Tag: emotional well being

Difference in psychosocial well-being between paternal and maternal AIDS orphans in rural China.

Written by matthew on . Posted in Educational Impact, OVC and HIV/AIDS, Psychological Effects of Orphanhood. Leave a Comment

Title: Difference in psychosocial well-being between paternal and maternal AIDS orphans in rural China

Authors: Qun Zhao, Xiaoming Li, Xiaoyi Fang, Guoxiang Zhao, Junfeng Zhao, Xiuyun Lin, Bonita Stanton

Date: 2010

Abstract: This study compares psychosocial well-being between paternal and maternal orphans in rural China in a sample (n = 459) of children who had lost one parent to HIV and who were in family-based care. Measures included academic marks, education expectation, trusting relationships with current caregivers, self-reported health status, depression, loneliness, posttraumatic stress, and social support. No significant differences were reported between maternal and paternal orphans, except that paternal orphans reported better trusting relationships with caregivers than maternal orphans. Children with a healthy surviving parent reported significantly better scores for depression, loneliness, posttraumatic stress, and social support than children with a sick parent. Analyses showed significance with regard to orphan status on academic marks and trusting relationships with caregivers while controlling for age, gender, surviving parent’s health status, and family socioeconomic status. Results underscore the importance of psychosocial support for children whose surviving parent is living with HIV or another illness.

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Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study

Written by matthew on . Posted in Longterm Consequences of Orphanhood, Psychological Effects of Orphanhood. 1 Comment

Title: Violence and abuse among HIV-infected women and their children in Zambia: a qualitative study

Authors: Laura Murray, Alan Haworth, Katherine Semrau, Mini Singh, Grace Aldrovandi, Moses Sinkala, Donald Thea, Paul Bolton

Date: 2006

Abstract: HIV and violence are two major public health problems increasingly shown to be connected and relevant to international mental health issues and HIV-related services. Qualitative research is important due to the dearth of literature on this association in low-income countries, cultural influences on mental health syndromes and presentations, and the sensitive nature of the topic. The study presented in this paper sought to investigate the mental health issues of an HIV-affected population of women and children in Lusaka, Zambia, through a systematic qualitative study. Two qualitative methods resulted in the identification of three major problems for women: domestic violence (DV), depression-like syndrome, and alcohol abuse; and children: defilement, DV, and behavior problems. DV and sexual abuse were found to be closely linked to HIV and alcohol abuse. This study shows the local perspective of the overlap between violence and HIV. Results are discussed in relation to the need for violence and abuse to be addressed as HIV services are implemented in sub-Saharan Africa.

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Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth

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Title: Cognitive behavioral therapy for symptoms of trauma and traumatic grief in refugee youth

Author: Laura Murray, Judith Cohen, B Heidi Ellis, Anthony Mannarino

Date: 2008

Abstract: The diverse clinical presentation of refugee children and adolescents after their traumatic experiences requires a treatment model that can mitigate a number of internalizing and externalizing symptoms. Refugee populations also require interventions that can adjust to the wide-ranging experiences likely encountered during preflight, flight, and resettlement. There is some evidence that immigration stressors or social stressors, such as discrimination, are associated with symptoms of posttraumatic stress disorder in refugee youth. Therefore refugee youth may benefit from multiple levels of services, ideally integrated. This article focuses on the mental and behavioral health component of services for refugee youth.

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Treatment of Suicidal and Self-Injurious Adolescents with Emotional Dysregulation

Written by matthew on . Posted in Emotional Wellbeing. 1 Comment

Study Title: Treatment of Suicidal and Self-Injurious Adolescents with Emotional Dysregulation

Study Aims: The long term aim of our research is to develop and evaluate effective treatments for adolescents at high risk for suicide that will reduce suicidal and self-injurious behaviors as well as improve functioning and the quality of life of teens and their families. The primary aim of the research proposed here is to evaluate the efficacy of dialectical behavior therapy (DBT) for adolescents by comparing it to a combined individual and group supportive therapy control condition (I/GST) chosen specifically to maximize internal validity.

