Utilizing a Family-Based Economic Strengthening Intervention to Improve Mental Health Wellbeing Among Female AIDS-Orphaned Adolescents in Uganda

Background and Purpose: Mental health problems among adolescents present a major public health challenge. Worldwide, an estimated 20 percent of adolescents have mental health or behavioral problems (UNICEF, 2011). Unfortunately, adolescents orphaned as a result of HIV/AIDS are at a greater risk of poor mental health functioning due to the recurrent trauma, starting with the illness and deaths of their primary sources of support—the parents. In addition, AIDS-affected households caring for AIDS-orphaned adolescents are likely to be more financially unstable due to the loss of income earners or the need to devote often scarce resources to the care of ill family members. This is usually followed by cycles of poverty and often, sexual abuse and exploitation that exposes orphans, especially females to HIV and other sexually transmitted infections. Therefore, by adversely affecting family functioning, household poverty constitutes an important risk factor for adolescent poor mental health wellbeing, which negatively impacts their development, limiting their opportunities to a healthy and productive adulthood life. However, very few studies exist on effective interventions to address both mental health wellbeing and poverty in poor sub-Saharan African communities– especially among female AIDS-orphaned adolescents—who are at an increased risk of experiencing negative consequences because of their gender. This study examines the effect of a family-based economic strengthening intervention on the mental health wellbeing of female AIDS-orphaned adolescents in Uganda.

Methods: This study utilizes longitudinal data from a NICHD funded study, called Bridges to the Future (2011-2016), implemented in southern Uganda. We utilize data from a sample of 789 female AIDS-orphaned adolescents, with an average age of 12.4 (range 10-16). Participants were randomly assigned to either the control condition (n=273) receiving usual care of services (scholastic materials and food aid) or the treatment condition (n=516) receiving the usual care mentioned above, plus three intervention components (youth matched savings account, workshops on financial management and microenterprise, and a mentorship program). Data was collected at baseline, 12-months, and 24-months post intervention initiation. Regression analyses were conducted to examine the effect of the intervention on participants’ mental health wellbeing, measured by depressive symptoms, hopelessness and self-esteem.

Results: Controlling for participants’ sociodemographic and household characteristics, female AIDS-orphaned adolescents who received an economic strengthening intervention were more likely than non-participants to report a statistically significant increase in self-esteem (b=2.78, 95%CI =. 82, 4.75, p=. 006); a decline in hopelessness levels (b= -.61, 95%CI = -1.07, -.14, p=. 012) at 12-months; and a significant decline in depressive symptoms (b= -1.23, 95%CI = -2.30, -.16, p =. 026) at 24-months post intervention.

Conclusions and Implications: Our findings suggest that addressing household poverty is a major pathway through which mental health wellbeing among female AIDS-orphaned adolescents could be improved. Future public health programs especially those that provide support and care to AIDS-orphaned children and adolescents should consider incorporating economic strengthening components in their programs to help mitigate the mental health risks associated with orphanhood and exacerbated by poverty. Moreover, economic strengthening may act as an additional effort to address health disparities among gender.