Table 2.
Summary of findings of twenty-five cross-sectional studies
| Author(year) | Location (year of the study) | Sampling | Sample description | Indicators of psychological well-being | Major findings | Moderating/mediating factors |
|---|---|---|---|---|---|---|
| Mueller et al. (2011) [13] | Nekkies, South Africa (2001) | Recruited from schools | N = 281 Age: 8–18 |
Standardized instruments: Self-esteem e, self-efficacy k, depression a, emotional problems l, behavioral problems l | Loss of both parents exerted a robust effect on child psychosocial health after controlling confounding factors |
Risk factors: AIDS-related stigma, community and household violence Protective factors: Social connection |
| 66 AIDS orphans (17 maternal, 33 paternal, 16 double), 215 comparison children | ||||||
| G. Zhao et al. (2011)[57, 62]; J. Zhao et al. (2011) [20]; Q. Zhao et al. (2011) [55]; Hong et al. (2010) [63]; Lin et al. (2010) [53]; Zhang et al. (2009) [64]; Fang et al. (2009) [45]; Li et al. (2009) [42] | Henan, China (2006–2007) | Recruited from orphanages, group homes, and family or kinship care |
N = 1625 Age: 6–18 |
Standardized instruments: Depression d, self-esteem e, future expectation f, future orientation g, school adjustment h, traumatic stress i, loneliness j | AIDS orphans and vulnerable children showed lower psychological well-being than comparison children Double orphans and single orphans had the similar level of psychological well-being |
Gender effect: Not significant Age effect: Not significant Risk factors: Traumatic events, stigma, child abuse Protective factors: Trusting relationship with caregivers, social support |
| 755 AIDS orphans; 466 vulnerable children; 404 comparison children | ||||||
| Cluver et al. (2010–2007) [23, 43, 50, 52, 54, 65] | Cape Town, South Africa (2005) | Recruited from urban settlements, schools, community organizations, street-children, and child-headed households |
N = 1025 Age: 10–19 |
Standardized instruments: Depression a, anxiety b, traumatic stress c, peer and conduct problems l, delinquency w | AIDS orphans showed higher level of depression, anxiety, post-traumatic stress, conduct problems, peer problems, delinquency, and suicidal ideation than the other two groups |
Risk factors: Food insecurity, bullying, child abuse, domestic violence, sibling separation, changes of caregiver Pathway: AIDS orphanhood → caregiver illness, excessive housework, stigma, poverty → psychological distress |
| 425 AIDS orphans; 241 other orphans, 278 comparison children | ||||||
| Doku (2010 – 2009) [46, 47] | Odumase, Ghana | Recruited from communities |
N = 200 Age: 10–18 |
Standardized instruments: Emotional-behavioral problems l | AIDS orphans had the most peer problems among the four groups Both AIDS orphans and other orphans had more conduct problems than the other two groups Emotional problems were very high in all the groups except among the comparison children |
Gender effect: Vulnerable boys had more peer problems than vulnerable girls, and such gender difference did not exist among AIDS orphans Age effects: Not significant |
| 50 AIDS orphans, 51 other orphans, 48 vulnerable children, 51 comparison children | ||||||
| Kaggwa & Hindin (2010) [22] | Mukono, Uganda (2007–2008) | Recruited from 10 randomly selected schools |
N = 1309 youth Age: 12–29 |
Standardized instruments: Depression a, hopelessness m | AIDS orphans did not show higher levels of depression and hopelessness than comparison children |
Gender effect: Loss of a parent to HIV was associated with worse psychological distress among the males but not females Risk factors: Lower parent/guardian connectedness, chronically illness of adults in the household, ill treatment in residence |
| 459 orphans (28.7% AIDS orphans, 35.8% other orphans, 35.5% orphan of unknown causes), 850 comparison children | ||||||
| Nyamukapa et al. (2010) [15] | Manicaland, Zimbabwe (2002–2003) | Stratified random household sampling: Recruited from 8 rural locations |
N = 527 Age: 12–18 |
