Lauren G. Wild

Sexual Abuse of Young Children in Southern Africa

Journal of Child and Adolescent Mental Health 2004, 16(2): 127–128 ISBN 0–7969–2053–2 (R180.00) 496 pages

The Psychosocial Adjustment Of Children Orphaned By AIDS

Abstract This paper reviews the current state of knowledge regarding the psychosocial adjustment of AIDS orphans—the uninfected children whose mothers and/or fathers die of AIDS. It draws on published and unpublished research and clinical reports from the USA and Africa involving children and adolescents who have a parent who is HIV-seropositive, has AIDS, or has died of the disease. The review begins by identifying the stressors which commonly face AIDS orphans both before and after the death of their parent, and the likely psychological impact of these adversities. It then proceeds to examine empirical evidence that more directly addresses the question of whether AIDS orphans are at risk for experiencing psychosocial adjustment difficulties, and discusses factors that might mediate or moderate childrens adjustment to the AIDS-related death of their parent. Finally, it makes recommendations for future research.

Associations among Sleep Problems, Learning Difficulties and Substance Use in Adolescence.

This study investigated the relationships among sleep problems, learning difficulties and substance use in adolescence. Previous research suggests that these variables share an association with executive functioning deficits, and are intertwined. The sample comprised 427 adolescents (M age = 16 years) attending remedial schools and 276 adolescents (M age = 15 years) attending a mainstream school in Cape Town, South Africa. Participants completed anonymous self-report questionnaires. Results indicated that adolescents without learning difficulties were more likely to use tobacco, methamphetamine and cannabis, whereas those with learning difficulties engaged in more inhalant use. Adolescents who had more sleep problems were more likely to use tobacco, alcohol, methamphetamine, cannabis, inhalants, cocaine, ecstasy and any other illegal drug. Adolescents with learning difficulties had more sleep problems than those without learning difficulties. However, sleep problems remained independently associated with tobacco, cannabis and inhalant use when learning difficulties were taken into account.

Substance Abuse, Suicidality, and Self-Esteem in South African Adolescents.

Associations among six different domains of self-esteem (peers, school, family, sports/athletics, body image, and global self-worth) and risk behaviors related to substance use and suicidality were investigated in a sample of South African adolescents. Students enrolled in Grades 8 and 11 at independent secondary schools in Cape Town (N = 116) completed the Self-Esteem Questionnaire (SEQ) and a questionnaire that asked about their participation in a range of risk behaviors. Logistic regression analyses indicated that particular domains of self-esteem were differentially associated with indicators of alcohol, cigarette and drug use and suicidal ideation or behaviors in adolescents. Family self-esteem showed the strongest overall pattern of associations with the risk behaviors. Overall, the findings of this study suggest that interventions which aim to protect adolescents from engaging in risk behaviors by increasing their self-esteem are likely to be most effective and cost-efficient if they are aimed at the family and school domains.

Effects and Processes Linking Social Support to Caregiver Health Among HIV/AIDS-Affected Carer-Child Dyads: A Critical Review of the Empirical Evidence

There is evidence to suggest that social support may be an important resource for the mental and physical health of caregivers and children affected by HIV/AIDS, especially in HIV-endemic areas of the developing world. Drawing from theory on social relations and health, in this paper we argue that it is important to assess not only the existence and direction of associations, but also the effects and processes explaining these. We refer to House et al’s (in Annu Rev Sociol 14;293–318, 1988) theoretical framework on social support structures and processes as a guide to present and discuss findings of a systematic review of literature assessing the relationship between social support and health among caregivers living with HIV or caring for HIV/AIDS-affected children. Findings confirm the importance of social support for health among this population, but also expose the absence of empirical work deriving from the developing world, as well as the need for further investigation on the biopsychosocial processes explaining observed effects.

Risk and resilience in orphaned adolescents living in a community affected by AIDS.

The AIDS pandemic has resulted in a dramatic rise in the number of orphans in South Africa. This study was designed to investigate the associations between family, peer, and community factors and resilience in orphaned adolescents. Self-report questionnaires were administered verbally to 159 parentally bereaved adolescents (aged 10-19) in an economically deprived urban area. Questionnaires included measures of depression, anxiety, and self-esteem. The results of a hierarchical multiple regression analysis indicate that cumulative stress exposure, losing a parent to a cause other than HIV and AIDS, and being cared for by a nonrelative were associated with an increased risk of internalizing symptoms. Family regulation and respect for individuality, peer connection, and community connection and regulation were significantly associated with greater emotional resilience. The findings support a main-effects model of resilience in which risk factors and protective factors contribute additively to the prediction of the outcome, without interaction.

