Institute for Global Health, University College London, UK.
Centre for Evidence-Based Intervention, Department of Social Policy & Social Intervention, University of Oxford, UK.
Clin Child Psychol Psychiatry. 2020 Oct;25(4):984-1001. doi: 10.1177/1359104520935502. Epub 2020 Jun 23.
Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children's resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], < .001), but this association was removed by CBO access (contrast = 0.07 [95%CI -0.28, 0.43], = .682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], < .001), however, this association was removed by CBO access (contrast = 0.01 [95%CI -0.55, 0.56], = .977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.
南非的儿童面临着较高的结构性和家庭逆境。本研究检验了南非社区组织（CBO）的服务是否可以促进儿童对暴露于此类逆境的抑郁的适应力。进行了两项相互关联的纵向研究，共纳入 1848 名 9 至 13 岁的儿童。一组接受 CBO 服务，另一组（准对照组）则不接受。分析采用回归模型中的交互项检验 CBO 参与的潜在调节效应，以及边际效应模型来解释显著的交互效应。结果显示了两个交互效应，表明 CBO 参与对常见结构性劣势有调节作用。首先，暴露于社区暴力的儿童表现出更多的抑郁（对比 = 0.62 [95%CI 0.43, 0.82]， <.001），但通过 CBO 介入（对比 = 0.07 [95%CI -0.28, 0.43]， =.682），这种关联被消除了。其次，居住在非正式住房中的儿童表现出更多的抑郁（对比 = 0.63 [95%CI 0.42, 0.85]， <.001），但通过 CBO 介入（对比 = 0.01 [95%CI -0.55, 0.56]， =.977），这种关联被消除了。CBO 参与与较少的抑郁症状相关，并能缓解贫困住房和暴力等常见的结构性逆境带来的影响，这些逆境在高 HIV 流行地区很常见。然而，CBO 参与并不能消除与孤儿和虐待等一些家庭层面脆弱性相关的增加的心理社会困扰。这些发现突出了 CBO 为南非儿童提供的心理社会支持的核心地位，并提示了加强服务提供的方向。
