Relationships Between Familial HIV/AIDS and Symptoms of Anxiety and Depression: The Mediating Effect of Bullying Victimization in a Prospective Sample of South African Children and Adolescents

Abstract

South African children and adolescents living in HIV/AIDS-affected families are at elevated risk of both symptoms of anxiety and depressive symptoms. Poverty and HIV/AIDS-related stigma are additional risk factors for these negative mental health outcomes. Community level factors, such as poverty and stigma, are difficult to change in the short term and identifying additional potentially malleable mechanisms linking familial HIV/AIDS with mental health is important from an intervention perspective. HIV/AIDS-affected children are also at increased risk of bullying victimization. This longitudinal study aimed to determine whether prospective relationships between familial HIV/AIDS and both anxiety symptoms and depressive symptoms operate indirectly via bullying victimization. Adolescents (M = 13.45 years, 56.67 % female, n = 3,515) from high HIV-prevalent (>30 %) communities in South Africa were interviewed and followed-up one year later (n = 3,401, 96.70 % retention). Census enumeration areas were randomly selected from urban and rural sites in two provinces, and door-to-door sampling included all households with a resident child/adolescent. Familial HIV/AIDS at baseline assessment was not directly associated with mental health outcomes 1 year later. However, significant indirect effects operating via bullying victimization were obtained for both anxiety and depression scores. Importantly, these effects were independent of poverty, HIV/AIDS-related stigma, and baseline mental health, which highlight bullying victimization as a potential target for future intervention efforts. The implementation and rigorous evaluation of bullying prevention programs in South African communities may improve mental health outcomes for HIV/AIDS-affected children and adolescents and this should be a focus of future research and intervention.

Orphanhood by AIDS-Related Causes and Child Mental Health: A Developmental Psychopathology Approach

“…In fact, several studies have reported that there are no direct effects of AO on mental health outcomes (e.g. Boyes et al, [111]), but that AO exerts indirect effects on indices of psychological distress, sexual risk behaviors, and educational difficulties through mediators such as community violence and abuse, as well as through poverty and AIDS-related stigma [31,66]. …”

Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review

“…These adolescents also experience stigma by association with family members living with HIV, which can drive persistent mental health symptoms of anxiety and depression. 23 A systematic review of psychosocial interventions focusing on mental health resilience of young people affected by HIV showed that parenting and family support were important to their mental health and psychosocial adjustment. 8…”

HIV, violence, blame and shame: pathways of risk to internalized HIV stigma among South African adolescents living with HIV

“…The literature on violence victimization and developmental psychology suggests that child maltreatment may also be a key driver of internalized HIV stigma via reduced psychological wellbeing [ 15 , 16 ]. Longitudinal findings from multiple systematic reviews consistently suggest that over time, child abuse victimization in the form of physical, sexual, emotional abuse and bullying leads to increases in depressive symptoms [ 17 – 22 ].…”

“…Longitudinal findings from multiple systematic reviews consistently suggest that over time, child abuse victimization in the form of physical, sexual, emotional abuse and bullying leads to increases in depressive symptoms [ 17 – 22 ]. Similarly, enacted HIV stigma and bullying have been shown to have enduring negative impacts on depressive symptoms among youth from families affected by AIDS, which includes both ALHIV and HIV-negative adolescents [ 16 ].…”

“…Additionally, it is essential to assess whether and how HIV-related health is associated with maltreatment of ALHIV and internalized HIV stigma. Evidence from South Africa suggests that children from AIDS-affected families are at elevated risk of various forms of maltreatment when compared to their peers [ 16 , 23 ]. The maltreatment is not always exhibited as HIV-specific enacted stigma, but is nonetheless often indirectly tied to the children’s health and HIV status.…”