Exposure to violence and psychological well-being over time in children affected by HIV/AIDS in South Africa and Malawi

Figures & data

Figure 1. Rates of domestic and community violence and harsh psychological discipline as a function of child HIV burden. Chi-square difference test was performed for all three types of violence *p < .05, **p < .01.

Table 1. Associations between exposure to violence and child functioning and mental health.

	Depressive symptoms	P	Trauma symptoms	p	Self-esteem	p	Internalising problems	p	Externalising problems	P	Int. & ext. problems	p
	M (SD)		M (SD)		M (SD)		M (SD)		M (SD)		M (SD)
Domestic violence
Any (n = 462)	1.22 (1.76)	≤.0001	4.69 (3.58)	≤.0001	20.46 (2.59)	≤.0001	2.02 (1.66)	.002	1.31 (1.43)	≤.0001	3.33 (2.55)	≤.0001
None (n = 510)	0.69 (0.96)		3.41 (2.92)		21.50 (3.08)		1.71 (1.43)		0.99 (1.22)		2.70 (2.17)
Community violence
Any (n = 413)	1.05 (1.61)	n.s.	4.68 (3.66)	≤.0001	20.86 (2.88)	n.s.	2.01 (1.61)	.01	1.27 (1.48)	.02	3.28 (2.56)	.003
None (n = 559)	0.86 (1.23)		3.42 (2.84)		21.11 (2.84)		1.75 (1.51)		1.06 (1.21)		2.82 (2.23)
Harsh physical discipline
Any (n = 473)	1.00 (1.41)	n.s.	4.12 (3.14)	n.s.	20.42 (2.55)	≤.0001	2.21 (1.64)	≤.0001	1.55 (1.40)	≤.0001	3.75 (2.45)	≤.0001
None (n = 516)	0.90 (1.45)		3.93 (3.46)		21.51 (3.04)		1.52 (1.39)		0.79 (1.16)		2.31 (2.09)
Harsh psychological discipline
Any (n = 449)	1.01 (1.48)	n.s.	4.29 (3.50)	n.s.	20.71 (2.73)	.009	2.16 (1.67)	≤.0001	1.37 (1.40)	≤.0001	3.53 (2.48)	≤.0001
None (n = 540)	0.89 (1.38)		3.80 (3.14)		21.22 (2.95)		1.59 (1.40)		0.97 (1.25)		2.56 (2.21)

Notes: p-Value associated with independent t-tests.

Depression scale (CDI) valid for 7–13-year olds (n = 720), TSCC valid for 8–13-year olds (n = 650).

Table 2. Associations between exposure to violence and risk behaviour among 10–13-year olds (n = 469).

	Delinquency		X^2 (df), p value
	Any (n = 163)	None (n = 306)
Domestic violence
Any (n = 462)	98 (60.1%)	121 (39.7%)	17.84 (1), ≤.0001
None (n = 510)	65 (39.9%)	184 (60.3%)
Community violence
Any (n = 413)	103 (63.2%)	126 (41.3%)	20.35 (1), ≤.0001
None (n = 559)	60 (36.8%)	179 (58.7%)
Harsh physical discipline
Any (n = 473)	93 (57.1%)	131 (42.8%)	8.65 (1), .004
None (n = 516)	70 (42.9%)	175 (57.2%)
Harsh psychological discipline
Any (n = 449)	90 (55.2%)	130 (42.5%)	6.92 (1), .009
None (n = 540)	73 (44.8%)	176 (57.5%)

Table 3. Linear regression models showing predictors of child outcomes.

