Communication with children and adolescents about the diagnosis of a life-threatening condition in their parent.

Children and youth in low-and middle-income countries (LMIC) are at greater risk for poor mental health. Adverse circumstances including poverty, violence, and lack of available psychological treatments increase their vulnerability. Given the importance of the family environment for child and youth wellbeing, family interventions are a powerful mode of treatment; however, their development and evaluation has received relatively little attention in LMIC. This review presents evidence for family- and parent-focused interventions on mental health outcomes for children and youth in LMIC and identifies treatment components present in promising interventions. A systematic search was conducted using comprehensive search terms in five databases (Global Health, PubMed, PsychINFO, PILOTS, and Cochrane Library). Reporting follows PRISMA guidelines. Independent raters screened and retrieved articles for inclusion, completed quality ratings, conducted data extraction, and coded common practice elements. This review included 36 papers representing 32 unique studies of family or parenting interventions in LMIC. Study designs covered: RCTs (50% of studies), pre-to-post studies (38%), and other (12%). The majority of interventions showed positive outcomes for child and youth mental health and wellbeing. The two most frequently used treatment techniques were caregiver psychoeducation and caregiver coping skills; the next most common were treatment processes of providing between-session homework and accessibility promotion. Evidence for family-focused interventions for child and youth mental health in LMIC is growing with several promising approaches that should be more rigorously evaluated. Further research into effects of specific intervention components will ensure targeted and optimally effective interventions.

/pdf/a-systematic-review-of-the-evidence-for-family-and-parenting-1rlxpqs8ww.pdf

A Systematic Review of the Evidence for Family and Parenting Interventions in Low- and Middle-Income Countries: Child and Youth Mental Health Outcomes

Family-Based Mental Health Promotion for Somali Bantu and Bhutanese Refugees: Feasibility and Acceptability Trial

Background Mental health difficulties and mental disorders are common in adolescents living with HIV or who are affected by HIV because of living in HIV-affected households in low- and middle-income (LMICs) countries, but little is known about the interventions that target these individuals and whether they are effective. Aims This systematic review aims to address these gaps by examining what has worked and what has not worked to support the mental health of adolescents living with HIV or affected by HIV in low- and middle-income contexts (PROSPERO Number: CRD42018103269). Method A systematic literature review of online databases from the year 2000 to 2018, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, included English-language publications of quantitative evaluations of psychosocial interventions aiming to improve mental health among adolescents living with HIV and adolescents from HIV-affected households (aged 10-24 years) in LMICs. Results Out of 2956 articles, 16 studies from 8 LMICs met the inclusion criteria. Thirteen studies focused on adolescents affected by HIV and only three studies on adolescents living with HIV. Only five studies included were from Sub-Saharan Africa. Interventions most often used a family-strengthening approach strengthening caregiver-adolescent relationships and communication and some problem-solving in groups or individually. Five studies reported statistically significant changes in adolescent and caregiver mental health or mental well-being, five among adolescents only and two among caregivers only. Conclusions Research on what works to improve mental health in adolescents living with HIV in LMIC is in its nascent stages. Family-based interventions and economic strengthening show promise.

/pdf/mental-health-interventions-for-adolescents-living-with-hiv-u31vzm2lry.pdf

Mental health interventions for adolescents living with HIV or affected by HIV in low- and middle-income countries: systematic review.

Although declining in all other age groups, AIDS-related deaths among adolescents are increasing. In the context of HIV, mental health problems are associated with negative health outcomes, including non-adherence to life-saving ART. For effective programming it is essential to identify factors associated with psychological outcomes in this population. Adopting a socioecological perspective, we aimed to identify correlates of internalising and externalising symptoms in a large, representative sample of South African adolescents living with HIV. HIV-positive adolescents (n = 1060), who received care in public health facilities in South Africa's Eastern Cape, completed measures of internalising and externalising symptoms. Hypothesised correlates included HIV and health-related factors (physical health, mode of infection, medication side-effects, disclosure, stigma), health-service related factors (negative interactions with clinic staff, clinic support group), interpersonal factors (abuse, bullying victimisation, social support), parenting-related factors (orphanhood, positive parenting, parental monitoring, parent communication), as well as individual and demographic-related factors (self-efficacy, age, gender, urban/rural location, poverty). Correlates operating across a variety of contexts were identified. Bullying victimisation, self-efficacy, and positive parenting may be particularly salient intervention targets as they were associated with better outcomes on most or all mental health measures, can be addressed without directly targeting adolescents living with HIV (reducing the chances of accidental exposure and stigma), and are associated with better adolescent mental health in South Africa more generally.

/pdf/mental-health-in-south-african-adolescents-living-with-hiv-2infob8cmy.pdf

Mental health in South African adolescents living with HIV: correlates of internalising and externalising symptoms.

Background
Children affected by HIV are at risk for poor mental health We conducted a pilot randomized controlled trial (RCT) of the Family Strengthening Intervention (FSI-HIV), a family home-visiting intervention to promote mental health and improve parent–child relationships in families with caregivers living with HIV, hypothesizing that child and family outcomes would be superior to usual care social work services

Methods
Eighty two families (N = 170 children, 4824% female; N = 123 caregivers, 6829% female) with at least one HIV-positive caregiver (n = 103, 8374%) and school-aged child (ages 7–17) (HIV+ n = 21, 1235%) were randomized to receive FSI-HIV or treatment-as-usual (TAU) Local research assistants blind to treatment conducted assessments of child mental health, parenting practices, and family functioning at baseline, post-intervention, and 3-month follow-up Multilevel modeling assessed effects of FSI-HIV on outcomes across three time points Trial Registration: NCT01509573, ‘Pilot Feasibility Trial of the Family Strengthening Intervention in Rwanda (FSI-HIV-R)' https://clinicaltrialsgov/ct2/show/;NCT01509573?term=Pilot+Feasibility+Trial+of+the+Family+Strengthening+Intervention+in+Rwanda+%28FSI-HIV-R%29&rank=1

Results
At 3-month follow-up, children in FSI-HIV showed fewer symptoms of depression compared to TAU by both self-report (β = −246; p = 009) and parent report (β = −174; p = 035) but there were no significant differences by group on conduct problems, functional impairment, family connectedness, or parenting

Conclusions
Family-based prevention has promise for reducing depression symptoms in children affected by HIV Future trials should examine the effects of FSI-HIV over time in trials powered to examine treatment mediators

/pdf/family-based-promotion-of-mental-health-in-children-affected-14owwif57y.pdf

Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial.

Fostering children is common in sub-Saharan Africa, but few studies examine these children’s mental health needs. This study investigated the impact of living in a foster family on the mental health of HIV-positive, HIV-affected and HIV-unaffected children (n = 681 aged 10–17) in rural Rwanda. Regression analyses assessed the impact of living in a foster family on mental health, parenting, and daily hardships; multiple mediation analyses assessed whether family factors mediated the association between foster status and mental health. HIV-positive children were eight times more likely to live in foster families than HIV-unaffected children. Being HIV-affected was predictive of depression and irritability symptoms after controlling for family factors. Controlling for HIV-status, foster children had more symptoms of depression, anxiety, and irritability than non-fostered children. Positive parenting fully mediated the association between foster status and mental health. Mental health and parenting interventions for foster children and HIV-affected children may improve child outcomes.

/pdf/mental-health-of-children-living-in-foster-families-in-rural-2gahu0s36a.pdf

Estella Nduwimana

Papers

Family-based promotion of mental health in children affected by HIV: a pilot randomized controlled trial.

Mental Health of Children Living in Foster Families in Rural Rwanda: The Role of HIV and the Family Environment