title: Neglect and perceived stigmatization impact psychological distress of orphans in Tanzania.
abstract: BACKGROUND
  Research has shown that orphans in sub-Saharan Africa are at increased risk for mental health problems. Exposure to maltreatment and HIV/AIDS-related stigmatization are related to orphans' psychological distress. Yet, researchers stress the need for more research in low-income countries to identify which factors of being an orphan may lead to psychological distress.
  
  
  OBJECTIVE
  The present study aims to systematically investigate orphans' experiences of maltreatment and stigmatization to identify factors that relate to their psychological distress.
  
  
  METHODS
  In total, 89 Tanzanian children who had lost at least one parent were compared to 89 matched non-orphans (mean age: 11 years; 51% boys). We measured exposure to maltreatment and perceived stigmatization as an orphan. Mental health was assessed using the Strengths and Difficulties Questionnaire, the Children's Depression Inventory, the UCLA PTSD Index for Children, and the Reactive-Proactive Questionnaire.
  
  
  RESULTS
  Orphans reported significantly more experiences of neglect, but not of abuse. A group comparison revealed more depressive symptoms, posttraumatic stress symptoms, and aggressive behavior among orphans. Neglect, abuse, and stigmatization correlated with orphans' internalizing and externalizing problems, yet only neglect and stigmatization were related to orphans' depression severity. Perceived stigmatization moderated the relationship between neglect and depression.
  
  
  CONCLUSIONS
  Our findings suggest that orphans in Tanzania are at increased risk of experiencing neglect. Maltreatment and perceived stigmatization may play a role in orphans' psychological distress. Culturally appropriate and evidence-based interventions may help to prevent maltreatment and stigmatization of orphans.
authors.affiliation: Department of Psychology, University of Konstanz, Konstanz, Germany.|vivo international, Konstanz, Germany.
authors.forename: Katharin
authors.initials: K
authors.lastname: Hermenau
authors.affiliation: Department of Psychology, University of Konstanz, Konstanz, Germany.
authors.forename: Ina
authors.initials: I
authors.lastname: Eggert
authors.affiliation: vivo international, Konstanz, Germany.|Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland.|Department of Psychology, University of Zurich, Zurich, Switzerland.
authors.forename: Markus A
authors.initials: MA
authors.lastname: Landolt
authors.affiliation: vivo international, Konstanz, Germany.|Department of Psychology, University of Zurich, Zurich, Switzerland; t.hecker@psychologie.uzh.ch.
authors.forename: Tobias
authors.initials: T
authors.lastname: Hecker
keywords: Orphans; maltreatment; mental health; neglect; stigmatization; sub-Saharan Africa