	Depressive symptoms		Trauma symptoms		Self-esteem		Internalising problems		Externalising problems		Int. & ext. problems
	B	β	B	β	B	β	B	β	B	β	B	β
South Africa	−.24	−.07	−1.9***	−.23***	.65*	.87*	−.22	−.05	.41**	.11**	.19	.03
Age	−.03	−.04	−.007	−.003	.14**	.12**	−.04*	−.08*	−.08***	−.17***	−.12***	−.14***
Male	−.05	−.02	−.55*	−.08*	−.11	−.02	.02	.006	.31***	.12***	.33*	.07*
HIV- positive	−.002	.01	−.21	−.02	−.04	−.14	.55***	.12***	.007***	.002***	.55**	.08**
Domestic violence	.49***	.17***	1.1***	.17***	−.94***	−.17***	.13	.04	.17*	.06*	.30*	.07*
Community violence	.10	.03	1.0***	.16***	−.04	−.007	.18	.06	.15	.05	.32*	.07*
Harsh physical discipline	.06	.02	.39	.06	−1.0***	−.18***	.58***	.19***	.55***	.21***	1.1***	.24***
Harsh psychological discipline	.06	.02	.39	.06	−.17	−.03	.41***	.13***	.18*	.07*	.58***	.12***
R^2	.038***		.11***		.08***		.09***		.15***		.15***
F (df)	3.52 (8, 708)***		10.2 (8, 639)***		8.96 (8, 827)***		12.2 (8, 959)***		21.3 (8, 969)***		20.8 (8, 959)***

Notes: B – unstandardised coefficient and β – standardised coefficient.

*Significant at p < .05.

**Significant at p < .01.

***Significant at p < .0001.

Table 4. Logistic regression model showing predictors of risk behaviour

	Any risk behaviour (n = 163)
	Univariate		Multivariate
	Unadjusted %	Unadjusted OR (95% CI)	Adjusted OR (95% CI)
All (n = 469)	34.8%
Country
Malawi (n = 98)	17.3%	Reference	Reference
South Africa (n = 371)	39.4%	3.09 (1.76–5.43)***	3.03 (1.63–5.66)***
Age (n = 469)	M = 11.4 (SD = 0.99)	1.00 (0.83–1.21)	1.09 (0.89–1.34)
Gender
Girl (n = 240)	31.2%	Reference	Reference
Boy (n = 229)	38.4%	1.37 (0.94–2.01)	1.23 (0.81–1.86)
HIV status
HIV− (n = 409)	35.7%	Reference	Reference
HIV+ (n = 60)	28.3%	0.71 (0.39–1.29)	0.62 (0.32–1.18)
Domestic violence
None (n = 249)	26.1%	Reference	Reference
Any (n = 219)	44.7%	2.29 (1.56–3.38)***	1.89 (1.25–2.85)**
Community violence
None (n = 239)	25.1%	Reference	Reference
Any (n = 229)	45.0%	2.44 (1.65–3.61)***	2.39 (1.57–3.62)***
Harsh physical discipline
None (n = 245)	28.6%	Reference	Reference
Any (n = 224)	41.5%	1.78 (1.21–2.61)**	0.73 (1.81)
Harsh psychological discipline
None (n = 249)	29.3%	Reference	Reference
Any (n = 220)	40.9%	1.67 (1.14–2.45)**	1.23 (0.80–1.90)

*Significant at p < .05.

**Significant at p < .01.

***Significant at p < .0001.

Figure 2. Change of child mental health measures over time according to exposure to domestic and community violence and harsh physical discipline. All differences between exposure and non-exposure to these three types of violence are significant (p < .05).

Table 5. Repeated measures ANOVAs showing effects of domestic violence, community violence, harsh physical and harsh psychological discipline on change over time of several psychosocial child outcomes.

	Depressive symptoms		Trauma symptoms		Self-esteem		Internalising problems		Externalising problems		Int. & ext. problems
	F	p	F	p	F	p	F	p	F	p	F	p
Country	0.33	.57	28.93	<.001	5.93	.015	5.90	.015	22.47	<.001	0.91	.34
Age	9.64	.002	0.031	.86	1.83	.18	0.59	.44	0.32	.57	0.046	.83
Gender	0.25	.62	0.003	.96	0.34	.56	0.95	.33	0.089	.77	0.70	.40
HIV status	0.085	.77	4.41	.036	4.05	.045	4.11	.043	0.13	.72	1.43	.23
Domestic violence	5.08	.024	2.89	.090	0.71	.40	0.12	.73	7.62	.006	3.13	.077
Community violence	0.65	.42	6.47	.011	0.29	.59	0.14	.71	0.94	.33	0.63	.43
Harsh physical discipline	0.001	.98	1.09	.30	4.73	.030	7.86	.005	8.58	.003	12.60	<.001
Harsh psychological discipline	1.99	.16	0.26	.61	0.051	.82	0.013	.91	0.26	.61	0.042	.84