HIV and child mental health: a case-control study in Rwanda.

Journal: Pediatrics

Volume: 134

Issue: 2

Year of Publication: 2014

Affiliated Institutions:  Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts; Theresa_Betancourt@harvard.edu. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York; Partners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda; Program in Infectious Disease and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts;Partners In Health, Boston, Massachusetts; Department of Clinical Psychology, University of Rwanda, Butare, Rwanda; Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts; Partners In Health, Boston, Massachusetts; Department of Mental Health, Rwinkwavu Hospital, Rwinkwavu, Eastern Province, Rwanda; François-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts; and. Rwanda Biomedical Center, Ministry of Health, Mental Health Division, Kigali, Rwanda.

Abstract summary 

The global HIV/AIDS response has advanced in addressing the health and well-being of HIV-positive children. Although attention has been paid to children orphaned by parental AIDS, children who live with HIV-positive caregivers have received less attention. This study compares mental health problems and risk and protective factors in HIV-positive, HIV-affected (due to caregiver HIV), and HIV-unaffected children in Rwanda.A case-control design assessed mental health, risk, and protective factors among 683 children aged 10 to 17 years at different levels of HIV exposure. A stratified random sampling strategy based on electronic medical records identified all known HIV-positive children in this age range in 2 districts in Rwanda. Lists of all same-age children in villages with an HIV-positive child were then collected and split by HIV status (HIV-positive, HIV-affected, and HIV-unaffected). One child was randomly sampled from the latter 2 groups to compare with each HIV-positive child per village.HIV-affected and HIV-positive children demonstrated higher levels of depression, anxiety, conduct problems, and functional impairment compared with HIV-unaffected children. HIV-affected children had significantly higher odds of depression (1.68: 95% confidence interval [CI] 1.15-2.44), anxiety (1.77: 95% CI 1.14-2.75), and conduct problems (1.59: 95% CI 1.04-2.45) compared with HIV-unaffected children, and rates of these mental health conditions were similar to HIV-positive children. These results remained significant after controlling for contextual variables, there were no significant differences on mental health outcomes groups, reflecting a potential explanatory role of factors such as daily hardships, caregiver depression, and HIV-related stigma [corrected].The mental health of HIV-affected children requires policy and programmatic responses comparable to HIV-positive children.

Authors & Co-authors:  Betancourt Theresa T Scorza Pamela P Kanyanganzi Frederick F Fawzi Mary C Smith MC Sezibera Vincent V Cyamatare Felix F Beardslee William W Stulac Sara S Bizimana Justin I JI Stevenson Anne A Kayiteshonga Yvonne Y

Study Outcome 

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Statistics
Citations :  Rochat TJ, Richter LM, Doll HA, Buthelezi NP, Tomkins A, Stein A. Depression among pregnant rural South African women undergoing HIV testing. JAMA. 2006;295(12):1376–1378
Authors :  11
Identifiers
Doi : 10.1542/peds.2013-2734
SSN : 1098-4275
Study Population
Male,Female
Mesh Terms
Adolescent
Other Terms
HIV-affected;HIV-infected;HIV/AIDS;Rwanda;child;mental health
Study Design
Study Approach
Country of Study
Rwanda
Publication Country
United States