Causes and consequences of psychological distress among orphans in eastern Zimbabwe

Figures & data

Figure 1.  Theoretical framework on the causes and consequences of psychological distress amongst orphans in the context of a large-scale HIV/AIDS epidemic.

Note: Adapted from Nyamukapa et al. (2008). Bold type indicates effects for which evidence was found in the study. Grey type indicates effects tested in the study for which no evidence was found. Standard type indicates effects not tested in the current study.

Table 1. Psychological distress variable items factor-loading results: children's responses (12–18 years olds).

Question items	Factor loadings
1. Do you cry more than usual?	0.55
2. Do you feel tense, nervous or worried?	0.54
3. Do you feel tired all the time?	0.54
4. Do you have uncomfortable feelings in your stomach?	0.48
5. Do you find it difficult to make decisions?	0.47
6. Is your appetite poor?	0.46
7. Do you feel more unhappy than usual?	0.45
8. Do you feel a worthless person?	0.44
9. Do your hands shake?	0.43
10. Do you sleep badly?	0.43
11. Is your digestion poor?	0.40
12. Are you easily frightened?	0.40
13. Do you get tired easily?	0.39
14. Do you have trouble thinking clearly?	0.38
15. Do find it difficult to enjoy your daily activities?	0.37
16. Has the thought of ending your life been In your mind?	0.31
17. Do you often have headaches?	0.31
Question items with <0.3 factor loadings: not used
18. Is your daily work suffering?
19. Are you able to play a useful part in life?
20. Have you lost interest in things?

Figure 2.  Associations between orphanhood and psychological distress by sex and form and duration of orphanhood. (a) Form of orphanhood, by sex of child. (b) Duration of orphanhood, by form of orphanhood.

Table 2. Hypothesised determinants and observed effects on psychological distress in 527 children aged 12–18 years.

				Effect on psychosocial distress
				Test for difference
Effects of orphanhood	Information source	Number	Percentage (%)	Coeff	95% CI	P-value
Immediate effects
Trauma – death in household	Caregiver	312	59	0.10	0.02–0.18	0.014
Trauma – illness in household	Caregiver	266	50	0.10	0.03–0.18	0.010
Stigma and discrimination	Child	29	6	0.41	0.27–0.56	<0.001
Relocation	Child and caregiver	56	11	0.10	−0.03–0.22	0.121
Residence in poorest quintile of households	Caregiver	178	34	0.00	−0.08–0.08	0.988
Less closely related caregiver (non-parent)	Child and caregiver	360	68	0.04	−0.04–0.12	0.327
Intermediate effects
Inadequate care	Child and caregiver	417	79	0.24	0.14–0.35	<0.001
Not enrolled in school	Child	76	14	0.26	0.14–0.38	<0.001
Inconsistent parenting	Child and caregiver	86	16	−0.02	−0.12–0.09	0.774
Child labour	Child	172	33	0.19	0.10–0.27	<0.001
Physical abuse	Child	75	14	0.27	0.17–0.38	<0.001
Sibling separation	Caregiver	102	19	−0.08	−0.19–0.02	0.114
Mitigating factors
Household received external support	Caregiver	196	37	0.03	−0.05–0.11	0.498

Table 3. Multivariate Poisson regression tests for experiences on the causal pathway between orphanhood and psychological distress, by form of orphanhood, in children aged 12–18 years.

	Orphans (444)		Double orphans (185)		Maternal orphans (109)		Paternal orphans (150)
	Test for difference		Test for difference		Test for difference		Test for difference
Model/effects of orphanhood	Coeff	P-value	Coeff	P-value	Coeff	P-value	Coeff	P-value
Sex- and age-adjusted model	0.15	0.013	0.13	0.040	0.08	0.245	0.21	0.001
Full multivariate model	0.07	0.339	−0.04	0.712	−0.02	0.873	0.17	0.044
Immediate effects
Trauma – death in household	0.10	0.040	0.11	0.214	0.17	0.063	0.02	0.767
Trauma – illness in household	0.09	0.028	0.08	0.157	−0.02	0.837	0.22	0.001
Stigma and discrimination	0.26	<0.001	0.23	0.066	0.42	0.001	0.31	0.027
Relocation	0.10	0.151	0.14	0.167	0.17	0.192	−0.07	0.636
Residence in poorest quintile of households	−0.08	0.090	−0.01	0.928	−0.20	0.011	−0.05	0.432
Less closely related caregiver (non-parent)	0.09	0.046	−	–	0.02	0.842	0.11	0.137
Intermediate effects
Inadequate care	0.19	0.001	0.23	0.007	0.30	0.001	0.14	0.110
Not enrolled in school	0.17	0.009	0.24	0.009	−0.03	0.808	0.16	0.089
Inconsistent parenting	−0.03	0.611	−0.08	0.249	0.11	0.345	0.19	0.207
Child labour	0.13	0.006	0.16	0.015	0.14	0.122	0.13	0.061
Physical abuse	0.21	<0.001	0.20	0.010	0.22	0.026	0.34	<0.001
Sibling separation	−0.11	0.044	0.00	0.963	−0.24	0.018	−0.04	0.711
Mitigating factors
Household received external support	0.00	0.994	0.16	0.017	−0.13	0.140	0.17	0.044
Note: Bold values signify statistically significant at p<0.1 level.

Nyamukapa , C. , Gregson , S. , Lopman , B. , Saito , S. , Watts , H.J. Monasch , R. 2008 . HIV-associated orphanhood and children's psychological distress: Theoretical framework tested with data from Zimbabwe . American Journal of Public Health , 98 ( 1 ) : 133 – 141 .

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