Living with HIV Increases Risk for Depression and Anxiety among Adults Caring for AIDS-Orphaned Children

Background: We have little understanding of whether living with HIV elevates risk for depression and anxiety among caregivers of AIDS-orphaned children in South Africa. We assess prevalence of depression and anxiety among adults caring for AIDS-orphaned children. We also compare prevalence of depression and anxiety among adults caring or AIDS-orphaned children versus adults who are living with HIV and caring or AIDS-orphaned children.

Methods: A cross-sectional survey of 4,954 participants (2,477 children 10-17 years and 2,477 of their primary adult caregivers) was conducted in KwaZulu-Natal Province (HIV prevalence 36.3-41.6%). Random sampling of census enumeration size areas was used and visits to all households undertaken. Caregiver depression and anxiety were assessed using the Center for Epidemiologic Studies Depression Scale and the Beck Anxiety Inventory. Chi-square tests compared whether mental health outcomes differed among caregivers living with HIV versus those without HIV.

Results: Caregivers reported poor mental health with 35.6% meeting criteria for depression and 49.4% meeting criteria for anxiety. Caregivers of AIDS-orphaned children were more likely to report depression or anxiety than caregivers of other-orphaned and non-orphaned children (p<0.001). Among caregivers of AIDS-orphaned children, those who were living with HIV were more likely to report depression or anxiety than caregivers not living with HIV (p<0.0001).

Conclusions: Our findings indicate that living with HIV can increase risk for depression and anxiety among this vulnerable group of caregivers. There is an urgent need to develop family interventions to meet the mental health needs of adults caring for orphaned children in HIV-endemic South Africa.