a prospective national studyLucie Cluver, Lorraine Sherr, Mark Orkin, Mark Boyes

Suicide and AIDS-affected children in South Africa

National longitudinal study: 6850 children, 2500 adult caregivers, 2008-2012

Longitudinal national survey• Main study: N=6000 (age: 10-18) • 3 provinces South Africa; 6 sites >30% prevalence; 5 languages• Stratified random sampling of census EAs• Every household with a child aged 10-17• Urban/rural, 1 year follow-up in 2 provinces (n=3401, 97% follow-up)

Measures• Standardised scales: (suicidality: MINI International • Psychiatric Interview for children & adolescents)• Analyses: Principal components analysis, MV hierarchical logistic regression, multiple mediation in PROCESS

Ethics• Approved by University of Cape Town, Oxford, KwaZulu-Natal, Province Health & Education Depts• Social & health service referrals.for prior HIV risk

AIDS-orphan

HIV Risk Behaviour

Abuse

AIDS-sick

parent

Psych. distress

Stigma

Poverty

.08

.13

.22

.10.15

.15

.32

.43

.72

.15

.24

.12

mean χ2(679)

Bollen-Stine

mean χ2/df

RMSEA SRMR CFI TLI

640.06 p=.001 1.57 .032 .044 .939 .930

Family AIDS increases childhood adversities

Cluver, Orkin, Boyes, Sherr, Nikelo, Makhasi (2013). Soc. Sci & Medicine. Analyses funded by RIATT.

Education risks

.18

.14

Violence.14

.48

.21

ACE 0 ACE 1 ACE 2 ACE 3 ACE 4 ACE 5 ACE 6+0

2

4

6

8

10

12

14

16

% Adolescents with past-month suicide attempts at Year 2, by Year 1 AIDS-related adversities

Suicide attempts

Suicide planning

Suicide ideation

% w

ith su

icid

al b

ehav

iour

AIDS-related adverse experiences (ACE):

AIDS-orphanhood, parental AIDS-illness; Abuse: physical, emotional, sexual; domestic violence; parental death by homicide; com-munity violence; hunger

AIDS-related adversities and child suicide attempts: mediated by mental health distress

Mental health: clinical levels of depression, anxiety, post-traumatic stress

Note: All regression weights are unstandardised. Analysis controls for child age and gender, suicide behaviour at baseline, poverty, living in informal vs. formal housing, urban vs. rural location, and province (all measured at baseline).

Family AIDS increases abuse, hunger & violence

For already-exposed children, mental health care may reduce suicide risks

Together, these raise suicide attempts from 2% - 6% (cumulative OR 2.46 CI 1.00–6.05).

We need to mitigate adversities for AIDS-affected families

The Nuffield Foundation

Funders: thank you.www.youngcarers.org.za

National Department of Social Development

The National Research Foundation

HEARD, University of KwaZulu-Natal

The John Fell Fund

The Claude Leon Foundation

The Economic & Social Research Council

Regional Interagency Task Team for Children Affected by AIDS – Eastern & Southern Africa