291960
Prevalence of mental health problems and protective factors in children and adolescents affected and unaffected by HIV/AIDS in rural Rwanda
Tuesday, November 5, 2013
: 11:30 a.m. - 11:50 a.m.
Theresa Betancourt, ScD, MA,
FXB Center for Health and Human Rights; Department of Global Health and Population, Harvard University / Harvard School of Public Health, Boston, MA
Josee Mukandanga,
Partners In Health Rwanda/Inshuti Mu Buzima, Rwinkwavu, Rwanda
Lauren Ng, PhD,
FXB Center for Health and Human Rights, Harvard University, Boston
Anne Stevenson, MSc,
FXB Center of Health and Human Rights; Department of Global Health and Population, Harvard School of Public Health, Boston, MA
William Beardslee, MD,
Department of Psychiatry; Center for Behavioral Science, Boston Children's Hospital, Boston, MA
Background: Children infected with and affected by HIV are at increased risk of mental health problems, which has implications for risk behavior, educational attainment and provision of healthcare services. Methods: A case-control design was used to assess the prevalence of mental health problems among N= 680 children aged 10-17 who are (a) HIV-infected; (b) HIV-affected but not infected (i.e. children who have an HIV-positive caregiver); and (c) non-HIV-affected, in southern Kayonza and Kirehe districts in Rwanda. Children and their caregivers were assessed for child mental health, functioning, and resilience factors. Sampling followed a 3-part procedure: electronic medical records identified all HIV-infected children 10-17, community health workers assembled stratified lists of all HIV-affected and non-affected children in the same villages, and one participant was randomly sampled from each of these two lists, matched at the village level, to compare with each HIV-infected child. Results: HIV-affected children had significantly worse mental health outcomes than HIV-unaffected children whereas HIV+ children did not. Compared with HIV non-affected children, HIV-affected children reported significantly higher levels of depression- mean symptom score 32.4 (95% CI 30.0-34.8) vs 26.8 (95% CI 24.5-29.2), p < .001, and impaired functioning- mean score 16.6 (95% CI 15.1-18.1) vs 13.4 (95% CI 11.9-14.8), p = .002; however, HIV-positive children did not report significantly higher levels compared with HIV non-affected children. Conclusions: HIV-affected children, in addition to HIV+ children, are at increased risk for mental health problems and require increased attention in programming and policy in low resource settings.
Learning Areas:
Advocacy for health and health education
Assessment of individual and community needs for health education
Chronic disease management and prevention
Program planning
Provision of health care to the public
Learning Objectives:
Describe resilience and mental health of children affected by HIV in rural Rwanda
Identify potential mechanisms for mental health problems in HIV affected children
Discuss future interventions that may prevent or reduce mental health problems in HIV affected children
Presenting author's disclosure statement:Qualified on the content I am responsible for because: I have been the Principal Investigator of multiple federally funded grants focusing on the developmental and psychosocial consequences of concentrated adversity on children and families, resilience and protective processes in child and adolescent mental health, and applied cross-cultural mental health research. My research aims to provide effective protections and services for children and families affected by communal violence/armed conflict, HIV/AIDS, and other forms of adversity.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines,
and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed
in my presentation.
