The mental health of orphans and vulnerable children within the context of HIV/AIDS in Ghana

Abstract

Background: The HIV/AIDS epidemic has contributed to a drastic increase in the number of orphans and vulnerable children in sub-Saharan Africa. However, little is known about the mental health of these children in low prevalence areas such as Ghana. The thesis investigated the relationship between orphanhood, parental HIV/AIDS status and mental health. It further examined the mediating effects of identified risk and protective factors on the relationship between orphanhood/parental HIV/AIDS status and psychological difficulties. Finally, the thesis identified pathways through which HIV/AIDS impacts children by exploring the interactive and cumulative effects of the various risk and protective factors on psychological difficulties. Method: The thesis employed cross-sectional, quantitative interviews that involved 291 children aged 10-18 years and their caregivers that compared children who have lost their parents to AIDS, those who have lost their parents to other causes, those who are living with HIV/AIDS-infected caregivers and children from intact families in the Manya Krobo district in Ghana. ANOVAs, T-tests, General Linear Models, Log-linear Analyses, Chi-Squares and Bivariate Correlations were used to analyze the data that were obtained from both the children and their caregivers. Results: After controlling for relevant socio-demographic factors, both children and informants’ reports showed that children orphaned by AIDS and those living with infected parents showed higher delinquency (p <.01), peer problems (p <.001), hyperactivity (p <.01) and lower self esteem (p <.001) than other orphans and children from intact families. AIDS orphans, other orphans and those living with HIV/AIDS-infected parents all reported significantly more depression (p <.001) and relationship problems (p <.001) than those for intact families. Conduct problems as indicated by informants’ reports were generally, significantly higher for orphans and vulnerable children compared to children from intact families. Over 70% of both AIDS orphans and children living with infected parents showed internalising symptoms that were above clinical cut-offs for abnormality. AIDS orphans and children living with infected parents reported more stigma, abuse, child labour and lower levels of SES and lower perceived social support. These factors independently, strongly mediated the relationship between orphanhood, parental HIV/AIDS status and mental health. The interactive and cumulative effect of engagement in child labour and being physically abused heightened the risks for depressive symptoms from 38% to 66%. Neglect and psychological abuse increased the risks for symptoms of Reactive Attachment Disorder from 26.6% to 67.3%. The cumulative effect of stigma and either child labour or physical abuse substantially increased the likelihood of delinquency symptoms to approximately 67%. Conclusion: The findings demonstrated that both AIDS orphans and children living with HIV/AIDS-infected parents showed heightened psychosocial symptoms. The present evidence also highlighted the interactive, cumulative, co-occurrence of contextual factors and HIV/AIDS unique exposures to create heightened vulnerabilities for psychological difficulties among children. The findings call for a comprehensive intervention programme that addresses factors specific to HIV/AIDS and contextual variables.