Investigator-developed questions: Psychological distress (20 questions on depression and anxiety) | AIDS orphans suffered greater psychological distress than comparison children after controlling sex and age Paternal orphans had greater psychological distress for all durations of parental loss Maternal orphans who lost their parents more than four years ago reported less psychological distress |
Gender effect: Not significant Risk factors: A recent death in the household, a seriously ill adult in the household, stigma, inadequate care, child labor, physical abuse, and being out of school |
| 444 AIDS orphans (185 double orphans, 109 maternal orphans, 150 paternal orphans), 83 comparison children | ||||||
| Onuoha et al. (2010–2009) [39, 40, 51] | Kampala, Uganda; Mafikeng/Klerksdorp, South Africa | Recruited from 9 local community schools and 6 child-care centers |
N = 952 Age: 10–17 |
Standardized instruments: Depression d, self-esteem e, anxiety o | AIDS orphans scored higher in depression, anxiety than the other two groups AIDS orphans scored lower on self-esteem than the other two groups Double orphans scored higher anxiety and lower self-esteem than did single orphans |
Gender effect: Not significant Age effect: Not significant Risk factors: Child abuse, stigma Protective factors: Natural mentorship, social support |
| 373 AIDS orphans, 287 other orphans, 290 comparison children | ||||||
| Xu T. et al. (2010) [35] | Yunan, China | Recruited from local health service providers |
N = 215 Age: 8–17 |
Standardized instruments: Health related quality of life α, | AIDS orphans and vulnerable children scored lower on subjective quality of life, especially in emotional functioning and school functioning domains |
Risk factors: Parental disclosure of HIV/AIDS status Protective factors: Caregiver’s perceived quality of life, grandparents fostering, more company time provided by the caregiver |
| 116 AIDS orphans and vulnerable children, 109 comparison children | ||||||
| Delva et al. (2009) [49] | Conakry and N’Zerekore, Guinea (2006) | Recruited with the assistance of local authorities, NGOs and CBOs |
N = 397 Age: 10–18 |
Investigator-developed questions: Psychological well-being (difficulties falling asleep, feeling safe, etc.) | AIDS orphans reported significantly lower psychological well-being than other orphans and comparison children | Risk factors: Bed hungry, child labor |
| 124 AIDS orphans, 133 other orphans, 140 comparison children | ||||||
| Ruiz-Casares et al. (2009) [38] | Caprivi and Kavango, Namibia (2004) | Recruited from 3 schools |
N = 157 Age: 7–21 |
Standardized instruments: Depression a | 21.9% of single and double orphans and 11.9% of non-orphans exhibited depressive symptoms. Double orphans were 3.2 times and single orphans were 1.5 times as likely to fall into clinical range of depression than comparison children Maternal orphans showed similar level of depression with paternal orphans |
N/A |
| 73 AIDS orphans (50 single plus 23 double), 84 comparison children | ||||||
| Killian and Durrheim (2008) [29] | KwaZulu Natal, South Africa | Recruited from communities with profound poverty and problems |
N = 741 Age: 10.05 ± 1.57 |
Standardized instruments: Emotional and behavioral difficulties q, traumatic stress r, depression s, | AIDS orphans and vulnerable children showed similar higher degree of emotional distress and behavioral difficulties (caregiver report), depression and traumatic stress (child report) than comparison children |
Risk factors: Bereavement, taking care of dying people, child abuse, poverty, protracted hospitalization Protective factors: Perceived social support |
| 319 maternal AIDS orphans, 276 vulnerable children, 146 comparison children | ||||||
| Mellins et al. (2008) [30]; Brackis-Cott et al. (2007) [34] | New York City, US | Recruited from 5 medical centers, 3 CBOs, and one network of HIV care provider |
N = 220 Age: 10–14 |
Standardized instruments: Depression a, anxiety n, internalizing problems and externalizing problems z | Vulnerable children and comparison children were not different in clinical range of depression, anxiety symptoms (child report), and internalizing/externalizing problems (mother report) |
