The Impact of Child Emotional and Behavioral Difficulties on Caregivers' Mental Health: Insights from Families of Children Orphaned by HIV in Southern Uganda.

Abstract

Background: In Uganda, children orphaned by HIV are at a high risk of emotional and behavioral difficulties (EBDs). This elevated risk of EBDs has implication on caregivers' mental health given that caregiving is an involving responsibility that can affect mental, physical health and overall well-being. While the existence of child EBDs and its impact on caregivers' mental health is well documented in high-income countries, few studies in Sub-Saharan Africa have examined the impact of child emotional and behavioral difficulties on caregiver mental health among families of children orphaned by HIV. This study aims to examine the relationship between child difficulties and caregiver mental health in Southern Uganda.

Methods: Utilizing baseline data from the Suubi-Maka study (N = 346 dyads), a two-arm cluster-randomized controlled trial, the current study examines the relationship between children's EBDs and caregiver mental health. Child EBDs were measured using the Child Strengths and Difficulties scale as reported by caregivers. Caregiver mental health was measured by the Brief Symptom Inventory. Mixed effect linear regression model was used to examine the relationship between child difficulties and caregiver mental health. Control variables were caregiver age, gender, household size, family size, social support, family cohesion, family assets, and substance use (alcohol and cigarettes).

Results: The mean age of the caregivers was 45.78 years. Results showed a significant positive association between child EBDs and caregiver mental health problems. High levels of child difficulties were associated with poorer caregiver mental health functioning (β = 0.85, 95% CI = 0.64, 1.06, p < 0.001). Additionally, being a male caregiver (β = 10.18, 95% CI = 5.65, 14.72, p < 0.001), and alcohol use (β = 5.22, 95% CI = 2.03, 8.41, p = 0.001) were associated with poorer caregiver mental health. Notably, there was also a significant negative association between family cohesion and caregivers' mental health problems (β=-0.57., 95% CI = -1.05, -0.09, p = -0.019).

Conclusion and implication: The results emphasize the complex interplay of child difficulties, family cohesion, gender, and their influence on caregivers' mental health, posing a significant implication for global health. The findings suggest caregiving may not be exclusively undertaken by women, highlighting the importance of considering the mental health needs of male caregivers in the development of policies and support services. Future research is needed to explore the longitudinal pathways of this relationship: whether improving child EBDs can improve caregiver mental health or vice versa. The result further indicates the need to build innovative and multifaceted interventions to address caregiver mental health challenges in SSA.