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Mental health of carers of children affected by HIV attending community-based programmes in South Africa and Malawi

机译：在南非和马拉维参加社区计划的艾滋病毒感染儿童的照顾者的心理健康

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There is strong evidence that both adults and children infected with and affected by HIV have high levels of mental health burden. Yet there have been few studies investigating carer mental health outcomes in the context of HIV in Malawi and South Africa. The objective of this study was to assess the mental health of carers of children affected by HIV as a part of the Child Community Care study, which aims to generate evidence on the effectiveness of community-based organisation (CBO) services to improve child outcomes. In a cross-sectional study, we interviewed 952 carers of children (aged 4-13 years) attending 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Psychological morbidity was measured using the Shona Symptom Questionnaire and suicidal ideation was measured using an item from the Patient Health Questionnaire. Carers were asked about care-seeking for emotional problems. Overall, 28% of carers scored above the clinical cut-off for current psychological morbidity and 12.2% reported suicidal ideation. We used logistic regression models to test factors associated with poor outcomes. Household unemployment, living with a sick family member and perceived lack of support from the community were associated with both psychological morbidity and suicidal ideation in carers. Reported child food insecurity was also associated with psychological morbidity. In addition, carers living in South Africa were more likely to present with psychological morbidity and suicidal ideation than carers in Malawi. Rates of help-seeking for mental health problems were low. Carers of children affected by HIV are at risk for mental health problems as a result of HIV, socio-economic, care-giving and community factors. We call for increased recognition of the potential role of CBOs in providing mental health care and support for families as a means to improve equity in mental health care. Specifically, we highlight the need for increased training and supervision of staff at CBOs for children affected by HIV, and the inclusion of CBOs in broader efforts to improve population mental health outcomes.
机译：有强有力的证据表明，感染了艾滋病毒并受其影响的成年人和儿童均具有很高的精神健康负担。但是，在马拉维和南非，很少有研究针对艾滋病毒感染者的心理健康状况进行研究。这项研究的目的是评估儿童感染者的照料者的心理健康，这是“儿童社区护理”研究的一部分，该研究旨在为基于社区的组织（CBO）服务改善儿童结局的有效性提供证据。在一项横断面研究中，我们采访了952名儿童看护人（4-13岁），他们参加了由南非和马拉维的11个主要捐助者资助的28个随机选择的社区组织。使用Shona症状问卷对心理发病率进行测量，并使用“患者健康问卷”中的一项对自杀意念进行测量。照顾者被问及寻求照顾以解决情绪问题。总体而言，有28％的护理人员的当前心理发病率得分高于临床临界值，而有12.2％的人报告有自杀意念。我们使用逻辑回归模型测试与不良结果相关的因素。家庭失业，与生病的家庭成员一起生活以及社区缺乏支持感与护理人员的心理发病率和自杀意念有关。报告的儿童粮食不安全状况也与心理发病率有关。此外，与马拉维的看护者相比，生活在南非的看护者更容易出现心理疾病和自杀念头。为精神健康问题寻求帮助的比率很低。由于艾滋病毒，社会经济，照料和社区因素，受艾滋病毒影响的儿童的照料者有可能面临精神健康问题。我们呼吁人们更多地认识到社区组织在为家庭提供精神保健和支持方面的潜在作用，以此作为改善精神保健公平性的一种手段。具体而言，我们强调有必要在社区组织中对受艾滋病毒感染的儿童进行培训和监督，并将社区组织纳入更广泛的工作中，以改善人口心理健康状况。

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