针对受艾滋病毒和艾滋病影响儿童的家庭心理健康问题预防：一项开放性试验。
Family-based prevention of mental health problems in children affected by HIV and AIDS: an open trial.
作者信息
Betancourt Theresa S, Ng Lauren C, Kirk Catherine M, Munyanah Morris, Mushashi Christina, Ingabire Charles, Teta Sharon, Beardslee William R, Brennan Robert T, Zahn Ista, Stulac Sara, Cyamatare Felix R, Sezibera Vincent
机构信息
aDepartment of Global Health and Population, Harvard School of Public Health bFrançois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA cPartners In Health/Inshuti Mu Buzima, Rwinkwavu, Rwanda dDepartment of Psychiatry, Boston Children's Hospital ePartners In Health, Boston, Massachusetts, USA fDepartment of Clinical Psychology, University of Rwanda, Butare, Rwanda.
出版信息
AIDS. 2014 Jul;28 Suppl 3(0 3):S359-68. doi: 10.1097/QAD.0000000000000336.
OBJECTIVE
The objective of this study is to assess the feasibility and acceptability of an intervention to reduce mental health problems and bolster resilience among children living in households affected by caregiver HIV in Rwanda.
DESIGN
Pre-post design, including 6-month follow-up.
METHODS
The Family Strengthening Intervention (FSI) aims to reduce mental health problems among HIV-affected children through improved child-caregiver relationships, family communication and parenting skills, HIV psychoeducation and connections to resources. Twenty families (N = 39 children) with at least one HIV-positive caregiver and one child 7-17 years old were enrolled in the FSI. Children and caregivers were administered locally adapted and validated measures of child mental health problems, as well as measures of protective processes and parenting. Assessments were administered at pre and postintervention, and 6-month follow-up. Multilevel models accounting for clustering by family tested changes in outcomes of interest. Qualitative interviews were completed to understand acceptability, feasibility and satisfaction with the FSI.
RESULTS
Families reported high satisfaction with the FSI. Caregiver-reported improvements in family connectedness, good parenting, social support and children's pro-social behaviour (P < 0.05) were sustained and strengthened from postintervention to 6-month follow-up. Additional improvements in caregiver-reported child perseverance/self-esteem, depression, anxiety and irritability were seen at follow-up (P < .05). Significant decreases in child-reported harsh punishment were observed at postintervention and follow-up, and decreases in caregiver reported harsh punishment were also recorded on follow-up (P < 0.05).
CONCLUSION
The FSI is a feasible and acceptable intervention that shows promise for improving mental health symptoms and strengthening protective factors among children and families affected by HIV in low-resource settings.
目的
本研究的目的是评估一项干预措施在卢旺达受照顾者感染艾滋病毒影响的家庭中减少儿童心理健康问题并增强其恢复力的可行性和可接受性。
设计
前后设计，包括6个月的随访。
方法
家庭强化干预（FSI）旨在通过改善儿童与照顾者的关系、家庭沟通和育儿技能、艾滋病毒心理教育以及与资源的联系，减少受艾滋病毒影响儿童的心理健康问题。招募了20个家庭（N = 39名儿童），这些家庭中至少有一名艾滋病毒呈阳性的照顾者和一名7至17岁的儿童参与FSI。对儿童和照顾者进行了本地改编并经过验证的儿童心理健康问题测量，以及保护过程和育儿测量。在干预前后以及6个月随访时进行评估。考虑到家庭聚类的多层次模型测试了感兴趣结果的变化。完成了定性访谈，以了解对FSI的可接受性、可行性和满意度。
结果
家庭对FSI表示高度满意。照顾者报告的家庭联系、良好育儿、社会支持和儿童亲社会行为的改善（P < 0.05）从干预后持续到6个月随访，并得到加强。在随访时，照顾者报告的儿童毅力/自尊、抑郁、焦虑和易怒方面有进一步改善（P <.05）。在干预后和随访时观察到儿童报告的严厉惩罚显著减少，随访时照顾者报告的严厉惩罚也有所减少（P < 0.05）。
结论
FSI是一项可行且可接受的干预措施，有望改善资源匮乏环境中受艾滋病毒影响的儿童和家庭的心理健康症状并增强保护因素。
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