Developmental Assets in South African Adolescents Exposed to Violence: a Qualitative Study on Resilience

Violence exposure is associated with psychological and behavioural maladjustment in adolescents. Yet, not all adolescents exposed to violence experience negative symptoms. Resilience is an outcome that is in part determined by multiple protective factors, or developmental assets, that protect adolescents from the negative influence of encountered stressors and allow them to attain positive developmental outcomes. A qualitative study was conducted to acquire an in-depth understanding of the developmental assets across different layers in the ecological system that promote positive psychological and behavioural functioning in South African adolescents exposed to violence. Semi-structured individual interviews were conducted with a multi-ethnic group (black, white, and people of mixed heritage) of South African adolescents (boy: n = 17; girl: n = 13; age: 14-19 years) from seven schools in Cape Town. Adolescents reported both internal and external assets that helped them adaptively cope with violence exposure. The internal assets entailed individual characteristics and skills, including commitment to learning, positive values, positive identity, social competencies, and emotional insight. The external assets were boundaries and expectations, social support from adolescents' peers, family, school, and community, and adolescents' constructive use of time. The findings of the study may inform strengths-based interventions to enhance emotional and behavioural skills in adolescents at risk for violence exposure. Moreover, involving key stakeholders in the interventions from major developmental domains can be particularly helpful to optimise the social support that are needed for adolescents to be resilient.

Bullying and ART Nonadherence Among South African ALHIV: Effects, Risks, and Protective Factors

BACKGROUND

Identifying risk and protective factors for adolescent antiretroviral therapy (ART) adherence is a public health priority, given high HIV-related mortality in this population. An area that merits further investigation is the relationship between bullying victimization, mental health problems, and ART nonadherence among adolescents living with HIV (ALHIV). However, no known studies assess effects of bullying on adolescent nonadherence or risk and protective factors that could moderate this relationship.

SETTING

This study investigates (1) the direct longitudinal relationship between bullying exposure and ART nonadherence, and the indirect relationship via psychological distress, and (2) potential risk and modifiable protective factors moderating these pathways, among vertically and horizontally infected ALHIV who initiated treatment across 53 public health care facilities in a South African health district.

METHODS

Survey data were collected at 2 time points, between 2014 and 2017, with 1046 ALHIV (94% retention). Various mediation and moderated mediation models were run as part of a staged analysis approach.

RESULTS

A significant longitudinal relationship was found between bullying victimization and nonadherence, operating indirectly through psychological distress [B = 0.07; 95% confidence interval (CI): (0.03 to 0.13)]. Moderation analyses indicated that older adolescents exposed to bullying are more at risk of nonadherence [B = 0.52; 95% CI: (0.07 to 0.97) P < 0.05], and parental monitoring is a potential protective factor buffering indirect effects of bullying on nonadherence [B = -0.22; 95% CI: (-0.42 to -0.02) P < 0.05].

CONCLUSIONS

These findings underscore the importance of interventions that address bullying and psychological distress, and strengthen parental monitoring, particularly among older ALHIV.

How Does Exposure to Violence Affect School Delay and Academic Motivation for Adolescents Living in Socioeconomically Disadvantaged Communities in South Africa?

To date, little is known about the effects of violence on the educational outcomes of adolescents in disadvantaged communities in South Africa. In response, self-report data were collected from a socioeconomically disadvantaged sample of 503 adolescents aged 10 to 18 participating in a child abuse prevention trial in the Eastern Cape. Adolescents were purposively selected in the trial. This study applies Latent Profile Analysis (LPA) to examine relationships between past-month exposure to violence, school delay, and academic motivation. About 93.8% of adolescents in the sample experienced poly-violence-exposure to at least two forms of violence in the past month. Results identified two distinct profiles in the socioeconomically disadvantaged sample: Profile 1, adolescents exposed to more frequent poly-violence, and Profile 2, adolescents exposed to less frequent poly-violence. Being exposed to more frequent poly-violence was associated with greater risk of school delay-based on age-appropriate grade in South Africa. However, being exposed to more frequent poly-violence was not associated with lower academic motivation-adolescents showed high rates of wanting to achieve. Our findings suggest that exposure to more frequent poly-violence increases risk of school delay among adolescents from disadvantaged communities, while not affecting their academic motivation. Thus, although adolescents maintained aspirations and goals to do well at school, exposure to high frequency of violence affected their capacity to fulfill these aims.

