Depression among carers of AIDS-orphaned and other-orphaned children in Umlazi Township, South Africa

Abstract

South Africa faces the challenge of supporting the well-being of adults caring for growing numbers of AIDS-orphaned children. These adults play a critical role in responses to the epidemic, but little information exists in regard to their mental health needs. This paper reports on findings from n=1599 adults, recruited through representative household sampling, who serve as primary carers for children in Umlazi Township, an HIV-endemic community. Overall, 22% of participants were carers of AIDS-orphaned children, 11% were carers of other-orphaned children and 67% were carers of non-orphaned children. Prevalence of depression was 30.3%. Orphan carers, regardless of whether they cared for AIDS-orphaned or other-orphaned children, were significantly more likely than carers of non-orphaned children to meet the clinical threshold for depression (35.2% vs. 27.9%, p < 0.01). In multivariate logistic regressions, food insecurity and being a female carer were identified as additional risk factors for greater depression. In contrast, households with access to running water and households dependent on salaries as the main source of income were identified as protective factors for disparities in depression. Mental health interventions are urgently needed to address an increased risk for depression among all orphan carers, not just those caring for AIDS-orphaned children.

Keywords:

• South Africa
• depression
• HIV/AIDS
• carer
• orphan

Acknowledgements

We would like to thank the carers in Umlazi; Professor Alan Whiteside, Dr Timothy Quinlan, Mr. S'bo Radebe, Dr Cathy Connolly and Dr Soraya Seedat for their expertise; Councilor Sthenjwa Nyawose, Ms. Mphume Sithole and Sifiso Nzama for their support; and Reggie Khanyile, Feziwe Mhlongo, Siyabonga Msomi, Nomvula Mohoto, Silindile Nyawose, Gugu Ndlovu and Thokozani Nzimande for their dedication as researchers. This research was supported by Award Number F31MH081820 to Dr Caroline Kuo and T32 MH078788 to Dr Larry Brown from the National Institute of Mental Health, the Leverhulme Trust Grant F08-599C to Dr Don Operario, and the Health Economics and HIV/AIDS Research Division at University of KwaZulu Natal. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the Leverhulme Trust.