Effects of a Family Economic Empowerment Intervention On Hopelessness and Depression Levels of AIDS-Affected Adolescents in Uganda: Results From a Randomized Controlled Trial

BACKGROUND and PURPOSE. Children who lose their parents to HIV/AIDS are more likely to experience hopelessness and depression than other children (Cluver & Gardner, 2007). Most interventions for AIDS orphaned children and adolescents (AIDS-affected adolescents) focus on therapeutic counseling. However, psychological support alone might not be enough to address the psychosocial and economic challenges of orphanhood. The Suubi-Maka program is an economic empowerment intervention based on asset theory. It involves the provision of a matched child savings account, mentorship service and financial literacy training, over and above psychological counseling. This study examines whether this innovative family economic empowerment intervention reduces hopelessness and depression levels of AIDS-affected adolescents in Uganda.

 

METHODS. This study is a randomized controlled trial (RCT) (N=297) consisting of two study arms – a treatment condition with 179 AIDS-affected adolescents and a control condition with 118 AIDS-affected adolescents – to examine the impact of the Suubi-Maka intervention on participants’ mental health functioning. The participating adolescents are recruited through schools and randomized at the school level. These adolescents are between the ages of 12 to 14 who have lost one or both parents and are residing in rural communities in Uganda. Data were collected from two time points: baseline (pre-intervention) and 12 months post-intervention through survey administered by trained Ugandan interviewers in either Luganda or English. The mental health functioning is measured by Beck’s Hopelessness Scale (Cronbach’s α at baseline and 12 months later = .66 and .67) and Children’s Depression Inventory (Cronbach’s α = .63 and .69). Descriptive, bivariate as well as multivariate regression analyses are employed to assess the impact of Suubi-Maka on levels of depression and hopelessness.

 

RESULTS.  Controlling for socioeconomic characteristics of the participating adolescents and their caregiving families, results indicate that participation in the family economic empowerment intervention influenced the mental health functioning among AIDS-affected adolescents. During the 12-month study period, adolescents in the treatment condition (receiving the economic empowerment intervention) reported significant reduction in both hopelessness (p<.001) and depression (p<.01) levels compared to adolescents in the control group (not receiving the economic empowerment intervention). Specifically, girls report higher levels of hopelessness than their male counterparts. In addition, a higher level of depression is associated with caregivers who are female and of older age as well as adolescents with poor to fair physical health.

 

CONCLUSIONS and IMPLICATIONS. Economic empowerment interventions may have a potential to reduce hopelessness and depression levels of AIDS-affected adolescents, which may have important long-term developmental impacts on adolescents. This finding has implication for future program and policy design in that economic empowerment may be an important approach in improving the psychological outcomes of the bereaving AIDS-affected adolescents. Future studies are necessary to examine how adolescents and families develop assets for a long-term period, and whether the positive effects of asset ownership and accumulation on mental health persist.

References:

Cluver, L., & Gardner, F. (2007). The mental health of children orphaned by AIDS: a review of international and southern African research. Journal of Child and Adolescent Mental Health, 19(1), 1-17.