The Prevalence and Associated Risk and Protective Factors of Psychological Difficulties and Prosocial Behavior Among Children Orphaned and Made Vulnerable By AIDS in Southern Uganda

Background: Sub-Saharan Africa (SSA) is home to more than 75% of the world’s 15.4 million children orphaned and made vulnerable by AIDS. Uganda, a poor East African country, is one of the most affected with over 900,000 children orphaned by AIDS. The adverse psychological impact of orphanhood have been well documented. While losing one or both parents to any cause is traumatic, those orphaned by AIDS may be at particularly high risk of adverse health outcomes. Indeed, studied have found that children orphaned and made vulnerable by AIDS have more severe psychological difficulties than non-orphaned children, which can persist into adulthood. Therefore, early detection of emotional and behavioral difficulties and associated risk and protective factors, is critical for intervention development. The strengths and difficulties questionnaire (SDQ) is an accessible, internationally validated screening tool for measuring emotional and behavioral difficulties; however, no studies have utilized it to investigate the prevalence and associated risk and protective factors of these psychological difficulties among adolescents orphaned by AIDS.

Methods: We analyzed baseline data from the Suubi-Maka (hope for families) study to investigate the prevalence of emotional and behavioral difficulties and prosocial behavior (outcomes) using the SDQ. We applied ≥80^th percentile for emotional and behavioral difficulties and ≥20^th percentile for prosocial behavior as cutoff points for determining positive and negative cases to compute prevalence rates. Child psychological functioning including depressive symptoms, hopelessness, self-concept, and other sociodemographic characteristics were considered risk factors. Logistic regression models were used to investigate risk and protective factors associated with the mental health outcomes.

Results: Approximately 22.5% of participants had emotional symptoms, 32.4% had conduct problems, 25.7% had peer relationship problems, 24.3% had hyperactivity, and 23.7% had difficulties based on total score. Conversely, 80.4% had prosocial behavior. Higher caregiver mental health scores were associated with psychological difficulties among adolescents. Specifically, for every one unit increase in caregiver mental health score, the odds of adolescents having emotional and behavioral difficulties increased by 2% to 5%. Double orphanhood was associated with peer relationship problems (aOR = 2.47; 1.29, 4.77) and higher depressive symptoms score was associated with increased odds of hyperactivity (aOR = 1.06; 1.01, 1.12). Caregivers’ savings decreased the odds of emotional and behavioral problems and peer relationship problems, by 50% and 55%, respectively.

Conclusions: This study revealed high prevalence of emotional and behavioral difficulties among adolescents orphaned by AIDS and caregiver mental health problems are important risk factors for these difficulties. Thus, a holistic approach that simultaneously addresses caregiver mental health and child emotional and behavioral difficulties is imperative. Conversely, having savings was an important protective factors against emotional and behavioral difficulties suggesting interventions focused on family-level economic empowerment and family strengthening may be useful tools to address mental health outcomes among adolescents.