Economic Empowerment and Mental Health Functioning of Caregivers for AIDS Affected Children in Uganda: Lessons From the Suubi-Maka Randomized Controlled Trial

BACKGROUND and PURPOSE. In sub-Saharan Africa, many extended families assume the role of caregivers for children orphaned by AIDS (AIDS-affected children). Overall, caregivers for these AIDS-affected children tend to be elderly women with low educational level (Bachman Desilva et al., 2008). Moreover, the economic and psychological stress and challenges ensued from caregiving duties often dispose these caregivers to worse health and mental health outcomes (Kuo & Operario, 2009). Nonetheless, there is limited literature evaluating how intervention could improve the wellbeing of caregivers for AIDS-affected children. Based on asset theory, this study hypothesizes that through providing asset accumulation intervention that improves the economic wellbeing of the orphans and the caregiving families, the mental health wellbeing of caregivers could be improved. This hypothesis leads to two research question of this study. First, does the asset-based economic empowerment intervention for children improve caregivers’ mental health? Second, does family cohesion or family communication mediate or moderate the intervention’s effects on caregivers’ mental health?

METHODS. The Suubi-Maka intervention in Uganda is a randomized clinical trial (RCT) study funded by the National Institute of Mental Health. AIDS-affected children (aged 12 to 14 who have lost one or both parents) and their caregivers were recruited through school and were randomly assigned to treatment (n=179) and control (n=118) conditions. The treatment intervention involves caregivers to support children to save money for educational purposes through the provided matched savings accounts, in addition to mentorship and trainings provided to the children. Both the AIDS-affected child and the caregiver from each participating family were individually interviewed before the intervention (wave 1) and 12 months after the intervention (wave 2) through a 90-minute survey administered by Ugandan research assistants in the respondents’ preferred languages. This study uses waves 1 and 2 caregiver data, and the key measure on caregiver’s mental health is adapted from previous studies (Kagotho & Ssewamala, 2012). Multivariate regression is employed to examine the impact of Suubi-Maka on the mental health of caregivers and how family dynamics mediate or moderate the effect.

 

RESULTS. Controlling for characteristics of caregivers and AIDS-affected children, the participation of the family economic empowerment intervention demonstrates significant impact (p<.001) on reducing the psychological distress of caregivers. After the 12-month intervention period, caregivers in the treatment condition showed significant reduction in reported mental health symptoms. Also, caregivers with higher family cohesion are likely to have better mental health than those with lower family cohesion. In addition, higher mental health distress is associated with caregivers who are female and reporting poor to fair physical health. Neither family cohesiveness nor communication show mediating or moderating effect in the hypothesized direction.  

 

CONCLUSIONS and IMPLICATIONS. Economic empowerment interventions not only have the potential to improve the mental health functioning of AIDS-affected children (Ssewamala et al., 2012), it also improves the mental health of their caregivers. Findings from this RCT study suggest that future policies and interventions aiming at addressing the impact AIDS brings to the AIDS-affected children and their caregivers should stress on the economic empowerment of the family.