Methods: Subjects will be 170 teens 13-17 years old with borderline personality traits referred to treatment due to high risk for suicide. Outcome targets include reduced frequency and severity of suicidal behaviors, especially suicide attempts, inpatient or ER treatment for suicidality, increased maintenance in and compliance with treatment, and enhanced functioning across multiple domains. DBT has an empirical track record with adults of reducing the incidence, frequency and medical risk of suicide attempts and non-suicidal self-injuries among individuals meeting criteria for borderline personality disorder (BPD). However, although DBT is widely used with suicidal adolescents, particularly those with difficulties characteristic of BPD such as poor emotion regulation and impulse control, no randomized trial of DBT with adolescents has been conducted. Thus, although non- randomized trials suggest effectiveness, without a randomized trial we simply do not know whether DBT for adolescents is efficacious or not. Given the severity of the problem and the lack of alternative treatments for high risk adolescents, addressing this question is important. The second aim of this research is to analyze mediators of reduced suicidal and self-injurious behaviors in adolescents. DBT is based on a theoretical model that suicidal behavior is a combined outcome of high stressful events and emotion dysregulation together with inadequate behavioral skills for coping with negative emotions and life events. Risk factors for adolescent suicide and intentional self-injury include most importantly family conflict but also conflict with peers, teachers, losses, legal or disciplinary problems (stressful events) combined with high negative emotions and inadequate abilities in emotion regulation. We will analyze the potential mediating effects on suicidal behaviors of decreases in family conflict, increases in parent DBT behavioral skills, reductions in emotion dysregulation and increases in DBT behavioral skills. Preliminary data on cost-effectiveness will also be collected.

Investigators: Michele Stacy Berk, Judith Cohen

Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Youth in Residential Treatment

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Study Title: Trauma-Focused Cognitive Behavioral Therapy for Adjudicated Youth in Residential Treatment

Context: Adjudicated youth have high rates of trauma exposure and   Stress Disorder (PTSD) which place them at increased risk for future offending and incarceration. Few of these youth receive evidence-based developmentally appropriate PTSD treatment.

Study Aims: Adjudicated youth have high rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) but most have never received effective treatment. The purpose of this study is to test two alternative methods for training therapists to deliver an evidence- based trauma treatment to adjudicated youth with PTSD symptoms during residential treatment and therefore decrease their risk of future offending and incarceration

Methods: This study proposes to evaluate two alternative strategies for training therapists to deliver a proven youth trauma treatment, Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) to adjudicated youth in ten juvenile justice RTF programs in New England. All RTF programs will receive organizational readiness consisting of 1) novel integrated trauma training for RTF staff (direct care milieu staff, teachers and administrators) about trauma impact and how to support TF-CBT implementation in the RTF; and 2) PTSD assessment training for therapists. Randomization will then occur within each RTF program at the therapist level, to one of two TF-CBT delivery strategies: 1) Web-based TF-CBT Delivery (“W”) in which therapists will receive web-based training and web-based consultation via the TF-CBTWeb and TF-CBTConsult distance learning programs; or 2) W+ Live (“W+L”) in which therapists will receive W+ face-to-face 2-day expert TF-CBT training and ongoing twice monthly expert phone consultation and training to TF-CBT fidelity standards via audiotape rating. The study’s central hypothesis is that W+L will lead to superior outcomes. However, based on cost- effectiveness analyses, W may be acceptable. The study will evaluate the differences in outcomes between the two strategies in terms of the following hypotheses: 1) fidelity: W+L strategy will lead to greater treatment fidelity and to youth receiving greater RTF staff support in TF-CBT delivery than W; several mechanisms are proposed for these differences; 2) improved youth outcomes: W+L will lead to greater improvement in youth PTSD and depressive symptoms than W; and 3) broad and sustained TF-CBT uptake: more youth will receive TF-CBT from W+L than from W therapists; 4) cost effectiveness: W may be acceptable due to cost effectiveness analyses.

Principal Investigator: Judith Cohen (Allegheny General Hospital)

Depressive symptoms in youth heads of household in Rwanda – Correlates and implications for intervention

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Title: Depressive symptoms in youth heads of household in Rwanda – Correlates and implications for intervention

Authors: Neil Boris, Lisanne Brown, Tonya Thurman, Janet Rice, Leslie Snider, Joseph Ntaganira, Laetitia Nyirazinyoye

