Emotional-behavior disorders in South African children affected by AIDS

描述(申请人提供)：撒哈拉以南非洲的艾滋病毒/艾滋病流行病已经使一代儿童成为孤儿，现在似乎还会有更多的孤儿(联合国儿童基金会，2003)。这种情况的破坏性影响对初级保健服务在满足孤儿的心理健康需求方面提出了重大挑战。鉴于南非等低资源国家相对缺乏熟练的临床医生(Deslarlais等人，1995年)，以及南非城镇普遍缺乏满足精神卫生需求的资源(Dlamini，2004年)，迫切需要开发可靠和有效的诊断工具，以便及早发现精神障碍，作为迈向成功干预的第一步。在这项建议中，我们寻求(具体目标1a)在750名7-11岁儿童(250名艾滋病孤儿、250名其他孤儿和250名非孤儿)中调查简短和易于管理的人口筛查(SDQ；Goodman，1997,2001)的标准效度。SDQ将对照临床医生的诊断和诊断工具进行验证，我们的团队已经在SESSOO家庭中调查了它的文化适宜性(NIH-DISC-IV；Shaffer，Fisher等人，2000)。我们还寻求(具体目标1b)调查SESOTO学校SDQ在早期发现EBD儿童的实用价值。然后，我们试图使用在特定目标1a中收集的多方法(基于问卷和访谈)和多个信息者(照顾者、教师和自我报告)信息来测试Cluver&Gardner(2007)风险和保护因素概念模型的各个方面，方法是调查孤儿类型(父亲、母亲、双胞胎和非孤儿)和EBD(特定目标2a)与孤儿状态(艾滋病孤儿、通过其他方式成为孤儿、非孤儿)和EBD(特定目标2b)之间的关系，并考虑可能调节这些关系的因素(贫困和照顾者物质使用障碍)。通过我们的前期工作建立的独特的伙伴关系和机构资源，三名国家卫生研究院高级调查人员的指导，以及汇集的研究团队的跨学科优势(发展精神病理学、心理计量学、南非背景下的定性和定量研究、跨文化精神病学和医学人类学)，以及在相关项目上卓有成效的合作历史表明，目前的提议成功的可能性很高。拟议的研究符合NIHM的目标，即为受艾滋病毒/艾滋病影响的儿童，特别是发展中国家的儿童开发精神健康评估工具。确定SDQ的有效性及其在小学作为早期干预和预防EBD的背景下的有用性，以及了解贫困和照顾者SUD在受艾滋病影响和未受影响的儿童发展EBD中的作用，将为基于学校的干预工作奠定基础，或为更有效地针对当前干预措施提供亟需的指导。 公共卫生相关性：艾滋病心理健康研究中心(NIMH)关于婴儿、儿童和青少年的拟议研究的意义和相关性。尽管本文建议的工作与前述NIMH计划的几个研究目标有间接关联，但它与研究的关键焦点之一直接相关：“开发评估技术以及方法和统计工具，用于评估感染艾滋病毒或受艾滋病毒影响的婴儿、儿童和青少年在行为、认知和社会发展方面的自然历史和治疗相关变化，特别是在适用于资源匮乏的环境的情况下”。作为解决南非这样的发展中国家儿童心理健康和服务需求的第一步，解决EBD的早期发现问题应是最高优先事项。确认SDQ并确定其在小学作为早期干预和预防EBD的环境的有用性，以及了解贫困和照顾者SUD在受艾滋病影响和未受影响的儿童发展EBD中的作用，将为更有效地有针对性地进行干预提供亟需的指导。因此，这项研究如果得到资助，可能会为设计一项后续研究奠定基础，在该研究中，可能会对受艾滋病毒/艾滋病影响的儿童进行基于学校的EBD评估和干预。

DESCRIPTION (provided by applicant): The HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a generation of children, and now seems set to orphan generations more (UNICEF, 2003). The devastating impact of this poses significant challenges for primary care services in addressing the mental health needs of orphans. Given the relative lack of skilled clinicians in low-resource countries like South Africa (Deslarlais et al., 1995), and a general lack of resources to address mental health needs in South African townships (Dlamini, 2004), there is an urgent need for the development of reliable and valid diagnostic tools for the early detection of psychiatric disorder as a first step towards successful intervention. In this proposal we seek (Specific aim 1a) to investigate the criterion validity of a brief and easy-to-administer population screen (SDQ; Goodman, 1997, 2001) in a sample of 750 7- 11 year old children (250 orphaned by AIDS, 250 orphaned by other means and 250 non-orphaned). The SDQ will be validated against clinician diagnosis and a diagnostic tool which our team has investigated for its cultural appropriateness in Sesotho families (the NIH-DISC-IV; Shaffer, Fisher, et al., 2000). We also seek (Specific aim 1b) to investigate the utility value of the SDQ in Sesotho schools to early detect children with EBD. We then seek to use the multi-method (questionnaire and interview-based) and multiple informant (caregiver-, teacher, and self-report) information collected in Specific aim 1a to test aspects of Cluver & Gardner's (2007) conceptual model of risk and protective factors by investigating the association between orphan type (paternal-, maternal-, double-, and non- orphan) and EBD (Specific aim 2a) and orphan status (orphan by AIDS, orphan by other means, non-orphan) and EBD (Specific aim 2b), taking into account factors that may mediate these relationships (poverty and caregiver substance use disorder). The unique partnerships and institutional resources established through our preliminary work, the mentorship of three senior NIH investigators combined with the interdisciplinary strengths of the assembled research team (developmental psychopathology, psychometrics, qualitative and quantitative research in the South African context, cross- cultural psychiatry and medical anthropology) and a demonstrated history of fruitful collaboration on related projects indicate a high likelihood of success for the current proposal. The proposed study is in line with the NIHM objective of developing assessment tools in mental health for children affected by HIV/AIDS especially in developing countries. Determining the validity of the SDQ and its usefulness in elementary schools as context for early intervention and prevention of EBD, in addition to understanding the role of poverty and caregiver SUD in the development of EBD in children affected and unaffected by AIDS will lay the foundation for school- based intervention work or offer much needed direction in targeting current interventions more effectively. PUBLIC HEALTH RELEVANCE: Significance and relevance of the proposed research for the program on Infants, Children, and Adolescents within the Center for Mental Health Research on AIDS (NIMH). Although the work proposed herein has indirect relevance for several research objectives of the aforementioned NIMH program, it has direct relevance for one of the key foci of research: "Develop assessment technologies as well as methodological and statistical tools for the evaluation of natural history and treatment related change in behavioral, cognitive, and social development of infants, children and adolescents infected with HIV or affected by HIV, particularly where applicable to resource poor environments". Addressing the problem of early detection of EBD should be of the highest priority as a first step in addressing the mental health and service needs of children in a developing country like South Africa. The validation of the SDQ and determining its usefulness in elementary schools as context for early intervention and prevention of EBD, in addition to understanding the role of poverty and caregiver SUD in the development of EBD in children affected and unaffected by AIDS, will offer much needed direction in targeting interventions more effectively. As such, this study if funded, may lay the foundation for the design of a follow-up study where a school-based assessment and intervention of EBD in children affected by HIV/AIDS may be conducted.