Emotional-behavior disorders in South African children affected by AIDS

受艾滋病影响的南非儿童的情绪行为障碍

• 批准号: 8052882
• 负责人: CARLA SHARP
• 金额: $ 27.39万
• 依托单位: UNIVERSITY OF HOUSTON
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-04-01 至 2012-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8052882
• 关键词: 11 year old; AIDS/HIV problem; Accounting; Acquired Immunodeficiency Syndrome; Address; Adolescence; Adolescent; Affect; Africa South of the Sahara; African; Age; Anthropology; Autopsy; Behavior Disorders; Behavioral; Caregivers; Child; Child Mental Health; Cognitive; Collaborations; Communities; Country; Data; Developing Countries; Development; Diagnosis; Diagnostic; Early Diagnosis; Early identification; Early treatment; Emotional; Environment; Epidemic; Epidemiology; Ethnic Origin; Evaluation; Expert Opinion; Factor Analysis; Family; Foundations; Funding; Generations; HIV; Health Services Needs; Household; Infant; Intervention; Intervention Studies; Interview; Language; Link; Measures; Mediating; Medical; Mental Health; Mental Health Services; Mental disorders; Mentorship; Methods; Modeling; National Institute of Mental Health; Natural History; Orphan; Patient Self-Report; Performance; Personal Satisfaction; Population; Poverty; Prevention; Primary Health Care; Psychiatry; Psychometrics; Psychopathology; Questionnaires; Recommendation; Recording of previous events; Recruitment Activity; Relative (related person); Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Sampling; Schedule; School Teachers; Schools; Services; Social Development; South Africa; Specificity; Structure; Substance Use Disorder; Technology Assessment; Testing; Time; Training; UNICEF; United States National Institutes of Health; Validation; Work; base; design; disorder risk; elementary school; follow-up; high risk; indexing; informant; instrument; interest; mental health center; primary care setting; programs; public health relevance; sex; success; successful intervention; teacher; tool; trait

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：撒哈拉以南非洲的艾滋病毒/艾滋病流行已经孤立了一代儿童，现在似乎更多地待给孤儿（联合国儿童基金会，2003年）。这一毁灭性影响在满足孤儿的心理健康需求方面对初级保健服务构成了重大挑战。鉴于南非等低资源国家（Deslarlais等人，1995年）相对缺乏熟练的临床医生，并且普遍缺乏解决南非乡镇心理健康需求的资源（Dlamini，2004年），因此需要迫切需要开发可靠的和有效的诊断工具，以使其早期诊断出早期的精神障碍，从而成功地进行了迈向第一步。在这项建议中，我们寻求（特定目标1A）来研究一个短暂且易于管理的人口屏幕（SDQ; Goodman，1997，2001）的标准有效性，该样本为750 7-11岁的孩子（由AIDS占250个孤儿，250个孤儿，250个孤儿，其他手段为250个孤儿，而250个非对个性的）。 SDQ将通过临床医生的诊断和诊断工具进行验证，我们的团队对其在Sesotho家族中的文化适用性进行了调查（NIH-DISC-IV； Shaffer，Fisher，Fisher等，2000）。我们还寻求（特定的目标1B）来调查Sesotho学校中SDQ的公用事业价值，以提早发现EBD的儿童。 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通过艾滋病，孤儿，其他方式，非孔）和EBD（特定的目标2b），考虑到可能介导这些关系的因素（贫困和照顾者使用障碍）。通过我们的初步工作建立的独特伙伴关系和机构资源，三名高级NIH研究者的指导与集会研究团队的跨学科优势相结合（发展心理病理学，心理病理学，心理学，定性和定量性研究，在南非的环境中，跨文化心理学和医学杂货学的相关性均具有效果，并在南非的环境中表现出了良好的良好史无前例。 提议。拟议的研究符合NIHM的目标，即为受艾滋病毒/艾滋病影响的儿童特别是发展中国家开发心理健康评估工具。除了了解贫困和照料者SUD在EBD发展中，在受艾滋病影响和不受艾滋病影响的儿童中，确定SDQ及其在小学中的有效性，作为早期干预和预防EBD的情况，除了了解贫困和护理人员SUD在EBD发展中的作用外，还将为基于学校的干预工作奠定基础，或者在针对当前干预措施中提供急需的方向。 公共卫生相关性：针对艾滋病心理健康研究中心（NIMH）中针对婴儿，儿童和青少年计划的拟议研究的意义和相关性。尽管本文提出的工作与上述NIMH计划的几个研究目标有间接相关性，但它与研究的关键重点之一具有直接相关性：“开发评估技术，以及评估自然历史和治疗的方法和统计工具，用于评估自然历史和治疗相关的行为，认知，认知能力和社会发展，以及对HHIV的儿童和社会发展的影响，而受到HIV的较差或受感染的环境。解决早期发现EBD的问题应该是解决南非等发展中国家儿童的心理健康和服务需求的第一步。 SDQ的验证并确定其在小学中的有用性，作为早期干预和预防EBD的背景，除了了解贫困和照料者SUD在EBD发展中EBD在受艾滋病影响和不受艾滋病影响的儿童中的作用外，还将为靶向干预措施提供更多的方向。因此，本研究如果资助，可以为后续研究的设计奠定基础，在该研究中，可以对受艾滋病毒/艾滋病影响的儿童进行基于学校的评估和干预。