Collishaw Stephan, Gardner Frances, Lawrence Aber J, Cluver Lucie
Child and Adolescent Psychiatry, Institute of Psychological Medicine and Clinical Neurosciences, School of Medicine, Cardiff University, Hadyn Ellis Building, Cardiff, CF24 4HQ, UK.
Department of Social Policy and Intervention, University of Oxford, Oxford, UK.
J Abnorm Child Psychol. 2016 May;44(4):719-30. doi: 10.1007/s10802-015-0068-x.
Children parentally bereaved by AIDS experience high rates of mental health problems. However, there is considerable variability in outcomes, and some show no mental health problems even when followed over time. Primary aims were to identify predictors of resilient adaptation at child, family and community levels within a group of AIDS-orphaned children, and to consider their cumulative influence. A secondary aim was to test whether predictors were of particular influence among children orphaned by AIDS relative to non-orphaned and other-orphaned children. AIDS-orphaned (n = 290), other-orphaned (n = 163) and non-orphaned (n = 202) adolescents living in informal settlements in Cape Town, South Africa were assessed on two occasions 4 years apart (mean age 13.5 years at Time 1, range = 10-19 years). Self-report mental health screens were used to operationalise resilience in AIDS-orphaned children as the absence of clinical-range symptoms of PTSD, anxiety, depression, conduct problems, and suicidality. A quarter of AIDS-orphaned children (24 %) showed no evidence of mental health problems at either wave. Child physical health, better caregiving quality, food security, better peer relationship quality, and lower exposure to community violence, bullying or stigma at baseline predicted sustained resilience. There were cumulative influences across predictors. Associations with mental health showed little variation by child age or gender, or between orphaned and non-orphaned children. Mental health resilience is associated with multiple processes across child, family and community levels of influence. Caution is needed in making causal inferences.
因艾滋病失去双亲的儿童出现心理健康问题的几率很高。然而，结果存在很大差异，有些儿童即使长期跟踪观察也未出现心理健康问题。主要目标是确定一群艾滋病孤儿在儿童、家庭和社区层面适应力强的预测因素，并考虑它们的累积影响。次要目标是检验这些预测因素对艾滋病孤儿的影响是否比对非孤儿和其他孤儿更为显著。对生活在南非开普敦非正式定居点的艾滋病孤儿（n = 290）、其他孤儿（n = 163）和非孤儿（n = 202）青少年进行了两次评估，时间间隔为4年（第一次评估时平均年龄13.5岁，范围为10 - 19岁）。使用自我报告心理健康筛查工具，将艾滋病孤儿中没有创伤后应激障碍、焦虑、抑郁、行为问题和自杀倾向等临床症状范围的情况定义为适应力强。四分之一的艾滋病孤儿（24%）在两次评估中均未表现出心理健康问题的迹象。基线时儿童身体健康状况良好、照料质量更高、食品安全、同伴关系质量更好以及社区暴力、欺凌或耻辱暴露程度较低可预测持续的适应力。各预测因素之间存在累积影响。心理健康方面的关联在儿童年龄或性别之间，以及孤儿和非孤儿之间变化不大。心理健康适应力与儿童、家庭和社区层面的多个过程相关。在进行因果推断时需要谨慎。
