Family-based prevention of mental health problems among children affected by HIV/AIDS in rural Rwanda: A pilot feasibility study

Background: HIV-affected children are at increased risk for a range of mental health problems including depression, anxiety, and social withdrawal. Prevention-focused, family-based interventions have important public health applications in preventing mental health problems, including behavioral problems that may increase risk of HIV infection. Methods: The Family Strengthening Intervention-Rwanda (FSI-R) consists of four core components: 1) Building parenting skills and improved family communication; 2) Developing a “family narrative”; 3) Providing psychoeducation on HIV and its effects on families; and 4) Strengthening problem solving skills and the ability to access formal and non-formal support. Twenty families (N=39 children) that had at least one HIV+ caregiver and one child between the ages of 7 and 17 were enrolled in the FSI-R. Children and caregivers were administered locally-adapted and validated measures of child depression, anxiety, irritability, conduct problems, and functioning, as well as measures of prosocial behavior, resilience/self-esteem, hopefulness, social support, family support, positive parenting, and harsh parenting. Quantitative assessments were administered pre and post intervention. Multi-level models accounting for clustering by families were used to test for pre to post-intervention change in outcomes of interest. Results: Results indicated that children participating in the FSI-R reported significantly less depression and irritability symptoms, and significantly less harsh punishment from caregivers post-intervention. Caregivers reported that their children displayed significantly more resilience/self-esteem and pro-social behaviors post-intervention (ps < .05). Conclusions: The FSI-R is a promising intervention that may improve mental health symptoms, strengthen protective factors, and improve parent-child relationships among children and families affected by HIV.