Criminal Spin, Self-Control, and Desistance From Crime Among Juvenile Delinquents: Determinism Versus Free Will in a Qualitative Perspective

The current research is a qualitative examination of the relations between self-control and deterministic/non-deterministic perceptions of life events and the drifts into or desistance from a criminal spin among juvenile delinquents. Based on in-depth semi-structured interviews with 21 adolescents (11 active delinquents and 10 desisters), we found that both the intensification of criminal behavior and the desistance from criminal activity are gradual and connected to the reduction or acquisition, respectively, of self-control and the offenders' belief in their self-control. Criminal behavior and self-control were found to be associated with deterministic or non-deterministic perceptions of life events: the former combined with low self-control are associated with a delinquent lifestyle; the latter combined with high self-control promote the likelihood that young offenders will modify their behavior and desist from criminal behavior. The study may provide better understanding of the role of the criminal spin in the engagement or desistance from criminal behavior.

Social support, violence exposure and mental health among young South African adolescents

OBJECTIVE

Cumulative violence exposure has been associated with both internalising and externalising difficulties in youth. Therefore, it is important to identify protective factors that may ameliorate both exposure to and the impact of cumulative violence. This study aimed to identify sources of perceived social support amongst early adolescents in a low-income, high-violence community in South Africa, and to examine the association of perceived support with exposure to violence and with the severity of depression, aggression and conduct disorder symptoms.

METHOD

A sample of 615 Grade 7 learners completed measures of perceived social support, different types of violence exposure and symptoms of depression, aggression and conduct disorder.

RESULTS

Maternal, paternal and overall family support were weakly associated with a reduced risk of domestic violence, but not with other forms of violence exposure, and were also weakly associated with a reduced risk of mental health difficulties. Peer support was associated with higher symptomatology across all mental health outcomes while teacher support was associated with greater severity of depression.

CONCLUSIONS

The stress-buffering effects of social support may not be maintained in contexts of high exposure to violence. Implications for interventions to enhance youth safety and resilience in high-violence contexts are considered.

Development and Validation of the Youth Violence Potential Scale

The assessment of violence risk among youth remains a priority for researchers and practitioners globally. The absence of scales designed or validated in developing countries drives the need for a psychometrically sound, alternative measure. The purpose of this article is to validate the Youth Violence Potential Scale (YVPS). The YVPS was administered twice over 12 months to 318 South African males, aged 12-24 years. Exploratory and confirmatory factor analysis of separate samples confirmed a 19-item, three-factor solution, comprised of a Deviant Peers subscale, a Pro-Gangs Attitude subscale, and a Pro-Violence Attitude subscale. The YVPS exhibited internal reliability (α = .91) and discriminant and convergent validity among its subscales. Correlation with self-reported problem behavior/offending (r = .48, p < .001) and risk assessment from the maternal caregiver (r = .39, p < .001) evidenced concurrent and external validity.

Can supportive parenting protect against school delay amongst violence-exposed adolescents in South Africa?

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.

Exposure to violence, teacher support, and school delay amongst adolescents in South Africa

BACKGROUND

Many adolescents in South Africa are exposed to multiple types of violence, socio-economic disadvantage, and low-quality education: all risk factors for educational outcomes including school delay (grade enrolment below that which is age-appropriate). Supportive teacher-student relationships are known to be associated with improved academic outcomes in high-income contexts.

