Mental Health of Youth Orphaned Due to HIV in South Africa: Biological and Supportive Links to Caregivers

Purpose: In South Africa over 5 million people live with HIV with 2.1 million children orphaned due to AIDS. Many of these children experienced orphan-hood at an age when parental guidance and socialization is most desirable, with the loss impacting the child’s psychological well-being and mental health throughout their lifetime.  Little is known about how the protective links between caregiver support and caregiver relations may interact to improve the mental health of children orphaned by AIDS. The researchers were exploring what specific factors related to caregiver support and caregiver relation may predict negative mental health outcomes (depression, PTS symptoms, anxiety, suicide) of children orphaned by AIDS when controlling for age and gender? 

Methods:  In 2005 1025 youth were purposely sampled matching those orphaned by AIDS to other orphans and non-orphaned controls to examine in more depth the particular vulnerabilities and resilience factors associated with each population.  Four years later in 2009, 71% of these original youth (N=723) were located and were re-interviewed, of these 266 were classified as being orphaned due to AIDS.  All 266 youth were living in neighborhoods formerly designated for Black Africans under apartheid, with high rates of violence, HIV prevalence (23-30%), and poverty.  Advanced statistical analysis (multiple regression and logistical regression) were used to estimate regression models that best predicts depression, anxiety, PTS symptoms, and suicidality among the 266 youth.  In all, 7 factors were entered into each analysis (age, gender, caregiver relation, support-having a person, emotional support, instrumental support, and support-perceived satisfaction).    

Results: Caregiver relation was analyzed in several combinations to determine if it was a significant predictor of mental health outcomes.  Anxiety was the only mental health outcome that showed a significance difference, specifically the mean anxiety score for those living with a parental caregiver was significantly higher than those living with a grandparent, other kin, or non-kin.  Age was the only significant variable (Beta=.22, p<.05) from the model that predicts depression accounting for 14.4% of the variance in depression.  Age, caregiver relation, presence of a caregiver and instrumental support all significantly predicted anxiety (p<.05), accounting for 15.6% of the variance in anxiety.  Age, emotional support, instrumental support, and perceived satisfaction all significantly predict PTS symptoms (p<.05) in this model.  All four variables account for 17.1% of the variance in PTS symptoms.    Gender and age predicted suicidality, specifically every boy is 2.25 times more likely to exhibit suicide tendencies compared to girls and every yearly increase in age results in the youth being 1.22 times more likely to exhibit suicidal tendencies. 

Implications: Having a stronger understanding of how the youth’s links with the caregiver (kin and social support) relates to mental health outcomes can lead to stronger intervention that support caregivers and strengthen families among these vulnerable youth affected by poverty, HIV, and crime in South Africa.  This research highlights the need to focus on providing key services to the youth themselves while also focusing on the family or caregiver who is often the first line of support to youth orphaned by AIDS.