Mental health of carers of children affected by HIV attending community-based programmes in South Africa and Malawi
Mental health of carers of children affected by HIV attending community-based programmes in South Africa and Malawi
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DOI：
10.1080/09540121.2014.906559
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发表时间：
2014-10-01
影响因子：
1.7
通讯作者：
Sherr, Lorraine
中科院分区：
文献类型：
--
作者：
Skeen, Sarah;Tomlinson, Mark;Sherr, Lorraine
有强有力的证据表明，感染艾滋病毒和受其影响的成人和儿童都面临着较高的心理健康负担。然而，在马拉维和南非，很少有研究调查艾滋病毒背景下护理人员的心理健康结果。本研究的目的是评估受艾滋病毒影响的儿童的护理人员的心理健康状况，作为儿童社区护理研究的一部分，该研究旨在提供社区组织 (CBO) 服务在改善儿童结局方面的有效性证据。在一项横断面研究中，我们采访了参加由南非和马拉维 11 个主要捐助者资助的 28 个随机选择的 CBO 的 952 名儿童（4-13 岁）照顾者。使用绍纳症状问卷测量心理发病率，并使用患者健康问卷中的项目测量自杀意念。护理人员被问及因情绪问题而寻求护理的情况。总体而言，28% 的护理人员当前心理发病率得分高于临床临界值，12.2% 的护理人员有自杀意念。我们使用逻辑回归模型来测试与不良结果相关的因素。家庭失业、与生病的家庭成员住在一起以及缺乏社区支持与护理人员的心理发病率和自杀意念有关。据报道，儿童粮食不安全也与心理发病率有关。此外，生活在南非的护理人员比马拉维的护理人员更有可能出现心理疾病和自杀意念。因心理健康问题寻求帮助的比率很低。由于艾滋病毒、社会经济、护理和社区因素，受艾滋病毒影响的儿童的照顾者面临着出现心理健康问题的风险。我们呼吁更多地认识到社区组织在提供精神卫生保健和家庭支持方面的潜在作用，以此作为改善精神卫生保健公平性的一种手段。具体来说，我们强调需要加强对受艾滋病毒影响的儿童的社区组织工作人员的培训和监督，以及将社区组织纳入更广泛的努力，以改善人口心理健康结果。
There is strong evidence that both adults and children infected with and affected by HIV have high levels of mental health burden. Yet there have been few studies investigating carer mental health outcomes in the context of HIV in Malawi and South Africa. The objective of this study was to assess the mental health of carers of children affected by HIV as a part of the Child Community Care study, which aims to generate evidence on the effectiveness of community-based organisation (CBO) services to improve child outcomes. In a cross-sectional study, we interviewed 952 carers of children (aged 4-13 years) attending 28 randomly selected CBOs funded by 11 major donors in South Africa and Malawi. Psychological morbidity was measured using the Shona Symptom Questionnaire and suicidal ideation was measured using an item from the Patient Health Questionnaire. Carers were asked about care-seeking for emotional problems. Overall, 28% of carers scored above the clinical cut-off for current psychological morbidity and 12.2% reported suicidal ideation. We used logistic regression models to test factors associated with poor outcomes. Household unemployment, living with a sick family member and perceived lack of support from the community were associated with both psychological morbidity and suicidal ideation in carers. Reported child food insecurity was also associated with psychological morbidity. In addition, carers living in South Africa were more likely to present with psychological morbidity and suicidal ideation than carers in Malawi. Rates of help-seeking for mental health problems were low. Carers of children affected by HIV are at risk for mental health problems as a result of HIV, socio-economic, care-giving and community factors. We call for increased recognition of the potential role of CBOs in providing mental health care and support for families as a means to improve equity in mental health care. Specifically, we highlight the need for increased training and supervision of staff at CBOs for children affected by HIV, and the inclusion of CBOs in broader efforts to improve population mental health outcomes.