AIMS

To investigate whether the academic and emotional support provided by teachers can protect against school delay for adolescents exposed to multiple types of violence and socio-economic disadvantage in South Africa.

SAMPLE

High-risk sample of 503 adolescents aged 10-18 exposed to multiple types of violence and socio-economic disadvantage at home, in school, and in their communities.

METHODS

Multilevel aggregated structural equation modelling was applied to pre/post-RCT data. This investigated whether associations between adolescent exposure to violence and school delay could be lessened by having teachers who were academically and/or emotionally supportive.

RESULTS

More frequent exposure to 'poly-violence' and receiving more emotional support from teachers were independently associated with greater school delay. On the contrary, higher academic support from teachers was associated with lower school delay. Neither academic nor emotional teacher support was found to moderate the relationship between more frequent exposure to 'poly-violence' and an increased risk of adolescent school delay.

CONCLUSION

Adolescents' academic support from teachers is low in poorly resourced school contexts in South Africa. School-based secondary prevention programmes assisting teachers with more training and academic support in deprived contexts have potential to reduce the impact of violence and socio-economic disadvantage on adolescents' school delay.

Resilience-promoting factors in war-exposed adolescents: an epidemiologic study

Studies of war-exposed children have not investigated a comprehensive array of resilience-promoting factors, nor representative samples of children and adolescents. A representative sample of N = 710 adolescents was randomly selected from communities recently exposed to war. All those who had experienced war trauma were administered questionnaires measuring war exposure, family violence, availability of leisure activities, school-related problems, interpersonal and peer problems, socialization, daily routine problems, displacement, availability of parental supervision and contact and medical needs as well as coping skills related to religious coping, denial, self-control, avoidance and problem solving. Mental health was measured by the Strengths and Difficulties Questionnaire (SDQ) and the Child-Revised Impact of Events Scale (CRIES). Resilient adolescents were defined as those who experienced war trauma, but did not manifest any symptoms on the SDQ or CRIES. Resilience was related to being male, using problem-solving techniques, having leisure activities, and having parents who spent time with their adolescents and who supported them with school work. Interventions designed for war-traumatized youth must build individual coping skills of children and adolescents, yet at the same time target parents and teachers in an integrated manner.

A parenting programme to prevent abuse of adolescents in South Africa: study protocol for a randomised controlled trial

BACKGROUND

An estimated one billion children experience child abuse each year, with the highest rates in low- and middle-income countries. The Sinovuyo Teen programme is part of Parenting for Lifelong Health, a WHO/UNICEF initiative to develop and test violence-prevention programmes for implementation in low-resource contexts. The objectives of this parenting support programme are to prevent the abuse of adolescents, improve parenting and reduce adolescent behavioural problems. This trial aims to evaluate the effectiveness of Sinovuyo Teen compared to an attention-control group of a water hygiene programme.

METHODS/DESIGN

This is a pragmatic cluster randomised controlled trial, with stratified randomisation of 37 settlements (rural and peri-urban) with 40 study clusters in the Eastern Cape of South Africa. Settlements receive either a 14-session parenting support programme or a 1-day water hygiene programme. The primary outcomes are child abuse and parenting practices, and secondary outcomes include adolescent behavioural problems, mental health and social support. Concurrent process evaluation and qualitative research are conducted. Outcomes are reported by both primary caregivers and adolescents. Brief follow-up measures are collected immediately after the intervention, and full follow-up measures collected at 3-8 months post-intervention. A 15-24-month follow-up is planned, but this will depend on the financial and practical feasibility given delays related to high levels of ongoing civil and political violence in the research sites.

DISCUSSION

This is the first known trial of a parenting programme to prevent abuse of adolescents in a low- or middle-income country. The study will also examine potential mediating pathways and moderating factors.

