title: Risk and protective factors for internalizing and externalizing outcomes among HIV-affected youth in Haiti.
abstract: The present study aims to: (1) estimate the levels of internalizing symptoms and externalizing behaviors among youth affected by HIV in central Haiti; and (2) examine the risk and protective factors associated with these outcomes to identify potential areas of intervention for HIV-affected youth. Baseline data for 492 youth affected by HIV (ages 10-17) and their 330 caregivers were collected for a pilot study of a psychosocial support intervention. Participants were recruited from a list of HIV-positive patients receiving care at Partners In Health/Zanmi Lasante clinic sites. Internalizing and externalizing behaviors were assessed using the Strengths and Difficulties Questionnaire. Demographic, economic, and social indicators were collected using a structured questionnaire administered by trained social workers. Youth affected by HIV in central Haiti displayed high levels of internalizing and, to a lesser degree, externalizing symptoms. Multivariate regression analysis demonstrated risk factors most strongly associated with internalizing symptoms (socioeconomic status, parental depressive symptoms) and externalizing behaviors (household living arrangements, such as living with a stepparent). Social support had a protective effect on externalizing behaviors for both caregiver (β=-0.03, p=0.01) and self-report (β=-0.05, p<0.0001). High levels of psychological distress were observed in this population, especially with respect to internalizing outcomes. Interventions should address the economic security, mental health, and access to antiretroviral therapy for families affected by HIV, as well as emphasize the importance of building supportive caregiver-child relationships to decrease the psychological symptoms and impact of other life stressors experienced by youth affected by HIV in Haiti and similar resource-limited settings.
authors.affiliation: a Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Li
authors.forename: Theresa
authors.initials: T
authors.lastname: Betancourt
authors.forename: Eddy
authors.initials: E
authors.lastname: Eustache
authors.forename: Catherine
authors.initials: C
authors.lastname: Oswald
authors.forename: Ermaze
authors.initials: E
authors.lastname: Louis
authors.forename: Joia
authors.initials: J
authors.lastname: Mukherjee
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.forename: Mary C
authors.initials: MC
authors.lastname: Smith Fawzi
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D019380:Anti-HIV Agents / Q000627:therapeutic use; D001007:Anxiety / Q000523:psychology; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D005190:Family / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006205:Haiti / Q000453:epidemiology; D006801:Humans; D007389:Internal-External Control; D008297:Male; D010290:Parents / Q000523:psychology; D010865:Pilot Projects; D015995:Prevalence; D065840:Protective Factors; D012111:Residence Characteristics; D012306:Risk; D012307:Risk Factors; D012944:Social Support; D011795:Surveys and Questionnaires
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-affected; Haiti; adolescents; caregivers; mental health; youth