Abstract: Objective: To examine the level of depressive symptoms and their predictors in youth from one region of Rwanda who function as heads of household (ie, those responsible for caring for other children) and care for younger orphans. Design: Cross-sectional survey Setting: Four adjoining districts in Gigonkoro, an impoverished rural province in southwestern Rwanda. Participants: Trained interviewers met with the eldest member of each household (n=539) in which a youth 24 years old or younger was caring for 1 child or more. Main Exposure: Serving as a youth head of household. Main Outcome Measures: Rates and severity of depressive symptoms using the Center for Epidemiologic Studies Depression scale; measures of grief, adult support, social marginalization, and sociodemographic factors using scales developed for this study. Results: Of the 539 youth heads of household, 77% were subsistence farmers and only 7% had attended school for 6 years or more. Almost half (44%) reported eating only 1 meal a day in the last week, and 80% rated their health as fair or poor. The mean score on the Center for Epidemiologic Studies Depression scale was 24.4, exceeding the most conservative published cutoff score for adolescents. Multivariate analysis revealed that reports of depressive symptoms that exceeded the clinical cutoff were associated with having 3 basic household assets or fewer, such as a mattress and a spare set of clothes (odds ratio [OR], 1.69; 95% confidence inter-vat [CI], 1.06-2.70), eating less than 1 meal per day (OR, 1.68; 95% CI, 1.092.60), reporting fair health (OR, 1.32; 95% CI, 0.762.29) or poor health (OR, 2.33; 95% CI, 1.17-4.64), endorsing high levels of grief (OR, 2.67; 95% CI, 1.734.13), having at least 1 parent die in the genocide as opposed to all other causes of parental death (OR, 1.83; 95% CI, 1.10-3.04), and not having a close friend (OR, 1.91; 95% CI, 1.1.7-3.1.2). There was an interaction between marginalization from the community and alcohol use; youth who were highly marginalized and did not drink alcohol were more than 3 times more likely to report symptoms of depression (OR, 3.07-1 95% CI, 1.73-5.42). When models were constructed by grouping theoretically related variables into blocks and controlling for other blocks, the emotional status block of variables (grief and marginalization) accounted for the most variance in depressive symptoms. Conclusions: Orphaned youth who head households in rural Rwanda face many challenges and report high rates of depressive symptoms. Interventions designed to go beyond improving food security and increasing household assets may be needed to reduce social isolation of youth heads of household. The effect of head-of-household depressive symptoms on other children living in youth-headed households is unknown.

[button link=”http://archpedi.jamanetwork.com/article.aspx?volume=162&issue=9&page=836″ color=”green” newwindow=”yes”] View Manuscript Here[/button]

Psychological Distress in Orphan, Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities

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Title: Psychological Distress in Orphan, Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities

Authors: Killian, B. and K. Durrheim.

Date: 2008

Abstract: The degree of psychological distress and access social support is investigated in children (n = 741) living in nine high prevalence HIV/AIDS communities. They comprised (1) vulnerable, maternally-orphaned (n = 319); (ii) vulnerable and not orphaned (n = 276); and (iii) typically developing (n = 146). The following psychometric tests were administered: The Trauma Symptom Checklist for Children (Townsend, 2002); the Reynolds Depression Scale for Children (Reynolds, 1989); and the Social Support Scale (Beale Spencer, Cole, Jones & Phillips Swanson, 1997). Primary caregivers completed the Conners’ Parent Rating Scale (Conners, Parker, Sitarenios, & Epstein, 1998) and an Adversity Index (Killian, 2004a) to establish the vulnerability status of each child. The data were analysed to distinguish the groups from each other regarding profiles of distress. The findings suggest that vulnerable children, be they orphaned or not, manifest similar degrees of emotional distress and perceived themselves as unable to access social support. Interventions should address the needs of both orphans and other vulnerable children, without prioritising the needs of orphans over other vulnerable children.

Citation: Killian, B. and K. Durrheim (2008). “Psychological Distress in Orphan, Vulnerable Children and Non-Vulnerable Children in High Prevalence HIV/AIDS Communities.” Journal of Psychology in Africa 18(3): 421-429.

The educational and psychological experiences of children orphaned by AIDS in Western Kenya

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Title: The educational and psychological experiences of children orphaned by AIDS in Western Kenya

Author: Grace Jepkemboi

Date: 2007

Abstract: The purpose of this study was to describe the perceptions of teachers and caregivers concerning the psychological and educational experiences of children orphaned by AIDS in Western Kenya. On the basis of qualitative inquiry, the design of the study focused on phenomenology inquiry. Audio-taped interviews were used as the primary source to gather data for this study. The questions that guided the study were “What are the psychological characteristics of children orphaned by AIDS in Kenya?” “What are the educational experiences of children orphaned by AIDS?” and “What strategies do the teachers and caregivers at the orphanages use to help the children orphaned by AIDS cope with the loss of the parent(s)?”