TRIAL REGISTRATION

Pan-African Clinical Trials Registry PACTR201507001119966. Registered on 27 April 2015. It can be found by searching for the key word 'Sinovuyo' on their website or via the following link: http://www.pactr.org/ATMWeb/appmanager/atm/atmregistry?_nfpb=true&_windowLabel=BasicSearchUpdateController_1&BasicSearchUpdateController_1_actionOverride=%2Fpageflows%2Ftrial%2FbasicSearchUpdate%2FviewTrail&BasicSearchUpdateController_1id=1119.

Brief school-based interventions and behavioural outcomes for substance-using adolescents

BACKGROUND

Adolescent substance use is a major problem in and of itself, and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.

OBJECTIVES

To evaluate the effectiveness of brief school-based interventions in reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.

SEARCH METHODS

We conducted the original literature search in March 2013 and performed the search update to February 2015. For both review stages (original and update), we searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to February 2015. We also contacted authors and organisations to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.

MAIN RESULTS

We included six trials with 1176 adolescents that measured outcomes at different follow-up periods in this review. Three studies with 732 adolescents compared brief interventions (Bls) with information provision only, and three studies with 444 adolescents compared Bls with assessment only. Reasons for downgrading the quality of evidence included risk of bias of the included studies, imprecision, and inconsistency. For outcomes that concern substance abuse, the retrieved studies only assessed alcohol and cannabis. We generally found moderate-quality evidence that, compared to information provision only, BIs did not have a significant effect on any of the substance use outcomes at short-, medium-, or long-term follow-up. They also did not have a significant effect on delinquent-type behaviour outcomes among adolescents. When compared to assessment-only controls, we found low- or very low-quality evidence that BIs reduced cannabis frequency at short-term follow-up in one study (standardised mean difference (SMD) -0.83; 95% confidence interval (CI) -1.14 to -0.53, n = 269). BIs also significantly reduced frequency of alcohol use (SMD -0.91; 95% CI -1.21 to -0.61, n = 242), alcohol abuse (SMD -0.38; 95% CI -0.7 to -0.07, n = 190) and dependence (SMD -0.58; 95% CI -0.9 to -0.26, n = 190), and cannabis abuse (SMD -0.34; 95% CI -0.65 to -0.02, n = 190) at medium-term follow-up in one study. At long-term follow-up, BIs also reduced alcohol abuse (SMD -0.72; 95% CI -1.05 to -0.40, n = 181), cannabis frequency (SMD -0.56; 95% CI -0.75 to -0.36, n = 181), abuse (SMD -0.62; 95% CI -0.95 to -0.29, n = 181), and dependence (SMD -0.96; 95% CI -1.30 to -0.63, n = 181) in one study. However, the evidence from studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on adolescents' delinquent or problem behaviours, although the effect at long-term follow-up on these outcomes in the assessment-only comparison was significant (SMD -0.78; 95% CI -1.11 to -0.45).

AUTHORS' CONCLUSIONS

We found low- or very low-quality evidence that brief school-based interventions may be more effective in reducing alcohol and cannabis use than the assessment-only condition and that these reductions were sustained at long-term follow-up. We found moderate-quality evidence that, when compared to information provision, brief interventions probably did not have a significant effect on substance use outcomes. It is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high-quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.

Children's exposure to community and war violence and mental health in four African countries

In this article we review the mental health consequences of children's exposure to community and war violence (ETV) in four African countries: South Africa, Sierra Leone, Gambia and Rwanda. A focus on Africa is particularly pressing because of children's high levels of community and war ETV in countries therein. Regions of Africa present important macro-contexts for understanding children's various types of violence exposure amidst war and economic disadvantage. Findings of the review across 20 quantitative studies from 2004 to 2015 indicate consistent associations between exposure to war and community violence and children's symptoms of Post-traumatic Stress disorder (PTSD), depression, and aggression. School climate and family support mitigate these ETV influences upon children: however, more research is needed on the buffering effects of such resources. The effects of war violence are mediated by perceived discrimination in communities post-conflict. We integrate findings across studies to synthesize knowledge on children's ETV in Africa around a model of its correlates, mediators, and moderators in relation to mental health. Emerging research points to avenues for prevention and future inquiry.

