Emotional-behavior disorders in South African children affected by AIDS

受艾滋病影响的南非儿童的情绪行为障碍

• 批准号: 8052882
• 负责人: CARLA SHARP
• 金额: $ 27.39万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8052882
• 关键词: 11 year old; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Affect; Africa South of the Sahara; African; Age; Anthropology; Autopsy; Behavior Disorders; Behavioral; Caregivers; Child; Child Mental Health; Cognitive; Collaborations; Communities; Country; Data; Developing Countries; Development; Diagnosis; Diagnostic; Early Diagnosis; Early identification; Early treatment; Emotional; Environment; Epidemic; Epidemiology; Ethnic Origin; Evaluation; Expert Opinion; Factor Analysis; Family; Foundations; Funding; Generations; HIV; Health Services Needs; Household; Infant; Intervention; Intervention Studies; Interview; Language; Link; Measures; Mediating; Medical; Mental Health; Mental Health Services; Mental disorders; Mentorship; Methods; Modeling; National Institute of Mental Health; Natural History; Orphan; Patient Self-Report; Performance; Personal Satisfaction; Population; Poverty; Prevention; Primary Health Care; Psychiatry; Psychometrics; Psychopathology; Questionnaires; Recommendation; Recording of previous events; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sampling; Schedule; School Teachers; Schools; Services; Social Development; South Africa; Specificity; Structure; Substance Use Disorder; Technology Assessment; Testing; Time; Training; UNICEF; United States National Institutes of Health; Validation; Work; base; design; disorder risk; elementary school; follow-up; high risk; indexing; informant; instrument; interest; mental health center; primary care setting; programs; public health relevance; sex; success; successful intervention; teacher; tool; trait

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.

描述（由申请人提供）：艾滋病毒/艾滋病在撒哈拉以南非洲的流行已经使一代儿童成为孤儿，现在似乎将使更多的一代成为孤儿（联合国儿童基金会，2003年）。这一灾难性的影响对初级保健服务在满足孤儿心理健康需求方面提出了重大挑战。鉴于在像南非这样的低资源国家中相对缺乏熟练的临床医生（Deslarlais等人，1995年），以及普遍缺乏资源来满足南非城镇的精神卫生需求（Dlamini，2004年），迫切需要开发可靠和有效的诊断工具，以早期发现精神障碍，作为成功干预的第一步。在本提案中，我们寻求（具体目标1a）在750名7- 11岁儿童（250名因艾滋病而成为孤儿，250名因其他原因成为孤儿，250名非孤儿）的样本中调查简单易行的人群筛查（SDQ; Goodman，1997，2001）的标准有效性。SDQ将针对临床医生诊断和诊断工具进行验证，我们的团队已经调查了其在Sesperium家族中的文化适当性（NIH-DISC-IV; Shaffer，Fisher等人，2000年）。我们还寻求（具体目标1b）调查SDQ在中小学校早期发现EBD儿童的实用价值。然后，我们寻求使用多方法（基于问卷和访谈）和多个信息提供者（照顾者，教师和自我报告）在具体目标1a中收集的信息，通过调查孤儿类型之间的关联来测试Cluver & Gardner（2007）的风险和保护因素概念模型的各个方面。（父源、母源、双源和非孤儿）和EBD（具体目标2a）和孤儿地位（艾滋病孤儿、其他方式孤儿、非孤儿）和EBD（具体目标2b），考虑到可能调解这些关系的因素（贫困和照料者药物使用障碍）。通过我们的初步工作建立的独特的合作伙伴关系和机构资源，三名高级NIH研究人员的指导，以及集合的研究团队的跨学科优势（发展精神病理学，心理测量学，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）以及在相关项目上富有成效的合作历史表明当前提案成功的可能性很大。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，开发心理健康评估工具。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艾滋病影响的儿童中EBD发展中的作用，将为学校干预工作奠定基础，或为更有效地针对当前干预提供急需的方向。 公共卫生相关性：对艾滋病心理健康研究中心（NIMH）内婴儿、儿童和青少年计划的拟议研究的意义和相关性。虽然本文提出的工作与上述NIMH计划的几个研究目标有间接相关性，但它与研究的关键焦点之一有直接相关性：“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、儿童和青少年的自然史和与治疗有关的行为、认知和社会发展变化，特别是在资源贫乏的环境中”。解决早期发现EBD的问题应该是最优先的，作为解决像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。SDQ的验证，并确定其在小学早期干预和预防EBD的背景下，除了了解贫困和照顾者SUD在受艾滋病影响和未受艾滋病影响的儿童EBD的发展中的作用，将提供更有效地针对干预措施急需的方向。因此，这项研究如果得到资助，可能会为后续研究的设计奠定基础，在后续研究中，可能会对受艾滋病毒/艾滋病影响的儿童进行以学校为基础的EBD评估和干预。