Africa Health Research Institute, Durban, Kwazulu-Natal, South Africa.
Human and Social Development Research Programme, Human Sciences Research Council, Pretoria, South Africa.
Eur Child Adolesc Psychiatry. 2018 Dec;27(12):1607-1620. doi: 10.1007/s00787-018-1146-8. Epub 2018 Apr 21.
Despite being home to a large population of vulnerable children there is a dearth of population-based evidence on childhood mental disorders in sub-Saharan Africa. Parent and child mental health are rarely measured concurrently, despite potential for confounding with other risk factors, including parental HIV. Using the parent-report Child Behaviour Checklist (CBCL) we assessed children's mental health in a population-based cohort of 1536 HIV-negative children (31% HIV-exposed, 18% HIV-affected, 51% HIV-unexposed) aged 7-11 years. CBCL was scored using CBCL Rating-to-Score software. A binary indicator was determined using the clinical threshold ≥ 65. We modelled mental disorders using logistic regression, including covariates associated with the mother, child, household, and parenting. Structural equation modelling techniques also derived continuous latent variables representing the underlying mental health and parent-relationship constructs. Prevalence of conduct disorders (11.8%) was high, regardless of HIV exposure, while HIV-affected children had increased odds of affective disorders. Maternal depression increased odds of externalising disorders; maternal anxiety was associated with affective and anxiety disorders. Mother-child relationship dysfunction increased odds of all disorders, including: affective [aOR = 5.1 (2.6-9.9)]; oppositional [aOR = 7.9 (4.0-15.5)]; conduct [aOR = 4.3 (2.6-7.2)] disorders. Food insecurity and male gender increased odds of somatic disorders; breastfeeding halved odds of conduct disorders. In the latent model, associations were substantially stronger for the mother-child relationship and externalising disorders (Oppositional 0.464 p < 0.001; Conduct 0.474 p = <0.001). Conduct disorders were high for all children regardless of HIV exposure. The mother-child relationship was strongly related to all child disorders, suggesting potential for concurrent interventions targeting child behaviours and the parent-child or mother-child relationship.
尽管撒哈拉以南非洲地区有大量弱势儿童，但针对儿童精神障碍的基于人群的证据却很少。尽管与其他风险因素（包括父母的 HIV 感染）存在潜在的混杂，但很少同时测量父母和儿童的心理健康状况。我们使用父母报告的儿童行为检查表（CBCL）评估了 1536 名 HIV 阴性儿童（31%暴露于 HIV，18%受 HIV 影响，51%未暴露于 HIV）的儿童心理健康状况。CBCL 使用 CBCL 评分至评分软件进行评分。使用临床阈值≥65 确定二进制指标。我们使用逻辑回归模型对精神障碍进行建模，包括与母亲、儿童、家庭和育儿相关的协变量。结构方程建模技术还推导出了代表潜在心理健康和父母关系结构的连续潜在变量。无论 HIV 暴露情况如何，品行障碍（11.8%）的患病率都很高，而受 HIV 影响的儿童则更有可能患有情感障碍。母亲抑郁增加了外化障碍的几率；母亲焦虑与情感和焦虑障碍有关。母子关系功能障碍增加了所有障碍的几率，包括：情感障碍 [优势比（aOR）=5.1（2.6-9.9）]；对立障碍 [aOR=7.9（4.0-15.5）]；品行障碍 [aOR=4.3（2.6-7.2）]。食物不安全和男性增加了躯体障碍的几率；母乳喂养将品行障碍的几率减半。在潜在模型中，母子关系和外化障碍的关联要强得多（对立障碍 0.464，p<0.001；品行障碍 0.474，p<0.001）。无论 HIV 暴露如何，所有儿童的品行障碍都很高。母子关系与所有儿童疾病都密切相关，这表明可以同时进行针对儿童行为以及亲子关系或母子关系的干预措施。
