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Millions of African children grow up under harsh and adverse psychosocial conditions which impact their emotional well-being. Evidence, mainly from the Global North, suggests that families that are close, open, emotionally connected, and flexible have children with better psychological adjustment than families that are distant, hostile or characterized by unhealthy alliances. Children with behavioral challenges are more vulnerable to depression. However, little is known about the relationship between family cohesion and depression among children with behavioral challenges in sub-Saharan Africa (SSA). Examining this relationship in SSA, especially in Uganda, is important given context-specific factors, including the high prevalence of caregiver death to HIV/AIDS, and high rates of chronic poverty.
Methods: We analyzed baseline data from children with elevated behavioral challenges (n=626 out of N=2089) who participated in the NIH-funded SMART Africa scale-up study in Southwestern Uganda. The study recruited children aged 8-13 and their caregivers from 30 public primary schools. We conducted multiple linear regression analyses to determine the association between family support and elevated symptoms of depression using the Child Depression Inventory and Family Cohesion scales. We controlled for sociodemographic variables, including gender, age and orphan hood status of the participant.
Results: In our sample, 52% of our participants were females. The mean age was 10.3 and majority of the participants were non orphan (85.3%). The overall mean score for CDI was 3.2 (SD=2.7, range=0-15). The results from the multiple linear regression model show that family cohesion is associated with lower levels of depression among children (b=-.11, 95%CI: -.15, -.07, p=0.000). Specifically, as family cohesion score increases, depression levels decrease. However, gender of the child, age and orphan-hood were not statistically significant in the model.
Implications and Conclusion: Our results reveal that children living in families with high cohesion have low depression levels. It is therefore crucial to develop programs that aim at strengthening family relationships as catalyst for addressing depression among school going children with behavioral challenges in Southwestern Uganda.