Boris Neil W, Brown Lisanne A, Thurman Tonya R, Rice Janet C, Snider Leslie M, Ntaganira Joseph, Nyirazinyoye Laetitia N
Department of Psychiatry and Neurology, Tulane University School of Medicine, 1440 Canal St, Box TB-52, New Orleans, LA 70112, USA.
Arch Pediatr Adolesc Med. 2008 Sep;162(9):836-43. doi: 10.1001/archpedi.162.9.836.
To examine the level of depressive symptoms and their predictors in youth from one region of Rwanda who function as heads of household (ie, those responsible for caring for other children) and care for younger orphans.
Cross-sectional survey
Four adjoining districts in Gigonkoro, an impoverished rural province in southwestern Rwanda.
Trained interviewers met with the eldest member of each household (n = 539) in which a youth 24 years old or younger was caring for 1 child or more.
Serving as a youth head of household.
Rates and severity of depressive symptoms using the Center for Epidemiologic Studies Depression scale; measures of grief, adult support, social marginalization, and sociodemographic factors using scales developed for this study.
Of the 539 youth heads of household, 77% were subsistence farmers and only 7% had attended school for 6 years or more. Almost half (44%) reported eating only 1 meal a day in the last week, and 80% rated their health as fair or poor. The mean score on the Center for Epidemiologic Studies Depression scale was 24.4, exceeding the most conservative published cutoff score for adolescents. Multivariate analysis revealed that reports of depressive symptoms that exceeded the clinical cutoff were associated with having 3 basic household assets or fewer, such as a mattress and a spare set of clothes (odds ratio [OR], 1.69; 95% confidence interval [CI], 1.06-2.70), eating less than 1 meal per day (OR, 1.68; 95% CI, 1.09-2.60), reporting fair health (OR, 1.32; 95% CI, 0.76-2.29) or poor health (OR, 2.33; 95% CI, 1.17-4.64), endorsing high levels of grief (OR, 2.67; 95% CI, 1.73-4.13), having at least 1 parent die in the genocide as opposed to all other causes of parental death (OR, 1.83; 95% CI, 1.10-3.04), and not having a close friend (OR, 1.91; 95% CI, 1.17-3.12). There was an interaction between marginalization from the community and alcohol use; youth who were highly marginalized and did not drink alcohol were more than 3 times more likely to report symptoms of depression (OR, 3.07; 95% CI, 1.73-5.42). When models were constructed by grouping theoretically related variables into blocks and controlling for other blocks, the emotional status block of variables (grief and marginalization) accounted for the most variance in depressive symptoms.
Orphaned youth who head households in rural Rwanda face many challenges and report high rates of depressive symptoms. Interventions designed to go beyond improving food security and increasing household assets may be needed to reduce social isolation of youth heads of household. The effect of head-of-household depressive symptoms on other children living in youth-headed households is unknown.
调查卢旺达某地区担任户主（即负责照顾其他孩子）并照顾年幼孤儿的青少年的抑郁症状水平及其预测因素。
横断面调查
卢旺达西南部贫困农村省份吉贡科罗的四个相邻地区
经过培训的访谈员与每户（n = 539）中24岁及以下青少年照顾1个或更多孩子的最年长者进行面谈。
担任青少年户主
使用流行病学研究中心抑郁量表评估抑郁症状的发生率和严重程度；使用为本研究开发的量表测量悲伤、成人支持、社会边缘化和社会人口学因素。
在539名青少年户主中，77%是自给自足的农民，只有7%接受过6年或更长时间的教育。近一半（44%）报告称上周每天只吃一顿饭，80%将自己的健康状况评为一般或较差。流行病学研究中心抑郁量表的平均得分是24.4，超过了已发表的针对青少年最保守的临界分数。多变量分析显示，抑郁症状超过临床临界值的报告与拥有3件或更少基本家庭资产（如床垫和一套备用衣服）有关（比值比[OR]，1.69；95%置信区间[CI]，1.06 - 2.70），每天吃饭少于一顿（OR，1.68；95% CI，1.09 - 2.60），报告健康状况一般（OR，1.32；95% CI，0.76 - 2.29）或较差（OR，2.33；95% CI，1.17 - 4.64），认可高度悲伤（OR，2.67；95% CI，1.73 - 4.13），至少有一位父母在种族灭绝中死亡而非因其他原因导致父母死亡（OR，1.83；95% CI，1.10 - 3.04），以及没有亲密朋友（OR，1.91；95% CI，1.17 - 3.12）。社区边缘化与饮酒之间存在交互作用；高度边缘化且不饮酒的青少年报告抑郁症状的可能性高出3倍多（OR，3.07；95% CI，1.73 - 5.42）。当通过将理论上相关的变量分组为块并控制其他块来构建模型时，变量的情绪状态块（悲伤和边缘化）在抑郁症状中占的方差最大。
卢旺达农村地区担任户主的孤儿青少年面临诸多挑战，且报告的抑郁症状发生率很高。可能需要设计超越改善粮食安全和增加家庭资产的干预措施，以减少青少年户主的社会孤立。户主的抑郁症状对生活在青少年当家的家庭中的其他孩子的影响尚不清楚。
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