Department of Global Health, University College London, London, United Kingdom.
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
J Acquir Immune Defic Syndr. 2018 Aug 1;78(4):390-398. doi: 10.1097/QAI.0000000000001704.
Parental loss is a major stressful event found to increase risk of mental health problems in childhood. Yet, some children show resilient adaptation in the face of adversity across time.
This study explores predictors of mental health resilience among parentally bereaved children in South Africa and Malawi and their cumulative effect. The study also explores whether predictors of resilience differed between orphaned and nonorphaned children.
Consecutive attenders of community-based organizations (children; 4-13 years, and their caregivers) were interviewed at baseline and 15- to 18-month follow-up (n = 833). Interviews comprising inventories on demographic information, family data, child mental health, bereavement experience, and community characteristics. Mental health screens were used to operationalize resilience as the absence of symptoms of depression, suicidality, trauma, emotional, and behavioral problems.
Almost 60% of children experienced parental loss. One-quarter of orphaned children showed no mental health problems at either wave and were classified as resilient. There were equal proportions of children classified as resilient within the orphaned (25%) versus nonorphaned group (22%). Being a quick learner, aiding ill family members, positive caregiving, household employment, higher community support, and lower exposure to domestic violence, physical punishment, or stigma at baseline predicted sustained resilience. There were cumulative influences of resilience predictors among orphaned children. Predictors of resilience did not vary by child age, sex, country of residence or between orphaned and nonorphaned children.
This study enhances understanding of resilience in younger children and identifies a number of potential environmental and psychosocial factors for bolstering resilience in orphaned children.
父母去世是一个重大的应激事件，研究发现它会增加儿童时期心理健康问题的风险。然而，有些儿童在面对逆境时表现出坚韧的适应能力。
本研究探讨了南非和马拉维父母去世的儿童的心理健康弹性的预测因素及其累积效应。该研究还探讨了弹性的预测因素是否在孤儿和非孤儿儿童之间存在差异。
连续参加社区组织（儿童；4-13 岁及其照顾者）的参与者在基线和 15-18 个月随访时接受访谈（n=833）。访谈包括人口统计信息、家庭数据、儿童心理健康、丧亲经历和社区特征的清单。使用心理健康筛查将弹性定义为没有抑郁、自杀意念、创伤、情绪和行为问题的症状。
近 60%的儿童经历了父母去世。四分之一的孤儿在两个时间点都没有心理健康问题，被归类为有弹性。在孤儿（25%）和非孤儿（22%）组中，都有同样比例的儿童被归类为有弹性。在基线时，学习能力强、帮助生病的家庭成员、积极的照顾、家庭就业、较高的社区支持以及较少暴露于家庭暴力、身体惩罚或污名化，预测了持续的弹性。孤儿儿童的弹性预测因素存在累积影响。弹性的预测因素不因儿童年龄、性别、居住国家或孤儿和非孤儿儿童而有所不同。
本研究增进了对年幼儿童弹性的理解，并确定了一些潜在的环境和心理社会因素，可以增强孤儿儿童的弹性。