Social support as a protective factor for depression among women caring for children in HIV-endemic South Africa.

Social support has been shown to be a protective resource for mental health among chronically ill adults and caregiver populations. However, to date no known studies have quantitatively explored the relationship between social support and depression among women caring for children in HIV-endemic Southern Africa, although they represent a high risk population for mental health conditions. Using data from a household survey with 2,199 adult female caregivers of children, living in two resource-deprived high HIV-prevalence South African communities, we conducted hierarchical logistic regression analysis with interaction terms to assess whether social support had a main effect or stress-buffering effect on depression. Findings provide evidence of stress-buffering of non-HIV-related chronic illness, but not HIV-related illness. Results reinforce the importance of social support for the mental health of chronically ill caregivers, and suggest that factors related to the specific nature of HIV/AIDS may be hindering the potential stress-buffering effects of social support among people living with the disease. Implications for future research and interventions are discussed.

The relationship between social support and anxiety among caregivers of children in HIV-endemic South Africa

Caring for children can be a source of joy and fulfilment, but also a source of stress, especially for caregivers living with illness and/or coping with difficult socio-economic conditions. Risks for poor caregiver mental health are especially salient in many parts of southern Africa affected by a generalised HIV-epidemic, high rates of physical illness, difficult livelihood conditions and an increasing number of orphaned and vulnerable children in need of care. Given limited availability and low uptake of formal mental health services in South Africa, the potential protective role of informal community or “social” resources for caregiver populations requires greater attention. To our knowledge, this is the first study to quantitatively assess the relationship between social support and symptomatic anxiety among caregivers of children living in HIV-endemic southern African communities. The data are from household survey interviews with 2477 adult primary caregivers of children aged 10–17 years living in two (urban and rural) resource-deprived HIV-endemic South African communities. Hierarchical logistic regression analysis with interaction terms was conducted to assess whether HIV and other illness were significant stressors for caregiver anxiety, whether social support had main or stress-buffering protective effects on anxiety and whether gender moderated the association between social support and anxiety. Our findings showed significant main effects of social support on caregiver anxiety, but no evidence of stress-buffering effects of support or of gender moderating the support-anxiety relationship. This suggests that social support is a general mental health resource for both male and female caregivers of children in these HIV-endemic communities, regardless of whether they are facing specific stressors related to HIV or other illness. Our results highlight the importance of paying greater attention to the social environment when designing and implementing caregiver health interventions, and indicate that social support could be a valuable component of such interventions.

Grandparental Involvement and South African Adolescents’ Psychological Well-Being

This study was designed to explore the grandparent-grandchild relationship from the perspective of South African adolescents, and to investigate whether grandparental involvement is independently associated with adolescents’ psychological well-being. Data were collected from 204 adolescents (mean age = 13.69) using a school-based survey. Results revealed high levels of contact between grandparents and grandchildren, although involvement varied depending on grandparent, grandchild, and family characteristics. Grandparental involvement was significantly associated with more adolescent prosocial behavior, independent of parental involvement. The findings suggest a unique association between grandparental involvement and prosocial behavior that is robust across different cultural contexts.

Family functioning and suicidal ideation/behaviour in adolescents: a pilot study

Objective: The main aim of this study was to explore the associations between specific aspects of family functioning and adolescent suicidal ideation/behaviour. Method: Participants were 87 high school students (43 male and 44 female) aged between 14 and 16 years of age. They completed a questionnaire measuring various aspects of family functioning and suicidal ideation/behaviour. The specific dimensions of family functioning assessed were: connection, psychological control and behavioural regulation in the parent-adolescent relationship, family conflict and family structure. Results: The results of t-test and chi-square analyses indicated that adolescents who reported suicidal ideation or behaviour in the previous year experienced lower levels of connection and regulation and higher levels of conflict and psychological control in the parent-child relationship than non-suicidal adolescents. Family structure and interparental conflict were not significantly associated with suicidal ideation/behaviour. Conclusions: The quality of relationships between adolescents and both of their parents may be important in distinguishing South African adolescents with recent suicidal ideation/behaviour from non-suicidal controls.