title: Persisting mental health problems among AIDS-orphaned children in South Africa.
abstract: BACKGROUND
  By 2008, 12 million children in sub-Saharan Africa were orphaned by AIDS. Cross-sectional studies show psychological problems for AIDS-orphaned children, but until now no longitudinal study has explored enduring psychological effects of AIDS-orphanhood in the developing world.
  
  
  METHODS
  A 4-year longitudinal follow-up of AIDS-orphaned children with control groups of other-orphans and non-orphans. 1021 children (M = 13.4 years, 50% female, 98% isiXhosa-speaking) were interviewed in 2005 and followed up in 2009 with 71% retention (49% female, M = 16.9 years), in poor urban South African settlements. Children were interviewed using sociodemographic questionnaires and well-validated standardised scales for assessing depression, anxiety, and post-traumatic stress. Data were analysed using mixed-design ANOVA and backward-stepping regression.
  
  
  RESULTS
  AIDS-orphaned children showed higher depression, anxiety, and post-traumatic stress disorder (PTSD) scores in both 2005 and 2009 when compared with other-orphans and non-orphans. Backward-stepping regression, controlling for baseline mental health, and sociodemographic cofactors such as age, gender, and type of bereavement, revealed that being AIDS-orphaned in 2005 was associated with depression, anxiety, and PTSD scores in 2009. This was not the case for other-orphaned or non-orphaned children. Age interacted with orphan status, such that there was a steep rise in psychological distress in the AIDS-orphaned group, but no rise with age amongst other-orphans and non-orphans.
  
  
  CONCLUSIONS
  Negative mental health outcomes amongst AIDS-orphaned children are maintained and worsen over a 4-year period. It is important that psychosocial support programmes are sustained, and focus on youth as well as young children.
authors: Centre for Evidence-Based Intervention, Department of Social Policy and Intervention, University of Oxford, Oxford, UK. lucie.cluver@spi.ox.ac.uk
authors: Lucie D
authors: LD
authors: Cluver
authors: Mark
authors: M
authors: Orkin
authors: Frances
authors: F
authors: Gardner
authors: Mark E
authors: ME
authors: Boyes
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology* / Q000523:psychology*; D000293:Adolescent; D017677:Age Distribution; D000704:Analysis of Variance; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D054540:Child, Orphaned / Q000523:psychology* / Q000706:statistics & numerical data; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology*; D011203:Poverty / Q000523:psychology / Q000706:statistics & numerical data; D013019:South Africa / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D011795:Surveys and Questionnaires; D014505:Urban Population / Q000706:statistics & numerical data