Youth Perspectives on Depression and Adult Caregiver Practices: Secondary Analysis of Data from the Collaborative HIV Prevention and Adolescent Mental Health Program in South Africa (CHAMPSA)

Background: By far too many Black South African youth live in communities in which there are many stressors, including poverty and inadequate healthcare, that can undermine youth mental health and parenting.  Adult caregivers’ approaches to family communication and rules can have both indirect and direct impact on youth mental health. While much research to date has focused on parenting and youth mental health from the adult perspective, the current study sought to examine the role of parenting processes in youth depression from the child’s perspective.  Accordingly, a conceptual model was developed and tested to examine the pathways of influence between exposure to a family-strengthening intervention, youth’s perspective on adult caregiver practices (communication and family rules), and youth depression.

Methods: A secondary analysis was conducted on data from a randomized controlled trial testing the impact of the Collaborative HIV Prevention and Adolescent Mental Health Program in South Africa (CHAMPSA), a family-strengthening intervention to reduce sexual risk behaviors among uninfected youth between 9 and 13 years of age within South African communities (n = 580).  Participants were either randomized to CHAMPSA or a comparison condition (HIV education in SA schools).  The majority of youth were female (59%), on average 10 years old, and lived most of the time with the mother (67%).  All instruments were administered to children to obtain the youth’s perspective at post-test.  Youth depression was measured by the Children’s Depression Inventory, communication was measured by the Parental Communication Styles scale, and family rules by the Parental Monitoring Family Rules scale.  The data were analyzed using Structural Equation Modeling (SEM) with Mplus 7 using a maximum likelihood algorithm.

Results: The SEM model yielded good model fit by both global (chi square, CFI, standardized RMR, RMSEA) and focused (standardized residuals and modification indices) fit indices.  Youth in the control group, on average there had a .706 unit increase in depression scores as compared to the CHAMPSA group (MOE= .452, p= .002).  For every one unit increase in communication, on average there was an associated .152 unit decrease in youth depression (MOE= .07, p= .000).  For every one unit increase in rules, on average there was an associated .063 unit decrease in youth depression (MOE=.032, p= .000).  Lastly, as determined by a joint significance test, communication and rules significantly mediated the relationship between treatment group and youth depression.  Essentially, treatment group directly related to youth depression and also indirectly related to youth depression through communication and rules, both of which served as mechanisms.

Conclusion: These findings support the prediction that youth exposed to the family-strengthening CHAMPSA intervention would yield greater improvements in depression at post-test compared to youth in the control group.  Furthermore, communication and family rules were found to partially mediate the relationship between treatment condition and youth depression, giving support for the positive role that these parenting practices can play in reducing depression.  This paper presents a much needed child’s perspective of parenting practices in the literature and how communication and family rules relate to and can improve youth depression.