Gender effect: Not significant Age effect: Not significant Risk factors: Maternal disclosure of HIV/AIDS status, being in Latina families, overall health of mothers Protective factors: Parent-child communication and involvement, youth autonomy |
| 120 vulnerable children with HIV+ mother; 100 comparison children | ||||||
| Nyamukapa et al. (2008) [16] | Zimbabwe (2004) | A subsample from National Survey: Probability proportional to size sampling | N = 5321 Age: 12–17 |
Investigator-developed questions: Psychological distress (25-item) | AIDS orphans showed higher psychological distress than comparison children Vulnerable boys but not girls, showed evidence of more psychosocial distress than comparison children The above link was regardless of orphanhood types (i.e., maternal, paternal, double) Maternal orphans were at particular risk of early onset of sexual intercourse |
Gender effect: Not significant for AIDS orphans, but significant for vulnerable children Age effect: Not significant Risk factors: Poverty, care arrangement and quality, no school enrollment Protective factors: Being connected with a close adult |
| 1952 AIDS orphans (548 double orphans, 281 maternal orphans, 1123 paternal orphans), 543 vulnerable children, 2165 comparison children | ||||||
| Ostergaard and Meyrowitsch (2008) [17] | Benin (2005) | Multistage random sampling |
N = 2043 Age: 10–16 |
Investigator-developed questions: Psychosocial condition (3-item) | Children affected by HIV/AIDS had higher levels of psychological distress than comparison children Children affected by HIV/AIDS were as much as five times as likely to reported negative perception of themselves |
Risk factors: Lack of food, lack of medical support |
| 1033 children affected by HIV/AIDS, 1010 comparison children | ||||||
| He and Ji (2007) [44] | Henan, China. (2005) | Recruited from four schools |
N = 186 Age: 8–15 |
Standardized instruments: Depression u, self-esteem e, subjective life quality v | AIDS orphans had less self-esteem and lower life quality and were more depressed than comparison children No differences were found between paternal, maternal and double orphans |
Gender effect: Boys were more vulnerable than girls in psychological well-being and life quality |
| 93 AIDS orphans (48 paternal orphans, 25 maternal orphans, 13 double orphans) 93 comparison children | ||||||
| Cluver et al. (2006) [26] | Cape town, South Africa. (2002–2003) | Recruited from Child Welfare Society |
N = 60 Age: 6–19 |
Standardized instruments: Traumatic stress x, emotional and behavioral problems l | AIDS orphans did not show more traumatic stress and prosocial, conduct, emotional, peer and hyperactivity problems than comparison children | N/A |
| 30 AIDS orphans, 30 comparison children | ||||||
| Howard et al. (2006) [36] | Rural eastern area, Zimbabwe (2003) | Recruited from 34 schools |
N = 340 Age = 6–19 |
Investigator-developed questions: Feeling of scared, worried, overwhelmed, difficulty sleeping, anxiety, unhappiness, future education orientation | Double orphans and single orphans had more feeling of scared and worried than comparison children. Double orphans felt overwhelmed more frequently than single orphans and comparison children Double orphans were less likely to say they hope to go to college |
Age effect: Distress was greatest among younger children among double orphans, but not among single orphans or non-orphans Gender effect: Not significant Risk factors: Lack of meals |
| 253 AIDS orphans(144 double orphans and 109 single orphans), 87 comparison children | ||||||
| Atwine et al. (2005) [18] | Bushenyi District, Uganda | Multistage stratified random sampling: Recruited at homes & schools |
N = 223 Age: 11–15 |
Standardized instruments: self-concept y, anxiety y, depression y, anger y, disruptive behavior y | AIDS orphans had greater risk for higher levels of anxiety, depression, and anger than comparison children AIDS orphans showed more disruptive behaviors AIDS orphans did not score lower than comparison children on self-concept Maternal orphans and paternal orphans did not show differences in depression 12.2% orphans wished they were dead |
Gender effect: Not significant Age effect: Not significant Protective factors: Support from extended family, peer support groups |
