Mental Health of Children Living in Foster Families in Rural Rwanda: The Role of HIV and the Family Environment

Abstract

Fostering children is common in sub-Saharan Africa, but few studies examine these children’s mental health needs. This study investigated the impact of living in a foster family on the mental health of HIV-positive, HIV-affected and HIV-unaffected children (n = 681 aged 10–17) in rural Rwanda. Regression analyses assessed the impact of living in a foster family on mental health, parenting, and daily hardships; multiple mediation analyses assessed whether family factors mediated the association between foster status and mental health. HIV-positive children were eight times more likely to live in foster families than HIV-unaffected children. Being HIV-affected was predictive of depression and irritability symptoms after controlling for family factors. Controlling for HIV-status, foster children had more symptoms of depression, anxiety, and irritability than non-fostered children. Positive parenting fully mediated the association between foster status and mental health. Mental health and parenting interventions for foster children and HIV-affected children may improve child outcomes.

The mediating effect of self-esteem on the relationship of living environment, anxiety, and depression of underprivileged children: A path analysis in Chinese context

“…Children living in these kinds of areas lack effective communication with their parents, which is essential to children’s development, especially from a mental health aspect. Furthermore, the experience of left-behind children would lead to low self-esteem and high incidence of mental health problems (Dai and Chu, 2018; Liu et al, 2017; Nduwimana et al, 2016). Besides, social support and interaction from community level in these poverty-stricken areas are very poor, which leads to the lack of sense of community belonging of children.…”

“…Living environments include social factors, such as socioeconomic status (Perna et al, 2010), parenting (Nduwimana et al, 2016), family structure (Bramlett and Blumberg, 2007; Fransson et al, 2016), living arrangement (Joutsenniemi et al, 2006), and neighborhood structure (Echeverría et al, 2008). In the family structure, the mental health of children in single-parent and grandparent-only families is poorer than that of children living with two biological parents (Bramlett and Blumberg, 2007).…”

“…Children who live in foster care are susceptible to increased rates of mental health problems, such as emotional and behavioral disorders (Sawyer et al, 2007; Williams and Sherr, 2009). Nduwimana et al (2016) investigated the effects of living in a foster family on the mental health of children in rural Rwanda and found that the number of symptoms of depression and anxiety faced by foster children is more than that experienced by non-foster children. In China, left-behind children are a unique social problem.…”

Mental health, substance use and viral suppression in adolescents receiving ART at a paediatric HIV clinic in South Africa

“…In addition to these biological mechanisms that link HIV and mental illness, several social and structural factors contribute to the poor mental health of ALHIV. Many ALHIV have lost their biological parents and are raised in extended families, or orphanages [8,9]. Caregivers of orphans might be overburdened by the responsibility to care for, and economically support an additional child or children [9].…”

Measuring Symptoms of Psychopathology in Zambian Orphans and Vulnerable Children: Scale Validation and Psychometric Evaluation

“…We therefore sought to explore the factor structure, psychometric proprieties, and validity of two commonly used measures of youth mental health, Achenbach’s Youth Self-Report (YSR) and the Child PTSD Symptom Scale (CPSS), as well as a locally developed measure of functional impairment, administered via ACASI and using an alternative criterion validity approach. We selected the Achenbach YSR because it has been used in multiple sub-Saharan African settings to assess a wide range of youth mental health-related behaviors and symptoms, including among children living with HIV, HIV-orphans, and children of parents living with HIV (Chi & Li, 2012; Cluver, Gardner, & Operario, 2007; Govender, Reardon, Quinlan, & George, 2014; Ndetei et al, 2016; Nduwimana et al, 2017; Okello et al, 2015). Only a few studies have examined the factor structure of the YSR in sub-Saharan Africa (Geibel et al, 2016; Hall et al, 2014; Harder et al, 2014), and its validity has only been thoroughly examined in one sub-Saharan African setting: Ethiopia (Geibel et al, 2016; Hall et al, 2014).…”