The contribution of different forms of violence exposure to internalizing and externalizing symptoms among young South African adolescents

While many youth are exposed to multiple forms of co-occurring violence, the comparative impact of different forms of violence on the mental health of children and adolescents has not been clearly established. Studies from low and middle income countries in particular are lacking. The present study examined the contribution of different forms of violence to internalizing and externalizing symptoms among young adolescents in South Africa. A community-based sample of 616 high school learners completed self-report scales assessing exposure to six different forms of violence and the severity of depression, aggression and conduct disorder symptoms. In bivariate analyses, all six forms of violence were significantly associated with internalizing and externalizing difficulties. When the contribution of all forms of violence to mental health outcomes was examined simultaneously, domestic victimization emerged as the strongest predictor of both internalizing and externalizing difficulties. Cumulative exposure to other forms of violence contributed further to the prediction of aggression and conduct disorder, but not depression. Recommendations for future research, and the implications of the findings for prioritizing the development of violence prevention and intervention initiatives in the South African context, are considered.

Violence Exposure and Victimization Among Rural Adolescents

Violence exposure is a serious public health concern for adolescents in schools today. Violence exposure can be quite severe and frequent with multiple acts of indirect and direct victimization having lasting effects on the physical, emotional, and intellectual well-being of adolescents. The purpose of the present study is to examine the rates of violence exposure and the relative risk for multiple exposures among adolescent youth living in rural communities. Results confirm that adolescents who live in rural areas were frequent victims of violence exposure and that males were more likely to be the victims than females. Moreover, the relative risk for multiple exposures either indirectly, directly, or in combination reveal that in all instances amplification of risk occurs. The study is an important first step in understanding the rates of violence exposure and victimization experienced by adolescent youth in rural Canada with implications for school-based programming presented.

Witnessing violence among high school students in Thailand

The goal of this study was to explore the levels of witnessing violence among Thai youths and to examine whether a Western model of witnessing violence that relates to personal and family characteristics, peer relationships, own violence, violence in the family, violence in the school, and in the community, is appropriate for the Thai reality. The random sample consisted of 2,897 youths: 1,107 (38.2%) males and 1,722 (59.4%) females. Results indicated that witnessing violence rates among the Thai youths are high, but in general, quite similar to those reported in the west. The most frequently witnessed violent act was hitting and punching in school. Peer characteristics and their advice were the most related factor to witnessing violence followed by own violence activities, violence in the family, and the surrounding subsystems, supporting the similarities of the Thai reality to the Western one. No significant differences were indicated between the rural and inner-city settings. The results were interpreted in light of the cultural characteristics of Thailand.

Rural Canadian Youth Exposed to Physical Violence

Exposure to physical violence is an unfortunate reality for many Canadian youth as it is associated with numerous negative psychosocial effects. The study aims to assist in understanding resilience in rural Canadian youth exposed to physical violence. This is accomplished by identifying the importance of protective factors, as measured by the Resiliency Scale for Children and Adolescents (RSCA), and physical violence exposure, when used together, in predicting disruptive behavior, depression, and posttraumatic stress. Results indicate positive emotional reactivity is more important in protecting youth from developing psychological symptoms than sense of mastery and sense of relatedness. Differences between the effect of hearing reports, witnessing, and being victim to violence as well as differences between male and female youth were found. The study adds to the research on physical violence exposure, protective factors, and internalizing/externalizing problems in rural youth, with implications for implementing school-based programs.

