Individual-level factors associated with mental health in Rwandan youth affected by HIV/AIDS

Abstract

Purpose Prevention of mental disorders worldwide requires a greater understanding of protective processes associated with lower levels of mental health problems in children who face pervasive life stressors. This study aimed to identify culturally appropriate indicators of individual-level protective factors in Rwandan adolescents where risk factors, namely poverty and a history of trauma, have dramatically shaped youth mental health. Methods The sample included 367 youth aged 10–17 in rural Rwanda. An earlier qualitative study of the same population identified the constructs “kwihangana” (patience/perseverance) and “kwigirira ikizere” (self-esteem) as capturing local perceptions of individual-level characteristics that helped reduce risks of mental health problems in youth. Nine items from the locally derived constructs were combined with 25 items from an existing scale that aligned well with local constructs—the Connor-Davidson Resilience Scale (CD-RISC). We assessed the factor structure of the CD-RISC expanded scale using exploratory factor analysis and determined the correlation of the expanded CD-RISC with depression and functional impairment. Results The CD-RISC expanded scale displayed high internal consistency (α = 0.93). Six factors emerged, which we labeled: perseverance, adaptability, strength/sociability, active engagement, self-assuredness, and sense of self-worth. Protective factor scale scores were significantly and inversely correlated with depression and functional impairment (r = −0.49 and r = −0.38, respectively). Conclusions An adapted scale displayed solid psychometric properties for measuring protective factors in Rwandan youth. Identifying culturally appropriate protective factors is a key component of research associated with the prevention of mental health problems and critical to the development of cross-cultural strength-based interventions for children and families.

Forging Resilience to HIV/AIDS: Personal Strengths of Middle-aged and Older Gay, Bisexual, and Other Men Who Have Sex With Men Living With HIV/AIDS

“…Among the research studies that have looked into individual attributes of PLWH in the context of resilience frameworks, several have explored the lived experiences of young MSM living with HIV/AIDS. Interestingly, the findings that have been documented from these studies revealed individual attributes that were similar, akin, or thematically related to the individual attributes that were described in this paper ( Barry et al, 2018 ; Haddad et al, 2019 ; Harper et al, 2014 ; Scorza et al, 2017 ). These included studies that have discussed: (a) the individual attribute perseverance or another finding thematically related to it such as patience ( Scorza et al, 2017 ); (b) other findings that were thematically related to the individual attribute having the right mindset (as defined and described in the Results section) such as self-acceptance, optimism, positive outlook, and taking responsibility for their health outcomes ( Barry et al, 2018 ; Harper et al, 2014 ); and (c) other findings that were thematically related to the individual attribute self-awareness with self-control such as sense of control ( Harper et al, 2014 ).…”

“…Among the research studies that have looked into individual attributes of PLWH in the context of resilience frameworks, several have explored the lived experiences of young MSM living with HIV/AIDS. Interestingly, the findings that have been documented from these studies revealed individual attributes that were similar, akin, or thematically related to the individual attributes that were described in this paper (Barry et al, 2018;Haddad et al, 2019;Harper et al, 2014;Scorza et al, 2017). These included studies that have discussed: (a) the individual attribute perseverance or another finding thematically related to it such as patience (Scorza et al, 2017);…”

The People Living with HIV (PLHIV) Resilience Scale: Development and Validation in Three Countries in the Context of the PLHIV Stigma Index

“…Taken together, these findings support convergent validity, i.e., that the scale is associated with other theoretically related variables. As described previously, more general resilience scales like the CD-RISC have demonstrated associations with mental and physical health outcomes in other studies among PLHIV [12, 15, 16]. However, it remains unclear the extent to which resilience as measured in those studies was in relation to HIV status—and hence what, precisely, was associated with those outcomes.…”

“…Many of these studies have used resilience scales that assess general psychological resilience, i.e., not in the context of particular types of adversity. The conner-davidson resilience scale (CD-RISC) [24], a 25-item scale that was originally developed to assess responses to treatment for anxiety, depression and stress reactions, has been most frequently used [11, 12, 15, 16, 18, 23, 25–27]. This scale was primarily oriented around personal qualities that enable thriving in the face of adversity (e.g., “I try my hardest on every occasion” and “I can adapt to change”), but also captures certain features the developers believed to underpin resilience, such as having close personal relationships and experience achieving one’s goals [24].…”

Barriers and Facilitators to Promoting Resilience to HIV/AIDS: A Qualitative Study on the Lived Experiences of HIV-Positive, Racial and Ethnic Minority, Middle-Aged and Older Men Who Have Sex with Men from Ontario, Canada

“…This reprieve further allows racial and ethnic minority MSM to sustain their perseverance to thrive even during the most challenging times after their HIV diagnosis. Research has shown that perseverance is an individual-level trait (similar to other protective factors like optimism and self-efficacy) that reduces risks of mental health problems among MSMLWH, and helps them deal with physical and psychosocial adversities related to living with HIV/AIDS [72,73].…”