| 123 AIDS orphans, 110 comparison children | ||||||
| Bhargava, (2005) [19] | Ethiopia (2001–2002) | Stratified random sampling: A subsample of National Survey of Prevalence of Orphans in Ethiopia |
N = 1053 Age: >10 Ethnicity: |
Standardized instruments: 60 items from MMPI-2 measuring social and emotional adjustment p | AIDS orphans showed lower emotional and social adjustment than other orphans |
Gender effect: Girls were more affected than boys Protective factors: Presence of the father, higher household income, adequate feeding and clothing condition, sympathetic attitude of the fostering family |
| 479 maternal and double AIDS orphans, 574 other orphans | ||||||
| Makame et al. (2002) [25] | Dar El Salaam, Tanzania (2000) | Recruited from local NGOs, ward, and local leaders in three poor suburbs |
N = 82 Age: 10–14 |
Investigator-developed instruments: Internalizing problems (derived from Rand Psychological well-being and Beck Depression Inventories) | AIDS orphans had more internalizing problems and higher level of depression 34% or the orphans reported had contemplated suicide in the past year |
Risk factors: Poor school attendance, lack of economic resources and basic need, being hungry |
| 41 AIDS orphans, 41 comparison children | ||||||
| Esposito et al. (1999) [31] | Milan, Italy | Recruited from HIV medical providers |
N = 117 Age: 6–11 |
Standardized instruments: Internalizing and externalizing problems z, social competence z, anxiety b, depression a | AIDS orphans and vulnerable children scored higher in anxiety, depression (children n report), externalizing problems, attention and social problems, and lower in social competence (caregiver report) than comparison children AIDS orphans were not different with vulnerable children on psychological problems |
N/A |
| 39 AIDS orphans or vulnerable children (18 maternal AIDS orphans), 78 comparison children | ||||||
| Forehand et al. (1998) [32] | New Orleans, USA | A subsample of Family Health Project |
N = 236 Age: 6–11 |
Standardized instruments: Depression a, externalizing and internalizing problems z, social competence t | Vulnerable children reported higher degree of depression and externalizing problems, and were rated lower on social competence according to the mother report but not child report |
Gender effect: Not significant Age effect: Not significant |
| 87 vulnerable children with HIV+ mother, 149 comparison children | ||||||
| Forehand et al.(1997) [12] | 22 hemophilia treatment centers, US | A subsample of Hemophilia: Parent and Children Project |
N = 137 Age: 3–18 |
Standardized instruments: Externalizing and internalizing problems z | Vulnerable children had higher levels of internalizing problems, but did not differ from comparison children on externalizing problems (child + parent report) |
Gender effect: Not significant Age effect: Not significant |
| 67 children living with HIV+ father, 70 comparison children living with father with Hemophilia | ||||||
| Sengendo and Nambi (1997) [37] | Rakai district, Uganda | Recruited with the help of community workers. |
N =193 Age: 6–20 |
Investigator-developed questions: Depression, locus of control | AIDS orphans had a higher average score of depression than comparison children AIDS orphans were less optimistic about the future than the comparison children |
Risk factors: Poverty, child headed household |
| 169 AIDS orphans, 24 comparison children | ||||||
| Forsyth et al. (1996) [24] | Connecticut, US | Recruited from a hospital |
N =52 Age: 6–16 |
Standardized instruments: Externalizing and internalizing problems z, depression a, anxiety b | Vulnerable children were found to be more withdrawn, have more problems with attention (mother report), report higher level of depression than comparison children (children report) Vulnerable children were not more anxious than comparison children (children report) |
Risk factors: Mother presenting symptoms of HIV |
| 26 vulnerable children with HIV+ mother, 26 comparison children |
Note. The upper class alphabets can be used to match the specific tools described in Table 1.