a prospective national studyLucie Cluver, Lorraine Sherr, Mark Orkin, Mark Boyes
Suicide and AIDS-affected children in South Africa
National longitudinal study: 6850 children, 2500 adult caregivers, 2008-2012
Longitudinal national survey• Main study: N=6000 (age: 10-18) • 3 provinces South Africa; 6 sites >30% prevalence; 5 languages• Stratified random sampling of census EAs• Every household with a child aged 10-17• Urban/rural, 1 year follow-up in 2 provinces (n=3401, 97% follow-up)
Measures• Standardised scales: (suicidality: MINI International • Psychiatric Interview for children & adolescents)• Analyses: Principal components analysis, MV hierarchical logistic regression, multiple mediation in PROCESS
Ethics• Approved by University of Cape Town, Oxford, KwaZulu-Natal, Province Health & Education Depts• Social & health service referrals.for prior HIV risk
AIDS-orphan
HIV Risk Behaviour
Abuse
AIDS-sick
parent
Psych. distress
Stigma
Poverty
.08
.13
.22
.10.15
.15
.32
.43
.72
.15
.24
.12
mean χ2(679)
Bollen-Stine
mean χ2/df
RMSEA SRMR CFI TLI
640.06 p=.001 1.57 .032 .044 .939 .930
Family AIDS increases childhood adversities
Cluver, Orkin, Boyes, Sherr, Nikelo, Makhasi (2013). Soc. Sci & Medicine. Analyses funded by RIATT.
Education risks
.18
.14
Violence.14
.48
.21
ACE 0 ACE 1 ACE 2 ACE 3 ACE 4 ACE 5 ACE 6+0
2
4
6
8
10
12
14
16
% Adolescents with past-month suicide attempts at Year 2, by Year 1 AIDS-related adversities
Suicide attempts
Suicide planning
Suicide ideation
% w
ith su
icid
al b
ehav
iour
AIDS-related adverse experiences (ACE):
AIDS-orphanhood, parental AIDS-illness; Abuse: physical, emotional, sexual; domestic violence; parental death by homicide; com-munity violence; hunger
AIDS-related adversities and child suicide attempts: mediated by mental health distress
Mental health: clinical levels of depression, anxiety, post-traumatic stress
Note: All regression weights are unstandardised. Analysis controls for child age and gender, suicide behaviour at baseline, poverty, living in informal vs. formal housing, urban vs. rural location, and province (all measured at baseline).
Family AIDS increases abuse, hunger & violence
For already-exposed children, mental health care may reduce suicide risks
Together, these raise suicide attempts from 2% - 6% (cumulative OR 2.46 CI 1.00–6.05).
We need to mitigate adversities for AIDS-affected families
The Nuffield Foundation
Funders: thank you.www.youngcarers.org.za
National Department of Social Development
The National Research Foundation
HEARD, University of KwaZulu-Natal
The John Fell Fund
The Claude Leon Foundation
The Economic & Social Research Council
Regional Interagency Task Team for Children Affected by AIDS – Eastern & Southern Africa