Conceptions of mental health among Ugandan youth orphaned by AIDS

Abstract

The AIDS epidemic has disproportionately affected developing or low-income sub-Saharan African countries. Within the context of the epidemic, children and youth are at risk of losing their parents at an early age. The experience of orphanhood due to AIDS has the potential to negatively impact on a child's mental health. A qualitative study was conducted to comprehensively describe the experience of orphanhood and its impact on mental health from the culturally specific perspective of Ugandan youths. We conducted interviews with a purposeful sample of 13 youths (ages 12 to 18) who had lost one or both parents to AIDS illness and who were also affiliated with a non-governmental organisation providing support to orphans. The orphaned youths experienced significant ongoing emotional difficulties following the death of their parent(s). The youths in this study were unfamiliar with the term 'mental health,' however they easily identified factors associated with good or poor mental health. In general, good mental health was associated with social conduct that is culturally appropriate. Poor mental health was perceived as a form of madness or insanity and it was associated with a loss of basic life necessities, such as access to food, education or shelter. The youths also identified factors that promote more successful orphans. The findings of this study suggest that Western terminologies and symptom constellations in the Diagnostic and Statistical Manual IV may not be applicable in an African cultural context. There are several clinical implications, including the development of a mental health intervention paradigm that emphasises resilience.

Toward a culturally sensitive conceptualization of resilience: Participatory research with war-affected communities in northern Uganda

“…These concepts emphasize that resilience applies to systems, involving families, communities, or broader social ecologies, and refers to the process of collective reflection, planning, and action to deal with encountered disturbances and challenges that may threaten or actually affect individual and communal well-being. The indicators generated by participants in this study show some overlap with other studies reporting culturally sensitive conceptualizations of resilience, wellbeing, or mental health (Ager, Akesson, et al, 2011;Harms, Kizza, Sebunnya, & Jack, 2009;Stark et al, 2009;Ungar & Liebenberg, 2011). For instance, sociability is consistently identified as an important indicator of youth well-being across different studies and contexts.…”

Child abuse and neglect among orphaned children and youth living in extended families in sub-Saharan Africa: What have we learned from qualitative inquiry?

“…Many studies (8/15) discussed participants’ experiences with reduced schooling during their parents’ illness or after their death (Ansell & Young, 2004; Chase, Wood, & Aggleton, 2006; Foster et al, 1997; Funkquist et al, 2007; Harms et al, 2009; Harms et al, 2010; Mangoma et al, 2008; Mmari, 2011; Oleke et al, 2006, 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003). This was due to an inability to pay school fees or uniforms (Funkquist et al, 2007; Mangoma et al, 2008; Oleke et al, 2007; Young & Ansell, 2003) or being required to engage in paid work or chores (Chase et al, 2006; Foster et al, 1997; Mmari, 2011; Oleke et al, 2006, 2007; van Blerk & Ansell, 2007; Young & Ansell, 2003): “[My uncle] said: ‘you are not my child so I cannot send you to school’” (Foster et al, 1997).…”

“…A number of studies (6/15) identified stigma as predisposing to maltreatment (Ansell & Young, 2004; Funkquist et al, 2007; Harms et al, 2009, 2010; McGraw & Wameyo, 2005; Snipstad et al, 2005; Wood et al, 2006; Young & Ansell, 2003). Stigma contributed to intra-household discrimination, neglect and emotional abuse (Funkquist et al, 2007; Harms et al, 2009, 2010; McGraw & Wameyo, 2005; Snipstad et al, 2005; Young & Ansell, 2003):

When my father comes home she [my stepmother] tells him that she will give me food on the plate where the dog feeds.

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Growing Up in the Era of AIDS: The Well-Being of Children Affected and Infected by HIV/AIDS in Sub-Saharan Africa

“…Recently the literature has started to explore the psychological impact on HIV/AIDS affected children (see for example Cluver et al, 2007;Cluver & Garner, 2007;Harms et al, 2009). …”