Child maltreatment mediates the relationship between HIV/AIDS family dysfunction trajectories and psychosocial problems among adolescents
The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial problems. A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES) and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial problems is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem (b = .59 [95%CI .32, .91]), delinquency and risky behaviours (b = .56 [95%CI .31, .86]) and peer problems (b = .74 [95%CI .48, 1.03]). Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem (b = .78 [95%CI .43, 1.23]), delinquency and risky behaviours (b = .76 [95%CI .45, 1.11]), depression/emotional problems (b = .64 [95%CI .40, .92]) and peer problems (b = .94 [95%CI .66, 1.26]). Partial mediation was found for hyperactivity. Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial problems among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychosocial problems among these children, thus enhancing their wellbeing. The findings therefore underscore the need for comprehensive psychosocial interventions that addresses both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.
Clinical relevance and conclusion
Literature evidence indicate that, this study is one of the first studies to examine the mediation role of child maltreatment on the association between family dysfunction trajectories and psychosocial problems on children in HIV/AIDS settings. The study confirmed the hypothesis that family dysfunction trajectory might also affect children’s psychosocial problems through its influence on child maltreatment. Children affected by HIV/AIDS need to be cared for. However, the experiences of dysfunction trajectory may create avenues for child maltreatment. Increased child maltreatment, in turn, heightens the risk for developing poor psychosocial outcomes. Conversely, lower child maltreatment may buffer the negative effects of family dysfunction trajectory on psychosocial problems. Thus, the findings underscore the urgent need for regular screening for maltreatment and psychosocial distress on children in family dysfunction trajectories. Finally, the findings further suggest that prevention and intervention programs for psychosocial distress that also consider the effects of child maltreatment may yield better results than those targeting family HIV/AIDS dysfunction alone. Thus, to increase the likelihood of enhanced psychosocial problems among adolescents affected by HIV/AIDS, targeted comprehensive interventions to address the effects of both family HIV/AIDS dysfunction trajectories and child maltreatment are urgently needed. On the theoretical level, the findings of the present study support the emotional security theory, as well as the socioecological and transactional models, and suggest that dysfunctional family trajectories caused by the presence of HIV/AIDS in the family may have a negative impact on children’s emotional and behavioural well-being. As a result, the findings support the relevance and potential utility of these models as theoretical frameworks for understanding HIV/AIDS family dysfunction trajectories and psychosocial problems among adolescents in Ghana.