Longitudinal evaluation of the psychosocial well-being of recent orphans compared with non-orphans in a school-attending cohort in KwaZulu-Natal, South Africa

Abstract

To assess differences in psychosocial well-being between recent orphans and non-orphans, we followed a cohort of 157 school-going orphans and 480 non-orphans ages 9–15 in a context of high HIV/AIDS mortality in South Africa from 2004 to 2007. Several findings were contrary to the published evidence to date, as we found no difference between orphans and non-orphans in anxiety/depression symptoms, oppositional behavior, self-esteem, or resilience. Female gender, self-reported poor health, and food insecurity were the most important predictors of children's psychosocial well-being. Notably, girls had greater odds of reporting anxiety/depression symptoms than boys, and scored lower on self-esteem and resilience scales. Food insecurity predicted greater anxiety/depression symptoms and lower resilience. Perceived social support was a protective factor, as it was associated with lower odds of anxiety/depression symptoms, lower oppositional scores, and greater self-esteem and resilience. Our findings suggest a need to identify and strengthen psychosocial supports for girls, and for all children in contexts of AIDS-affected and economic adversity.

Keywords:

• Orphans
• psychosocial
• HIV/AIDS
• gender
• food insecurity

Acknowledgements

The authors wish to acknowledge the efforts of the members of the Amajuba Child Health and Welfare Research Project team who collected the household, caregiver, and child-level data and worked in the Newcastle field office.

Conflicts of interest: The authors declare that they have no conflict of interest.

Notes

¹ Because of the interaction in this model, it appears that orphan status is a significant predictor of oppositional behavior, but statistically, if an interaction term is present in a model, the significance of one of the components of the included interaction is not interpretable. As noted, in the stratified results, among non-orphans, girls had higher oppositional scores than boys.