Health of adults caring for orphaned children in an HIV-endemic community in South Africa

Abstract

In South Africa, an estimated 2.5 million children have been orphaned by AIDS and other causes of adult mortality. Although there is a growing body of research on the well-being of South African orphaned children, few research studies have examined the health of adult individuals caring for children in HIV-endemic communities. The cross-sectional survey assessed prevalence of general health and functioning (based on Short-Form 36 version 2 scale), depression (based on Center for Epidemiologic Studies-Depression scale), anxiety (using Kessler-10 scale), and post-traumatic stress (using the Harvard Trauma Questionnaire) among a representative community sample of adults caring for children in Umlazi Township, an HIV-endemic community in South Africa. Of 1599 respondents, 33% (n=530) were carers of orphaned children. Results showed that, overall, carers reported poor general health and functioning and elevated levels of depression, anxiety, and post-traumatic stress. Carers of orphaned children reported significantly poorer general health and functioning and higher rates of depression and post-traumatic stress compared with carers of non-orphaned children. In multivariate analyses, orphan carer and non-orphan carer differences in general health were accounted for by age, gender, education, economic assets, and source of income, but differences in depression were independent of these cofactors. Interventions are needed to address physical and mental health of carers in general. Greater health problems among orphan carers appeared to be fully explained by socioeconomic characteristics, which offer opportunities for targeting of programs. More research is needed to understand determinants of mental health disparities among orphan carers, which were not explained by socioeconomic characteristics.

Keywords:

• South Africa
• general health and functioning
• mental health
• depression
• anxiety
• post-traumatic stress
• HIV/AIDS
• orphan carer

Acknowledgements

We thank 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.