who were diagnosed with breast cancer and receiving treatment at a public health care facility. We administered several measures, including a demographic questionnaire, the Berlin Social Support subscales, the Duke-UNC Functional Social Support Questionnaire, and The Functional Assessment of Cancer Therapy to participants. Validity and reliability analyses were conducted. Factor analysis resulted in the retention of 17 items that clustered on two factors, namely received support and perceived support. The 17-item version of the Berlin Social Support Scale demonstrated strong reliability and validity in the sample. The two subscales are quick to administer, easy to interpret, and are a reliable measure of social support among breast cancer patients in South Africa.
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Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, South Africa
| | - Nina Knoll
- Department of Psychology, Freie Universität Berlin, Germany
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12
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Besthorn F, Kalomo EN, Lightfoot E, Liao M. The relationship between social support and anxiety amongst children living with HIV in rural northern Namibia. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:293-300. [PMID: 30466364 DOI: 10.2989/16085906.2018.1534748] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined how HIV-related stigma and social support are related to anxiety among children living with HIV in rural northern Namibia. This is a cross-sectional exploratory study with a sample of 132 caregiver-child dyads. Our study found that higher levels of social support was correlated with lower levels of anxiety among children living with HIV, but higher levels of HIV-related stigma was not correlated with higher levels of anxiety. These findings point to the need for the development of more culturally and age specific interventions that enhance social support among children living with HIV, especially those in high-prevalence and socio-economically deprived settings.
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Affiliation(s)
- Fred Besthorn
- a Wichita State University , School of Social Work , Wichita , Kansas , USA
| | - Eveline N Kalomo
- a Wichita State University , School of Social Work , Wichita , Kansas , USA
| | - Elizabeth Lightfoot
- b University of Minnesota , School of Social Work , St Paul , Minnesota , USA
| | - Minli Liao
- c Morgan State University , School of Social Work , Baltimore , Maryland , USA
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13
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Ofori-Atta A, Reynolds NR, Antwi S, Renner L, Nichols JS, Lartey M, Amissah K, Tettey JK, Alhassan A, Ofori IP, Catlin AC, Gan G, Kyriakides TC, Paintsil E. Prevalence and correlates of depression among caregivers of children living with HIV in Ghana: findings from the Sankofa pediatric disclosure study. AIDS Care 2018; 31:283-292. [PMID: 30360643 DOI: 10.1080/09540121.2018.1537463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Prior studies show an association between caregiver depression and child health outcomes. There has been little examination of depression among caregivers of HIV-infected children in sub-Saharan countries where pediatric HIV is concentrated. Using baseline data collected in the pediatric HIV disclosure intervention trial, Sankofa, we examined the prevalence and factors associated with depression among caregivers (N = 446) of children infected with HIV in Ghana. Data were analyzed with descriptive and regression analyses. The mean age of the caregivers was 42.2 ± 10.4 years. Eighty percent of the caregivers were female and 59% were HIV-infected. Twenty-eight percent (n = 126) of the caregivers were found to have mild to severe depression. In the adjusted model, factors significantly associated with caregiver depression included: HIV-positive caregiver status (P = 0.04), low income (P = 0.02), lower social support, (P = 0.01), lower HIV knowledge, (P = 0.01), worse HIV illness perceptions (P≤0.001), and greater perceived HIV stigma (P≤0.001). Although we found a high prevalence of depression among our study participants, several of the risks factors identified are modifiable and amenable to interventions that are locally available and affordable.
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Affiliation(s)
- Angela Ofori-Atta
- a Department of Psychiatry , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Nancy R Reynolds
- b School of Nursing , Johns Hopkins University , Baltimore , MD , USA
| | - Sampson Antwi
- c Department of Child Health, School of Medical Sciences , Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Lorna Renner
- d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Ghana
| | - Justin S Nichols
- e Department of Pediatrics , Yale School of Medicine , New Haven , CT , USA
| | - Margaret Lartey
- f Department of Medicine , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Accra , Ghana
| | - Kofi Amissah
- c Department of Child Health, School of Medical Sciences , Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Jonas Kusah Tettey
- d Department of Child Health , University of Ghana School of Medicine and Dentistry and Korle-Bu Teaching Hospital Accra , Ghana
| | - Amina Alhassan
- c Department of Child Health, School of Medical Sciences , Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Irene Pokuaa Ofori
- c Department of Child Health, School of Medical Sciences , Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital , Kumasi , Ghana
| | - Ann C Catlin
- g Rosen Center for Advanced Computing , Purdue University , West Lafayette , IN , USA
| | - Geliang Gan
- h Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Tassos C Kyriakides
- h Yale Center for Analytical Sciences , Yale School of Public Health , New Haven , CT , USA
| | - Elijah Paintsil
