Brief screen may identify mental disorders in children orphaned by HIV/AIDS

Issue: May 2014

A brief questionnaire used by caregivers may be useful in identifying emotional and behavioral problems in children orphaned by HIV/AIDS in sub-Saharan Africa, where clinically trained mental health care workers are scarce, according to recent study results.

The U.N. estimates that approximately 12 million children are orphaned by HIV/AIDS in sub-Saharan Africa. Research suggests that orphanhood may have a detrimental effect on children, including the development of psychiatric disorders.

“There has been a big push to understand what we can do to help these kids, but also how to identify these children in the community,” Carla Sharp, PhD, associate professor and director of the developmental psychopathology lab at the University of Houston, said in a press release.

Carla Sharp

“Part of the challenge is that there are four psychologists per 100,000 people in South Africa and 0.03 psychiatrists per 100,000 people. Individuals that are typically trained to help with mental health needs in the community are not available, and the few people who are available are often not culturally aware,” she said.

Sharp is the principal investigator for a $951,147 NIH grant to develop a reliable, valid screening tool for the early detection of psychiatric disorders in children affected by HIV/AIDS in sub-Saharan Africa.

For the present study, the researchers evaluated the construct validity of the Strengths and Difficulties Questionnaire (SDQ) in 466 Sesotho-speaking children aged 7 to 11 years (51.93% female) in South Africa who were orphaned by HIV/AIDS. The SDQ is a 25-item questionnaire developed in the United Kingdom to assess emotional-behavioral disorders in children, and several studies have demonstrated the questionnaire’s validity in a number of locations, including Australia, the Nordic countries, Dhaka, southern Europe, the Netherlands and Germany. However, no screening tool has been validated in pre-adolescent children living in sub-Saharan Africa.

Three versions of the questionnaire were translated and delivered to caregivers, teachers and orphaned children. The researchers measured the validity of the SDQ against a computerized version of the Diagnostic Interview Schedule for Children (DISC-IV), an assessment based on DSM-IV criteria that does not require clinical training to administer. In a previous study, Sharp and colleagues determined that the DISC-IV was, for the most part, a culturally appropriate diagnostic tool for use with Sesotho-speaking families in South Africa.

Figure 1. Carla Sharp, PhD, works with children in South Africa. Her research focuses on identifying emotional and behavioral problems in children orphaned by HIV/AIDS.

Source: University of Houston

According to the researchers, approximately 15% of the cohort met full diagnostic criteria for a psychiatric disorder, and almost half met criteria for sub-threshold levels of psychopathology.

Results from the evaluation of the SDQ suggested either poor internal consistency or construct validity of the versions administered to children and teachers, and that only the caregiver version could be used with any certainty to identify children with psychiatric disorders.

Sharp said she plans to study an intervention to train community-based organization (CBO) workers to respond to the mental health needs of children.

“[The] problem that exists in South Africa … is that once you’ve identified children with emotional-behavior problems, then what do you do with them?” she said. “That’s the next step. It’s all good and well if you are identifying them. That’s what we are looking at now, but I don’t think CBOs and church-based organizations always know how to intervene with kids if they were able to identify them.”

For more information:

Sharp C. AIDS Behav. 2014;doi:10.1007/s10461-014-0739-6.

Sharp C. AIDS Behav. 2010;doi:10.1007/s00127-010-0241-z.

Disclosure: The study was supported by the NIH, grant no. R01 MH078757.