Brief school-based interventions and behavioural outcomes for substance-using adolescents

BACKGROUND

Adolescent substance use is a major problem, in and of itself and because it acts as a risk factor for other problem behaviours. As substance use during adolescence can lead to adverse and often long-term health and social consequences, it is important to intervene early on in order to prevent progression to more severe problems. Brief interventions have been shown to reduce problematic substance use among adolescents and are especially useful for individuals who have moderately risky patterns of substance use. Such interventions can be conducted in school settings. This review set out to evaluate the effectiveness of brief school-based interventions for adolescent substance use.

OBJECTIVES

To evaluate the effectiveness of brief school-based interventions on reducing substance use and other behavioural outcomes among adolescents compared to another intervention or assessment-only conditions.

SEARCH METHODS

We searched 10 electronic databases and six websites on evidence-based interventions, and the reference lists of included studies and reviews, from 1966 to March 2013. We also contacted authors and organisations to identify any additional studies.

SELECTION CRITERIA

We included randomised controlled trials that evaluated the effects of brief school-based interventions for substance-using adolescents.The primary outcomes were reduction or cessation of substance use. The secondary outcomes were engagement in criminal activity and engagement in delinquent or problem behaviours related to substance use.

DATA COLLECTION AND ANALYSIS

We used the standard methodological procedures outlined by The Cochrane Collaboration, including the GRADE approach for evaluating the quality of evidence.

MAIN RESULTS

Six studies involving 1139 participants were included in this review. Overall the quality of evidence was moderate in the information provision comparison, and low or very low in the assessment only comparison. Reasons for downgrading the quality included risk of bias of the included studies, imprecision and inconsistency. Our findings suggested that compared to information provision only, brief interventions (BIs) did not have a significant effect on any substance use (three studies, 732 participants, standardised mean difference (SMD) -0.06; 95% confidence interval (CI) -0.20 to 0.09) or delinquent-type behaviour outcomes among adolescents (two studies, 531 participants, SMD -0.26; 95% CI -0.54 to 0.02). When compared to assessment-only controls, BIs had some significant effects on substance use and delinquent-type or problem behaviours, but high levels of heterogeneity existed between studies and it was not always possible to pool the results. When the comparison was with assessment-only conditions, studies of individual interventions that measured BI effectiveness reported significantly reduced substance use in general and in two studies reduced frequency of alcohol use specifically. When the data were pooled, BIs reduced cannabis frequency (SMD -0.22; 95% CI -0.45 to -0.02) across three studies (n = 407). Cannabis quantity was also reduced by BIs in comparison to assessment only (SMD -60.27; 95% CI -66.59 to -53.95) in one study (n = 179). However, the evidence for studies that compared brief interventions to assessment-only conditions was generally of low quality. Brief interventions also had mixed effects on participants' delinquent or problem behaviours.

AUTHORS' CONCLUSIONS

There was limited quality evidence that brief school-based interventions were more effective in reducing substance use than the assessment-only condition, but were similar to information provision. There is some evidence for the effectiveness of BI in reducing adolescent substance use, particularly cannabis, when compared to assessment only. However, it is premature to make definitive statements about the effectiveness of brief school-based interventions for reducing adolescent substance use. Further high quality studies examining the relative effectiveness of BIs for substance use and other problem behaviours need to be conducted, particularly in low- and middle-income countries.

Gender patterns in the contribution of different types of violence to posttraumatic stress symptoms among South African urban youth

OBJECTIVE

Identifying the comparative contributions of different forms of violence exposure to trauma sequelae can help to prioritize interventions for polyvictimized youth living in contexts of limited mental health resources. This study aimed to establish gender patterns in the independent and comparative contributions of five types of violence exposure to the severity of posttraumatic stress symptoms among Xhosa-speaking South African adolescents.

METHOD

Xhosa-speaking adolescents (n=230) attending a high school in a low-income urban community in South Africa completed measures of violence exposure and posttraumatic stress symptoms.

