Building resilient families: Developing family interventions for preventing adolescent depression and HIV in low resource settings

Abstract

Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to reduce onset of depression. Involving families in promoting adolescent mental health is developmentally appropriate, but few existing interventions take a family approach to prevention of adolescent depression. We conducted a qualitative investigation from 2013–2015 to inform the development of a family intervention to prevent adolescent depression in South Africa among families infected or at risk for HIV. Using focus groups with adolescents and parents (eight groups, n = 57), and interviews (n = 25) with clinicians, researchers, and others providing mental health and related services, we identified context-specific factors related to risk for family depression, and explored family interactions around mental health more broadly as well as depression specifically. Findings indicate that HIV and poverty are important risk factors for depression. Future interventions must address linguistic complexities in describing and discussing depression, and engage with the social interpretations and meanings placed upon depression in the South African context, including bewitchment and deviations from prescribed social roles. Participants identified family meetings as a context-appropriate prevention strategy. Family meetings offer opportunities to practice family problem solving, involve other family members in communal parenting during periods of parental depression, and serve as forums for building Xhosa-specific interpretations of resilience. This study will guide the development of Our Family Our Future, a resilience-focused family intervention to prevent adolescent depression (ClinicalTrials.gov #NCT02432352).

Caregiver socioemotional health as a determinant of child well‐being in school‐aged and adolescent Ugandan children with and without perinatal HIV exposure

“…Studies of the independent or contributory role of caregiver mental health parameters remain poorly elucidated. The importance of instrumental support of caregivers through the treatment of depression, alleviation of caregiving stress by means of cash transfer programmes to meet material caregiving needs and through specific training to enhance caregiving quality has been described among HIV‐affected caregivers . By delineating these specific child psychosocial adjustment indices that are negatively impacted by poor caregiver social support, depression and anxiety, we provide additional data on the importance of caregiver mental health as a modifiable risk factor for improving the well‐being of vulnerable children.…”

“As a Young Pregnant Girl… The Challenges You Face”: Exploring the Intersection Between Mental Health and Sexual and Reproductive Health Amongst Adolescent Girls and Young Women in South Africa

“…The way in which mental health issues, such as stress and depression, are defined and conceptualised differs across settings and socio-cultural contexts, and interventions needs to be contextually relevant [1]. In addition to contextual and conceptual equivalence, linguistic equivalence of terms related to mental health should be taken into account.…”

“…Poor mental health, including depressive disorders and stress, contributes significantly to the burden of disease in South Africa, and other parts of sub-Saharan Africa, and is also associated with negative sexual and reproductive health (SRH) outcomes for women, such as ‘unintended’ or early pregnancy, and increased risk behaviours for HIV [ 1 – 3 ]. Researchers in the field of women’s health have highlighted the need to further explore the syndemic interactions between psychosocial vulnerability, mental health, HIV infection, and poor SRH outcomes [ 4 ].…”

The effects of parental relationships, and gender and grade differences on depressive disorder in Chinese adolescents: the evidence from multiple cross-sectional surveys (1999–2016)

“…In addition, children exposed to violence at home (witnessing violence against the mother and/or being the victims of parental violence themselves) are more likely to suffer from depression and affective disorders (Amato 2010(Amato , 2001Izaguirre and Calvete 2018). Conversely, parental involvement and warmth have the potential to reduce the onset of depression (Kuo et al 2019;Quach et al 2015). Family interventions are a developmentally appropriate approach for preventing depression among adolescents (Kuo et al 2019).…”

“…Conversely, parental involvement and warmth have the potential to reduce the onset of depression (Kuo et al 2019;Quach et al 2015). Family interventions are a developmentally appropriate approach for preventing depression among adolescents (Kuo et al 2019). Although previous studies have discussed the association of parent-child relationships with depressive disorders in adolescents, studies that examine this from the perspective of different culture backgrounds are few, and longitudinal tracking studies are relatively scarce, a scarcity that is exacerbated by China's divorce rate in the twenty first century.…”