Testing Reciprocal Relationships between Perceived Social Support, Self-Concept, and Depression Among Adolescents Orphaned By AIDS in Uganda: A Cross-Lagged Structural Equation Model

Purpose: Adolescents orphaned by AIDS face several stressors, all of which are predictors of psychosocial functioning, including depression, negative self-concept, and poor social support. Although evidence shows a direct relationship between perceived social support (PSS), self-concept, and depression, there is a need for longitudinal analyses in sub-Saharan Africa to clarify these relationships’ directionality. This study fills this gap by examining the causal and directional relationships between PSS, self-concept, and depression among adolescents orphaned by AIDS in Uganda.

Methods: We conducted a longitudinal mediation analysis with data from a National Institute of Health-funded Suubi-Maka (Hope for families), a three-year longitudinal cluster-randomized controlled trial conducted in Southwestern Uganda. The study included a total of 346 participants from 10 comparable public primary schools. Participants were assessed at three-time points: baseline (T1), 12- (T2), and 24-months post-baseline (T3). Validated measures on PSS, self-concept, and depression symptoms were used. Structural equation modeling (SEM) was used to construct complete longitudinal path models.

Results: Majority of participants, (n = 225; 65%) were girls aged on average, 13.38 years (SD = 1.24). At baseline, on average participants reported 12.43 (SD = 5.35) depression score, 86.25 (SD = 9.26) PSS score and 78.37 (SD = 10.62) self-concept score. The final model based on the full sample yielded good model fit indices (χ2 to df ratio = 2.24; RMSEA = 0.06, [95% CI = 0.030, 0.089]; CFI = 0.96; sRMR = 0.037). Our longitudinal SEM analysis found that PSS quality had a longitudinal effect on depression symptoms. PSS quality at T1 was negatively associated with depression symptoms at T3 (β = -0.10; p = .043). We found evidence of an indirect relationship between self-concept and PSS quality. Also, we found that self-concept at T1 was negatively associated with depression at T2 (β = -.16; p = .0001), and depression symptoms were, in turn, negatively related to PSS quality at T3 (β = -.13; p = .003). Sobel test of indirect effect (β = .02, SE = .01; p = .029) showed that there was a depression was a mediator in the relationship between self-concept and PSS quality. In the final mediation model, we found that depression symptoms at T1 reduced self-concept at T2 (β = -.34; p = .0001), which, in turn, increased PSS quality at T3 (β = .22; p = .015). The statistically significant Sobel test results supported the existence of an indirect effect from depression to PSS quality through self-concept (β = -.07, SE .03; p = .024).

Conclusion and implications: Our findings emphasize the importance of strengthening depressed adolescents’ self-concept to promote support-seeking practices. Thus, interventions should increase the availability and accessibility of contextual resources while helping resource-poor adolescents recognize and develop their strengths by teaching strategies, including self-compassion, which can promote psychological and subjective wellbeing in light of self-criticism.