- e Department of Pediatrics , Yale School of Medicine , New Haven , CT , USA.,i Department of Pharmacology , Yale School of Medicine , New Haven , CT , USA.,j Department of Epidemiology & Public Health , Yale School of Medicine , New Haven , CT , USA
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14
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Sharer M, Cluver L, Shields JJ, Ahearn F. The power of siblings and caregivers: under-explored types of social support among children affected by HIV and AIDS. AIDS Care 2017; 28 Suppl 2:110-7. [PMID: 27392006 PMCID: PMC5004198 DOI: 10.1080/09540121.2016.1178942] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Children affected by HIV and AIDS have significantly higher rates of mental health problems than unaffected children. There is a need for research to examine how social support functions as a source of resiliency for children in high HIV-prevalence settings such as South Africa. The purpose of this research was to explore how family social support relates to depression, anxiety, and post-traumatic stress (PTS). Using the ecological model as a frame, data were drawn from a 2011 cross-sectional study of 1380 children classified as either orphaned by AIDS and/or living with an AIDS sick family member. The children were from high-poverty, high HIV-prevalent rural and urban communities in South Africa. Social support was analyzed in depth by examining the source (e.g. caregiver, sibling) and the type (e.g. emotional, instrumental, quality). These variables were entered into multiple regression analyses to estimate the most parsimonious regression models to show the relationships between social support and depression, anxiety, and PTS symptoms among the children. Siblings emerged as the most consistent source of social support on mental health. Overall caregiver and sibling support explained 13% variance in depression, 12% in anxiety, and 11% in PTS. Emotional support was the most frequent type of social support associated with mental health in all regression models, with higher levels of quality and instrumental support having the strongest relation to positive mental health outcomes. Although instrumental and quality support from siblings were related to positive mental health, unexpectedly, the higher the level of emotional support received from a sibling resulted in the child reporting more symptoms of depression, anxiety, and PTS. The opposite was true for emotional support provided via caregivers, higher levels of this support was related to lower levels of all mental health symptoms. Sex was significant in all regressions, indicating the presence of moderation.
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Affiliation(s)
- Melissa Sharer
- a John Snow Research & Training Institute , Arlington , VA, USA.,b The National Catholic School of Social Service , The Catholic University of America , Washington , DC , USA
| | - Lucie Cluver
- c Department of Social Policy & Intervention , University of Oxford , Oxford , UK.,d Department of Psychiatry and Mental Health , University of Cape Town , Cape Town , South Africa
| | - Joseph J Shields
- b The National Catholic School of Social Service , The Catholic University of America , Washington , DC , USA
| | - Frederick Ahearn
- b The National Catholic School of Social Service , The Catholic University of America , Washington , DC , USA
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15
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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: 2.3] [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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16
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A cross-sectional study of associations between casual partner, friend discrimination, social support and anxiety symptoms among Chinese transgender women. J Affect Disord 2016; 203:22-29. [PMID: 27267953 DOI: 10.1016/j.jad.2016.05.051] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 05/22/2016] [Indexed: 11/21/2022]
Abstract
Anxiety symptoms are the prevalent mental disorders for transgender women. However, only a few studies are available pertaining to this problem among Chinese Transgender women. Chinese Transgender women are a vulnerable population which is exposed to discrimination and loss of social support due to their gender identity and transition. This study was conducted to estimate the prevalence and factors associated with anxiety symptoms among Chinese transgender women. A cross-sectional study was performed by convenience sampling. This comprised of 209 Chinese transgender women in Shenyang, China. The Zung Self-Rating Anxiety Scale (SAS) was used to assess anxiety symptoms for these transgender women. Hierarchical multiple regression analysis was performed to explore the associated factors of SAS. The prevalence of anxiety symptoms in Chinese transgender women was found to be 34.5%. Regression analyses indicated that SAS was associated with casual partnership, friend discrimination and social support in the final model. Sexual partnership and discrimination contributed the most to the model, R-square, accounting for 19.2% and 15.5% of the total variance respectively. Chinese transgender women showed considerably high level of anxiety symptoms. It was also found that they were exposed to significant transition challenges, such as high risk sexual partnership, excessive discrimination and a reduction in social support. Furthermore, anxiety symptoms was best predicted by the absence or presence of a casual partner, friend discrimination and social support rather than the disclosure of their gender identity, knowledge of HIV prevention and health service. Improvement of social support, reduction of friend discrimination and determination of the characteristics of risky sexual partnerships especially for the casual partner can help to attenuate anxiety symptoms and increase mental well-being for transgender women.