RESULTS

While witnessing of community violence was by far the most common form of violence exposure, for the sample as a whole only sexual victimization and being a direct victim of community violence, together with gender, contributed independently to the severity of posttraumatic stress symptoms. When the contribution of different forms of violence was examined separately for each gender, only increased exposure to community and sexual victimization were associated with symptom severity among girls, while increased exposure to direct victimization in both the community and domestic settings were associated with greater symptom severity in boys.

CONCLUSIONS

The findings provide some preliminary motivation for focusing trauma intervention initiatives in this community on girls who have experienced sexual abuse compounded by victimization in the community, and boys who have been direct victims of either domestic or community violence. Further research is required to establish whether the risk factors for posttraumatic stress symptoms identified among adolescents in this study are consistent across different communities in South Africa, as well as across other resource-constrained contexts.

Exposure to domestic violence and identity development among adolescent university students in South Africa

This study examined the relationship between exposure to domestic violence and identity development in a sample of 108 undergraduate students with an average age of 18.7 yr. from University of Limpopo in South Africa. There were more women (n = 64; 58.7%) in the study than men (n = 45; 41.3%). Participants were classified into high and low domestic violence exposure groups on the basis of a median split in physical violence scores from the Child Exposure to Domestic Violence Scale (CEDV). Exposure was then compared with identity development as measured by the Ochse and Plug Erikson scale. The results indicated a significant mean difference between the two groups on identity development. Furthermore, exposure to domestic violence was significantly associated with lower scores for identity development as represented by subscales measuring trust, autonomy, initiative and other Eriksonian constructs. Implications and limitations of the study are discussed.

The Manifestation of Anxiety among Sesotho Speakers

Mental health research in black communities in South Africa has been neglected to an alarming degree. Consequently the health system is in a precarious situation owing to a lack of accurate data to facilitate proper planning. This study investigates the way in which anxiety is clinically manifested among Sesotho speakers. For this exploratory descriptive study, the participants consisted of 101 Sesotho speakers diagnosed with anxiety disorders. They were drawn from the population of patients visiting various health establishments in the Mangaung area, South Africa. A semi-structured interview based on the Psychiatric Interview Questionnaire was used to evaluate the participants. It consisted of two types of data collection: the open-ended interview and clinical observation. The results show that there were marked differences in the presentation of anxiety symptoms among Sesotho speakers in comparison with what has been reported in western literature. Anxiety among Sesotho speakers is characterized by the prevalence of hallucinations, and there are also overlapping symptoms of anxiety and depression.

The Determinants of Family Resilience among Families in Low- and Middle-Income Contexts: A Systematic Literature Review

Resilience research has traditionally revolved around individual risk and protective factors that enable people to succeed in spite of adverse circumstances. More recently, the scope of resilience research has expanded into the interpersonal realm, giving rise to constructs such as family resilience (FR). In this systematic literature review, we identify the empirically validated determinants of family resilience, with particular reference to low- and middle-income countries (LMICs). Twelve databases were searched for relevant peer-reviewed publications from 1991 to 2010. A review of the findings revealed several familial and social resilience-building factors for families in LMICs. We discuss these findings in relation to findings from better-resourced contexts and provide recommendations for future research.

A quasi-experimental evaluation of a community-based art therapy intervention exploring the psychosocial health of children affected by HIV in South Africa

OBJECTIVES

To evaluate the efficacy of the Make A Difference about Art programme, a community art programme in South Africa for children affected by HIV and AIDS, which aims to reduce psychosocial problems by increasing self-esteem, self-efficacy and HIV insight.

METHODS

A quasi-experimental cross-sectional post-intervention survey of 297 children aged 8-18 years (177 programme attendees and a control group of 120). Participants completed an inventory comprising standardized, validated psychosocial measures of depression, emotional and behavioural problems, self-esteem and self-efficacy and key sociodemographic variables potentially relevant as risk and protective factors.

