Depressive symptoms among children attending community based support in South Africa - pathways for disrupting risk factors.

Lorraine Sherr,Ana Macedo,Lucie D Cluver,Sarah Skeen,Alexa R Yakubovich,Mark Tomlinson,Kathryn J Roberts

doi:10.1177/1359104520935502

Abstract

Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children’s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.

Highlights

The HIV/AIDS epidemic has exposed many children in Southern Africa to severe structural disadvantages that raise risks of mental health distress
This study investigated whether Community Based Organisations (CBOs) attendance moderates the relationship between a range of family and structural vulnerabilities and child depressive symptoms
We examined whether three family-level factors – orphanhood, physical abuse, and household size – as well as three structural factors – exposure to community violence, household unemployment, and living in informal housing – are differentially associated with depressive symptoms among children depending on whether or not they are receiving CBO services

Summary

Introduction

The HIV/AIDS epidemic has exposed many children in Southern Africa to severe structural disadvantages that raise risks of mental health distress. Affected families experience substantial burdens of mortality and morbidity, parental and child illness, as well as a widespread psychological burden (Sherr et al, 2014; Stein et al, 2014). Parental illness and death are extreme consequences – with lifelong implications for child wellbeing (Cluver et al, 2013). The burden of HIV/AIDS can further contribute to strains on children’s living environment, such as increased poverty, diversion of household assets to healthcare, and relationship disruption (Richter et al, 2014). HIV and AIDS-affected children experience contribution demands such as replacement caregiving for others in the household and education disruptions due to lack of funds increased household responsibilities for caregiving or finance generation needs (Richter, 2010)

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Conclusion