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17
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Chukwuorji JC, Amazue LO, Ekeh OH. Loneliness and psychological health of orthopaedic patients’ caregivers: does gender make a difference? PSYCHOL HEALTH MED 2016; 22:501-506. [DOI: 10.1080/13548506.2016.1173711] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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18
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Casale M, Wild L, Cluver L, Kuo C. Social support as a protective factor for depression among women caring for children in HIV-endemic South Africa. J Behav Med 2015; 38:17-27. [PMID: 24510353 PMCID: PMC4127162 DOI: 10.1007/s10865-014-9556-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 01/27/2014] [Indexed: 01/12/2023]
Abstract
Social support has been shown to be a protective resource for mental health among chronically ill adults and caregiver populations. However, to date no known studies have quantitatively explored the relationship between social support and depression among women caring for children in HIV-endemic Southern Africa, although they represent a high risk population for mental health conditions. Using data from a household survey with 2,199 adult female caregivers of children, living in two resource-deprived high HIV-prevalence South African communities, we conducted hierarchical logistic regression analysis with interaction terms to assess whether social support had a main effect or stress-buffering effect on depression. Findings provide evidence of stress-buffering of non-HIV-related chronic illness, but not HIV-related illness. Results reinforce the importance of social support for the mental health of chronically ill caregivers, and suggest that factors related to the specific nature of HIV/AIDS may be hindering the potential stress-buffering effects of social support among people living with the disease. Implications for future research and interventions are discussed.
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Affiliation(s)
- Marisa Casale
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, PO Box X54001, Durban, 4000, South Africa,
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19
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Casale M. The importance of family and community support for the health of HIV-affected populations in Southern Africa: what do we know and where to from here? Br J Health Psychol 2014; 20:21-35. [PMID: 25487636 DOI: 10.1111/bjhp.12127] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/11/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Informal family and community support deriving from social relations can play an important role in protecting mental and physical health in resource-scarce contexts and may help facilitate health service access and uptake. Yet, to date, there has been surprisingly little empirical research investigating the role of social support as a resource for health in HIV-affected Southern African communities, despite the known importance of social connectedness, high rates of physical and mental health conditions, and existing 'treatment gaps'. METHODS This paper brings together and discusses findings of multiple linked analyses, from the first large-scale explanatory sequential mixed methods research investigating the relationship between social support and health with caregiver populations in HIV-endemic South Africa. RESULTS Overall, findings highlight the protective role of social support for caregiver mental health, the multiple perceived psychological and behavioural mechanisms possibly explaining the relationship between social support and both mental and physical health, and gender differences in the provision, effects, and availability of support. CONCLUSIONS Drawing from these findings and the broader literature, four potential foci for future research in Southern Africa are identified and discussed, as are implications for research design and methodologies. These involve achieving a better understanding of the following: The pathways and processes explaining common and differential effects of social support across different population groups; the potential protective role of social support for physical health; and the role of factors such as gender and social and cultural norms in shaping the relationship between social support and health. Statement of contribution What is already known on this subject? Mental and physical health are closely related. HIV increases the risk of mental health conditions. Studies mainly from high-income countries have shown social relations and support to be protective of health. What does this study add? First mixed methods research of this dimension on social support and health in Southern Africa. Highlights importance of social support for mental health among caregivers of children in HIV-endemic South Africa. Points to biological and psychological pathways explaining the support-health relationship in this sample.
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Affiliation(s)
- Marisa Casale
- Health Economics and HIV/AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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20
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Skeen S, Tomlinson M, Macedo A, Croome N, Sherr L. Mental health of carers of children affected by HIV attending community-based programmes in South Africa and Malawi. AIDS Care 2014; 26 Suppl 1:S11-20. [PMID: 24766642 PMCID: PMC4554389 DOI: 10.1080/09540121.2014.906559] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There is strong evidence that both adults and children infected with and affected by HIV have high levels of mental health burden. Yet there have been few studies investigating carer mental health outcomes in the context of HIV in Malawi and South Africa. The objective of this study was to assess the mental health of carers of children affected by HIV as a part of the Child Community Care study, which aims to generate evidence on the effectiveness of community-based organisation (CBO) services to improve child outcomes. In a cross-sectional study, we interviewed 952 carers of children (aged 4-13 years) attending 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Psychological morbidity was measured using the Shona Symptom Questionnaire and suicidal ideation was measured using an item from the Patient Health Questionnaire. Carers were asked about care-seeking for emotional problems. Overall, 28% of carers scored above the clinical cut-off for current psychological morbidity and 12.2% reported suicidal ideation. We used logistic regression models to test factors associated with poor outcomes. Household unemployment, living with a sick family member and perceived lack of support from the community were associated with both psychological morbidity and suicidal ideation in carers. Reported child food insecurity was also associated with psychological morbidity. In addition, carers living in South Africa were more likely to present with psychological morbidity and suicidal ideation than carers in Malawi. Rates of help-seeking for mental health problems were low. Carers of children affected by HIV are at risk for mental health problems as a result of HIV, socio-economic, care-giving and community factors. We call for increased recognition of the potential role of CBOs in providing mental health care and support for families as a means to improve equity in mental health care. Specifically, we highlight the need for increased training and supervision of staff at CBOs for children affected by HIV, and the inclusion of CBOs in broader efforts to improve population mental health outcomes.
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Affiliation(s)
- Sarah Skeen
- a Department of Psychology, Centre for Public Mental Health , Stellenbosch University , Stellenbosch , South Africa
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