RESULTS

Attending the intervention was predictive of significantly higher self-efficacy, but was not associated with differences in self-esteem, depression, or emotional/behavioural problems. This association remained in the multivariate analysis, controlling for potential confounders. Double parental death exerted a powerful effect on child psychosocial health, eliminating the association between intervention attendance and higher self-efficacy. However, an interaction was found between bereavement status and intervention attendance on child self-efficacy, indicating that the intervention programme may ameliorate some of the psychosocial vulnerabilities associated with becoming an orphan. Other key risk factors for poor psychosocial health in this sample were AIDS-related stigma and community and household violence. Social connection emerged as a key protective factor.

CONCLUSIONS

Our findings suggest that such interventions may offer opportunities to increase the self-efficacy of vulnerable children to protect their psychological health.

The Hidden Resilience of Street Youth

The phenomenon of resilience among street children as a group of at-risk youth goes unnoticed, since they are not typically regarded as resilient. Street children are mostly categorised as vulnerable youth who need care and support, and this deficit view ignores the assets and resources that enable them towards resilience. Nevertheless, street children are remarkably resilient. Using a qualitative approach (semi-structured and focus group interviews), we explore the hidden resilience of 20 street youths in the Free State and Gauteng. The findings transform the popular conceptualisation of street youth as vulnerable and, instead, paint a picture of young people who negotiate resilient trajectories, strengthened in part by personal resources (that are typically unconventional), bonds to their peer groups, and religiosity, to cope resiliency with the multiple challenges of streetism.

Cumulative risk and AIDS-orphanhood: interactions of stigma, bullying and poverty on child mental health in South Africa

Research shows that AIDS-orphaned children are more likely to experience clinical-range psychological problems. Little is known about possible interactions between factors mediating these high distress levels. We assessed how food insecurity, bullying, and AIDS-related stigma interacted with each other and with likelihood of experiencing clinical-range disorder. In South Africa, 1025 adolescents completed standardised measures of depression, anxiety and post-traumatic stress. 52 potential mediators were measured, including AIDS-orphanhood status. Logistic regressions and hierarchical log-linear modelling were used to identify interactions among significant risk factors. Food insecurity, stigma and bullying all independently increased likelihood of disorder. Poverty and stigma were found to interact strongly, and with both present, likelihood of disorder rose from 19% to 83%. Similarly, bullying interacted with AIDS-orphanhood status, and with both present, likelihood of disorder rose from 12% to 76%. Approaches to alleviating psychological distress amongst AIDS-affected children must address cumulative risk effects.

Effects of stigma on the mental health of adolescents orphaned by AIDS

PURPOSE

By 2010, an estimated 18.4 million children in Sub-Saharan Africa will be orphaned by AIDS. Research in South Africa shows that AIDS orphanhood is independently associated with heightened levels of psychological problems. This study is the first to explore the mediating effects of stigma and other factors operating on a community level, on associations between AIDS orphanhood and mental health. We assessed the associations of four risk factors that can potentially be addressed at a community level (bullying, stigma, community violence, and lack of positive activities) with psychological problems and orphanhood status.

METHOD

One thousand twenty-five participants aged 10-19 were recruited from deprived urban settlements in South Africa. The sample included adolescents orphaned by AIDS (n = 425), adolescents orphaned by non-AIDS causes (n = 241), and nonorphaned adolescents (n = 278). Participants were interviewed using standardized psychological measures of depression, anxiety, posttraumatic stress, peer problems, delinquency, and conduct problems. Information on risk factors and demographic characteristics were also assessed.

RESULTS

AIDS-orphaned adolescents reported higher levels of stigma and fewer positive activities than other groups. There were no reported differences on bullying or community violence. All community-level risk factors were associated with poorer psychological outcomes. Multivariate analyses controlling for age and gender showed that experience of stigma significantly mediated associations between AIDS orphanhood and poor psychological outcomes.

CONCLUSIONS

Reduction of AIDS-related stigma could potentially reduce adverse psychological outcomes among AIDS-orphaned adolescents.