There were 20 participants, 12 teachers and 8 caregivers, in seven orphanages who volunteered to participate in the study. Findings of the study revealed that the children orphaned by AIDS went through a continuum of experiences. At one end of the continuum are the experiences that arise as the children see their parents develop signs of HIV/AIDS, become terminally ill, and eventually die. Children were most affected psychologically and educationally in their first year in the orphanages. Some of the emotions they expressed were feeling sad, rejected and unwanted, lonely, strange, in need of acceptance, gloomy, dull, cold, worried, desperate, afraid, hopeless, angry, annoyed, upset, feeling stigmatized, in panic, disturbed, frustrated, confused, tensed, angry, reserved, desperate, violent, stigmatized, emotional, and in grief.

At the other end of the continuum are the emotions, personalities, and attitudes of the orphaned children toward the end of the first year and in the second year, which included being happy, hopeful, trusting, confident, respectful, outgoing, cooperative, warm, complacent, and courageous. The techniques that teachers and caregivers used to help children cope with grief after the loss of the parent(s) are also described. The results of the study could provide information for early childhood educators, psychologists, administrators at orphanages, and policy makers, as they consider the psychological and educational needs of the children orphaned by AIDS.

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Experiences of Children Heading Households

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Title: Experiences of Children Heading Households in Hammarsdale, KwaZulu-Natal, South Africa

Author: Nomlindo Dlungwana, Reshmna Sathiparsad

Date: 2008

Abstract: This study explored the experiences of children who are heads of households, particularly with regard to the psychological, emotional and social effects of heading a household, and access to schooling and support services. Fifteen children (females, n=9; males, n=6; age range 3 to 18) participated. Data were collected using in-depth interviews. Content analysis was employed in the qualitative analysis of the data. The findings revealed that many children from child-headed households lived in poverty, experienced psychological and emotional problems, received limited or no support from relatives and had irregular school attendance. Children heading households face ongoing challenges in relation to fulfilling their basic needs for food, clothing, shelter and security.

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Malawi Orphans and Vulnerable Children Evaluation (MOVE)

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Title: Malawi Orphans and Vulnerable Children Evaluation (MOVE) 

Context: Between 700,000 and 1.2 million children in Malawi have been orphaned by AIDS, and many others are vulnerable. The Funders’ Collaborative for Children (FCFC), a novel collaboration between 4 independent funding organizations, is funding an intervention that aims to establish a collaborative, replicable, and sustainable model of prevention, treatment, and care which will result in a “system of care” better able to support children and their families than the currently fragmented organization of agencies and groups.  The program is implemented in Salima District, Malawi, by Family Health International (FHI) in collaboration with XXX implementing partner organizations. Duke University and Malawi’s College of Medicine were contracted to jointly evaluate the effectiveness of the 5-year program. MOVE assesses the impact of the intervention on child outcomes in four domains: health; education; social welfare; and nutrition and livelihood. 

Study Aims: The FCFC intervention aims to improve the lives of 65 percent of vulnerable children in Salima District in terms of their education, health, livelihood, and social welfare. Researchers at Duke University and the College of Medicine will determine if the Funder’s Collaborative for Children achieved its objective.

Methods: The effectiveness of this intervention model is evaluated using qualitative and quantitative monitoring and evaluation methods. Repeated cross-sectional cluster surveys with a total of 1,260 vulnerable children and their caregivers assess district-level intervention coverage and changes in outcomes over time.  Repeat assessments with 200 of these children, half in intervention areas and half in non-intervention areas seek to attribute changes to the program.  Twice-annual surveys with implementing partners assess changes in scale and scope of service delivery.

Policy Implications:

This evaluation will determine if the FCFC intervention is effective in improving the wellbeing of orphans and other vulnerable children in Salima District, Malawi. If the evaluation demonstrates that the intervention is effective, it will help funders and national policymakers design more integrated and more effective care systems for orphans and vulnerable children.

Investigators: Karen O’Donnell (Duke University) Jan Ostermann (Duke University), Eric Umar (College of Medicine, Malawi), Kathryn Whetten (Duke University), Sara Legrand (Duke University)

Funding Source: Funders’ Collaborative for Children (Children’s Investment Fund Foundation, Comic Relief, Elton John AIDS Foundation and the Diana Princess of Wales Memorial Fund)

Contact: duke.ovcstudies@gmail.com

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