Author

Yanping Jiang

Date of Award

Summer 2019

Document Type

Open Access Dissertation

Department

Health Promotion, Education and Behavior

First Advisor

Xiaoming Li

Second Advisor

Sayward E. Harrison

Abstract

Background: Children affected by parental HIV are commonly exposed to multiple risk factors, including parental illness and death, other traumatic life events, HIV stigma, and poverty, all of which in turn put them at elevated risk of experiencing poor mental health outcomes. Previous research has suggested the promise of psychosocial interventions in improving mental health for children affected by parental HIV through an integrated and multilevel resilience-based approach. However, there are few multilevel resilience-based interventions for this group, and the efficacy of such interventions on mental health outcomes has not been fully examined. Furthermore, very few studies have examined whether resilience-based interventions impact various sub-populations differently or explored the mechanisms through which such intervention effects occur. Therefore, the first aim of this dissertation research was to examine the short-term efficacy (e.g., up to 18 months) of the Child-Caregiver-Advocacy Resilience (ChildCARE) intervention, a multilevel resilience-based psychosocial intervention, on selected mental health outcomes (i.e., depressive symptoms, school anxiety, loneliness) among children affected by parental HIV, as well as testing the potential moderation roles of gender and age in the intervention effects. The second aim of this dissertation research was to examine whether the ChildCARE intervention would yield improvement in mental health beyond 18 months of follow up and whether emotional regulation and coping would act as the potential mechanisms of change through which the ChildCARE intervention improves mental health outcomes for these children.

Methods: The ChildCARE intervention is a culturally tailored intervention developed for children affected by parental HIV in China, which consists of intervention components at three levels: child, caregiver, and community. The intervention was evaluated using a 4-arm community-based cluster randomized controlled trial with a sample of 790 children 6-17 years of age (51.6% boys) affected by parental HIV in a rural county in central China from 2012 to 2016. Children and their primary caregivers were randomly assigned by school clusters to a control condition or one of three intervention conditions (i.e., child-only, child + caregiver, child + caregiver + community). Of the three intervention conditions, children and caregivers assigned to the child-only condition were provided child intervention component only, those assigned to the child + caregiver condition were provided both child and caregiver intervention components, and children and caregivers assigned to the child + caregiver + community condition were provided all three intervention components. Data on depressive symptoms, school anxiety, loneliness, emotional regulation, coping, and demographic characteristics were collected from children via self-report at baseline and every six months over 36 months.

Results: Overall, the ChildCARE intervention yielded some short-term improvements in depressive symptoms and loneliness, but these improvements were not sustained at 18 months or beyond for children affected by parental HIV. Older children (i.e., ≥ 12 years of age) benefited more from the intervention than their younger counterparts (i.e., < 12 years). Mediation analyses further showed that the ChildCARE intervention yielded significant improvements in positive coping, but not emotional regulation or negative coping at 18 months, whereas changes in emotional regulation, positive coping, and negative coping were consistently associated with depressive symptoms, school anxiety, and loneliness.

Conclusions: The findings in this research provide support for the benefits of the ChildCARE intervention on mental health outcomes but highlight the challenges in producing robust, long-term impacts for children affected by parental HIV in central China. This research also suggests the important roles of emotional regulation and coping in influencing mental health outcomes for these children.

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