A Qualitative Study of Mental Health Problems Among Orphaned Children and Adolescents in Tanzania

Abstract

Low- and middle-income countries (LMIC) have a high number of orphans, many of whom have unmet mental health needs. Effective mental health interventions are needed; however, it is necessary to understand how mental health symptoms and needs are perceived locally in order to tailor interventions and refine measurement of intervention effects. We used an existing rapid ethnographic assessment approach to identify mental health problems from the perspective of orphans and guardians to inform a subsequent randomized controlled trial of a Western-developed, evidence-based psychosocial intervention, Trauma-focused Cognitive Behavioral Therapy (TF-CBT). Local, Kiswahili-speaking interviewers conducted 73 free list interviews and 34 key informant interviews. Results identified both common cross-cultural experiences and symptoms as well as uniquely described symptoms (e.g., lacking peace, being discriminated against) not typically targeted by the intervention or included on standardized measures of intervention effects. We discuss implications for adapting mental health interventions in LMIC and assessing effectiveness.

Clinical risk factors among youth at high risk for suicide in South Africa and Guyana

“…Low somatization may reflect internalizing negative cognitions and effects, contrary to the typical interpersonal expression of distress, albeit somatic, for females. As with previous studies, our findings showed higher levels of social stress predicted previous suicide attempt (Blum et al, 2003;Dorsey et al, 2015;Hagaman et al, 2013;Shilubane et al, 2012). Adult-led engagement and interpersonal skills training for internalizing problems may benefit high-risk females in LMIC settings (Kapur, House, May, & Creed, 2003).…”

“…Adult-led engagement and interpersonal skills training for internalizing problems may benefit high-risk females in LMIC settings (Kapur, House, May, & Creed, 2003). As with previous studies, our findings showed higher levels of social stress predicted previous suicide attempt (Blum et al, 2003;Dorsey et al, 2015;Hagaman et al, 2013;Shilubane et al, 2012). The absence of communication about thoughts of suicide, distress, and hopelessness are common in low-income settings, especially among orphans (Fleischmann et al, 2008;Keys, Kaiser, Kohrt, Khoury, & Brewster, 2012).…”

“…Orphaned youths are more likely to engage in interactions considered socially malignant, with males more likely to have behavioral problems and females emotional problems (Dorsey et al, 2015;Ibrahim et al, 2012;Seager & Tamasane, 2010). Therefore, orphaned youth remain at the highest risk for suicide as clinical disorders, and social deficits complicate their utilization of limited but available treatment resources and systematic aids (Shilubane et al, 2012;Tadesse, Dereje, & Belay, 2014;Ugochukwu, Okeke, Onubogu, & Edokwe, 2012).…”

“…Orphan status has also been linked to hopelessness and suicidal ideation and attempt (Cumber, & Tsoka-Gwegweni, 2015;Dorsey et al, 2015;Kinyanda, Kizza, Levin, Ndyanabangi, & Abbo, 2011).…”

The impact of school support on depression among adolescent orphans: a cluster‐randomized trial in Kenya

“…This could reflect mounting pressures on control students not shared by intervention students. For instance, difficulty paying secondary school fees is a major source of stress for orphaned students in low‐income countries that can accumulate over time (Cluver et al., ; Dorsey et al., ). It is possible that control students experienced increasing stress as they struggled to remain enrolled, whereas intervention students were spared this particular stressor due to the education guarantees of the program.…”