Marseille 2007
| Abstract #23 - Psychological distress amongst children orphaned by AIDS: Effects of stigma and other community factors in South Africa | ||||
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Session: 22.6: Stigma (Parallel) on Monday @ 16.30-18.30 in Auditorium/Overflow Chaired by Heather Worth, Osman Malik Authors: Presenting Author: Ms Lucie Cluver - Cape Town Child Welfare and Oxford University, South Africa |
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| Additional Authors: Dr Frances Gardner, Dr Don Operario, | ||||
| Aim: Orphanhood is a major consequence of the AIDS epidemic in Sub-Saharan Africa, and a predicted 2.3 million children will be orphaned by 2020 (ASSA, 2005). Children orphaned by AIDS may experience heightened levels of psychological distress, and distress levels may be mediated by a range of community-level factors. This study explores associations between mental health outcomes, orphanhood status and selected community-level factors in deprived urban settlements in Cape Town, South Africa. The study examines a) whether orphanhood by AIDS is independently associated with poorer mental health outcomes of depression, anxiety, post-traumatic stress, peer problems, delinquency and conduct problems, when controlling for socio-demographic factors: b) associations between orphanhood and community-level risks of bullying, stigma, community violence and lack of positive recreational activities, c) the potential mediating effects of reductions in stigma and increased positive activities on psychological outcomes. Finally, the study assesses d) childrens perceptions of three potential settings for intervention programmes: school, church and youth groups. | ||||
| Method / Issue: Participants were 1025 children and adolescents orphaned by AIDS, compared to control groups of children orphaned by non-AIDS causes and non-orphaned children. Participants (aged 10-19) were interviewed using standardized psychological scales. Information on socio-demographic and community-level factors was also collected. | ||||
| Results / Comments: a) Orphanhood by AIDS, but not orphanhood by other causes, was independently associated with poorer psychological health for depression, post-traumatic stress, peer problems, conduct problems and delinquency (p<.001) b) AIDS-orphaned children reported higher levels of stigma, and fewer positive activities than other groups (p<.001). There were no differences on bullying or community violence. c) All community risk factors were associated with poorer psychological outcomes (p<.001). When all factors were entered into regressions (controlling for sociodemographic factors such as age and gender), backwards elimination found that the combination of experience of stigma and number of positive activities eliminated associations between AIDS orphanhood and poorer psychological outcomes for depression, anxiety, post-traumatic stress, delinquency and conduct problems. This suggests that reducing stigma and increasing positive recreational activities (such as sport) could improve psychological well-being for AIDS-orphaned children to levels equivalent to other children. Mediational analyses confirmed the strong mediational effect of these factors d) Children identified high levels of attendance at school, church and youth groups, suggesting possible settings for intervention programmes. | ||||
| Discussion: 19% of the total South African child population will be orphaned by 2010. Unless effective interventions are implemented, AIDS-orphaned children will experience heightened psychological distress. This study finds that (amongst other factors) reducing community-level stigma, and improving provision of positive recreational activities, are likely to improve outcomes for this vulnerable group. In the context of such high proportions of orphans, interventions aiming to alleviate mental health problems may be more feasible on community, rather than individual, levels (Foster et al, 2005). | ||||
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