The HIV/AIDS epidemic in sub-Saharan Africa has already orphaned a generation of children, and now seems set to orphan generations more (UNICEF, 2003). The devastating impact of this poses significant challenges for primary care services in addressing the mental health needs of orphans. Given the relative lack of skilled clinicians in low-resource countries like South Africa (Deslarlais et al., 1995), and a general lack of resources to address mental health needs in South African townships (Dlamini, 2004), there is an urgent need for the development of reliable and valid diagnostic tools for the early detection of psychiatric disorder as a first step towards successful intervention. In this proposal we seek (Specific aim 1a) to investigate the criterion validity of a brief and easy-to-administer population screen (SDQ;Goodman, 1997, 2001) in a sample of 750 7- 11 year old children (250 orphaned by AIDS, 250 orphaned by other means and 250 non-orphaned). The SDQ will be validated against clinician diagnosis and a diagnostic tool which our team has investigated for its cultural appropriateness in Sesotho families (the NIH-DISC-IV;Shaffer, Fisher, et al., 2000). We also seek (Specific aim 1b) to investigate the utility value of the SDQ in Sesotho schools to early detect children with EBD. We then seek to use the multi-method (questionnaire and interview-based) and multiple informant (caregiver-, teacher, and self-report) information collected in Specific aim 1a to test aspects of Cluver &Gardner's (2007) conceptual model of risk and protective factors by investigating the association between orphan type (paternal-, maternal-, double-, and non- orphan) and EBD (Specific aim 2a) and orphan status (orphan by AIDS, orphan by other means, non-orphan) and EBD (Specific aim 2b), taking into account factors that may mediate these relationships (poverty and caregiver substance use disorder). The unique partnerships and institutional resources established through our preliminary work, the mentorship of three senior NIH investigators combined with the interdisciplinary strengths of the assembled research team (developmental psychopathology, psychometrics, qualitative and quantitative research in the South African context, cross- cultural psychiatry and medical anthropology) and a demonstrated history of fruitful collaboration on related projects indicate a high likelihood of success for the current proposal. The proposed study is in line with the NIHM objective of developing assessment tools in mental health for children affected by HIV/AIDS especially in developing countries. Determining the validity of the SDQ and its usefulness in elementary schools as context for early intervention and prevention of EBD, in addition to understanding the role of poverty and caregiver SUD in the development of EBD in children affected and unaffected by AIDS will lay the foundation for school- based intervention work or offer much needed direction in targeting current interventions more effectively.

Public Health Relevance

Significance and relevance of the proposed research for the program on Infants, Children, and Adolescents within the Center for Mental Health Research on AIDS (NIMH). Although the work proposed herein has indirect relevance for several research objectives of the aforementioned NIMH program, it has direct relevance for one of the key foci of research: """"""""Develop assessment technologies as well as methodological and statistical tools for the evaluation of natural history and treatment related change in behavioral, cognitive, and social development of infants, children and adolescents infected with HIV or affected by HIV, particularly where applicable to resource poor environments"""""""". Addressing the problem of early detection of EBD should be of the highest priority as a first step in addressing the mental health and service needs of children in a developing country like South Africa. The validation of the SDQ and determining its usefulness in elementary schools as context for early intervention and prevention of EBD, in addition to understanding the role of poverty and caregiver SUD in the development of EBD in children affected and unaffected by AIDS, will offer much needed direction in targeting interventions more effectively. As such, this study if funded, may lay the foundation for the design of a follow-up study where a school-based assessment and intervention of EBD in children affected by HIV/AIDS may be conducted.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Study Section
Behavioral and Social Consequences of HIV/AIDS Study Section (BSCH)
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Kamath, Susannah M Allison
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University of Houston
Schools of Arts and Sciences
United States
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Pappin, Michele; Marais, Lochner; Sharp, Carla et al. (2015) Socio-economic status and socio-emotional health of orphans in South Africa. J Community Health 40:92-102
Sharp, Carla; Jardin, Charles; Marais, Lochner et al. (2015) Orphanhood by AIDS-Related Causes and Child Mental Health: A Developmental Psychopathology Approach. J HIV AIDS 1:
Marais, Lochner; Sharp, Carla; Pappin, Michelle et al. (2014) Community-based mental health support for orphans and vulnerable children in South Africa: A triangulation study. Vulnerable Child Youth Stud 9:151-158
Skinner, Donald; Sharp, Carla; Marais, Lochner et al. (2014) Assessing the value of and contextual and cultural acceptability of the Strength and Difficulties Questionnaire (SDQ) in evaluating mental health problems in HIV/AIDS affected children. Int J Ment Health 43:76-89
Sharp, Carla; Venta, Amanda; Marais, Lochner et al. (2014) First evaluation of a population-based screen to detect emotional-behavior disorders in orphaned children in Sub-Saharan Africa. AIDS Behav 18:1174-85
Marais, Lochner; Sharp, Carla; Pappin, Michele et al. (2013) Housing conditions and mental health of orphans in South Africa. Health Place 24:23-9
Michonski, Jared D; Sharp, Carla; Steinberg, Lynne et al. (2013) An item response theory analysis of the DSM-IV borderline personality disorder criteria in a population-based sample of 11- to 12-year-old children. Personal Disord 4:15-22
Sharp, Carla; Skinner, Donald; Serekoane, Motsaathebe et al. (2011) A qualitative study of the cultural appropriateness of the Diagnostic Interview Schedule for Children (DISC-IV) in South Africa. Soc Psychiatry Psychiatr Epidemiol 46:743-51