Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors

Lorraine Sherr; Alexa R. Yakubovich; Sarah Skeen; Mark Tomlinson; Lucie D. Cluver; Kathryn J. Roberts; Ana Macedo

doi:10.1177/1359104520935502

Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors

Lorraine Sherr^*, Alexa R. Yakubovich, Sarah Skeen, Mark Tomlinson, Lucie D. Cluver, Kathryn J. Roberts, Ana Macedo

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

5 Citations (Scopus)

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Abstract

Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children’s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p '.001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p =.682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p '.001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p =.977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.

Original language	English
Pages (from-to)	984-1001
Number of pages	18
Journal	Clinical Child Psychology and Psychiatry
Volume	25
Issue number	4
Early online date	23 Jun 2020
DOIs	https://doi.org/10.1177/1359104520935502
Publication status	Published - 01 Oct 2020
Externally published	Yes

Bibliographical note

Funding Information:
The authors want to acknowledge the contribution of Zena Jacobs, Natasha Croome, Kathryn Roberts, Fiona Lampe, Phathiswa Mhlebi, Zanele Siqabatiso, Nomandla Mhlaba, Boniswa Mvumvu, Ntombiyakhe Zepe, Nozuko Matiso, Nomfusi Ngalimane and Ntombizethu Tyoko to the study. We would also like to thank our partners, UNICEF, Save the Children, HelpAge, Firelight Foundation, Comic Relief, AIDS Alliance, Stop AIDS Now, The Diana Princess of Wales Memorial Fund, World Vision, Bernard van Leer Foundation, REPSSI, RIATT, The Coalition for Children affected by HIV/AIDS, the Economic and Social Research Council (UK) and the National Research Foundation (South Africa) [grant number UNICEF, the National Department of Social Development (South Africa), the Claude Leon Foundation, the Nuffield Foundation, the Health Economics and AIDS Research Division of the University of KwaZulu-Natal, the John Fell Fund, the Leverhulme Trust, the University of Oxford’s ESRC Impact Acceleration Account and the European Research Council under the European Union’s Seventh Framework Programme [FP7/2007-2013] as well as the community-based organisations, carers and children for their participation. We thank our fieldwork teams and all participants and their families.

Funding Information:
The authors want to acknowledge the contribution of Zena Jacobs, Natasha Croome, Kathryn Roberts, Fiona Lampe, Phathiswa Mhlebi, Zanele Siqabatiso, Nomandla Mhlaba, Boniswa Mvumvu, Ntombiyakhe Zepe, Nozuko Matiso, Nomfusi Ngalimane and Ntombizethu Tyoko to the study. We would also like to thank our partners, UNICEF, Save the Children, HelpAge, Firelight Foundation, Comic Relief, AIDS Alliance, Stop AIDS Now, The Diana Princess of Wales Memorial Fund, World Vision, Bernard van Leer Foundation, REPSSI, RIATT, The Coalition for Children affected by HIV/AIDS, the Economic and Social Research Council (UK) and the National Research Foundation (South Africa) [grant number UNICEF, the National Department of Social Development (South Africa), the Claude Leon Foundation, the Nuffield Foundation, the Health Economics and AIDS Research Division of the University of KwaZulu-Natal, the John Fell Fund, the Leverhulme Trust, the University of Oxford?s ESRC Impact Acceleration Account and the European Research Council under the European Union?s Seventh Framework Programme [FP7/2007-2013] as well as the community-based organisations, carers and children for their participation. We thank our fieldwork teams and all participants and their families. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: YC was funded by the UK Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Additional support was provided to LC by European Research Council (ERC) under the European Union?s Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n?313421 and the Philip Leverhulme Trust (PLP-2014-095). KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP. CCC was funded by Sweden/Norad through a nesting agreement with HelpAge. Partner organisations for CBO recruitment included World Vision, Bernard van Leer Foundation, Firelight Foundation, Save the Children, UNICEF, REPSSI, Help Age, Stop AIDS Now, AIDS Alliance, The Diana Memorial Fund, and Comic Relief. The Coalition for Children affected by AIDS provided support in the study initiation. UNICEF provided funding to partially support the creation of a combined database. The upcoming follow-up studies are supported by the UKRI GCRF Hub on Accelerating Achievement for Africa?s Adolescents. No funder, from either study, played a role in data collection, analysis, interpretation, writing the report, or the decision to submit the article for publication.

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: YC was funded by the UK Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Additional support was provided to LC by European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n°313421 and the Philip Leverhulme Trust (PLP-2014-095). KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP. CCC was funded by Sweden/Norad through a nesting agreement with HelpAge. Partner organisations for CBO recruitment included World Vision, Bernard van Leer Foundation, Firelight Foundation, Save the Children, UNICEF, REPSSI, Help Age, Stop AIDS Now, AIDS Alliance, The Diana Memorial Fund, and Comic Relief. The Coalition for Children affected by AIDS provided support in the study initiation. UNICEF provided funding to partially support the creation of a combined database. The upcoming follow-up studies are supported by the UKRI GCRF Hub on Accelerating Achievement for Africa’s Adolescents. No funder, from either study, played a role in data collection, analysis, interpretation, writing the report, or the decision to submit the article for publication.

Publisher Copyright:
© The Author(s) 2020.

Keywords

Children
depressive symptomology
LMIC
mental health
South Africa

ASJC Scopus subject areas

Pediatrics, Perinatology, and Child Health
Clinical Psychology
Psychiatry and Mental health

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1177/1359104520935502Licence: CC BY

Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors
© 2020 The Authors. This is an open access article published under a Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium, provided the author and source are cited.
Final published version, 337 KBLicence: CC BY

Cite this

@article{917e04610bcd42cb8b72e3926a30d587,

title = "Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors",

abstract = "Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children{\textquoteright}s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p '.001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p =.682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p '.001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p =.977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.",

keywords = "Children, depressive symptomology, LMIC, mental health, South Africa",

author = "Lorraine Sherr and Yakubovich, {Alexa R.} and Sarah Skeen and Mark Tomlinson and Cluver, {Lucie D.} and Roberts, {Kathryn J.} and Ana Macedo",

note = "Funding Information: The authors want to acknowledge the contribution of Zena Jacobs, Natasha Croome, Kathryn Roberts, Fiona Lampe, Phathiswa Mhlebi, Zanele Siqabatiso, Nomandla Mhlaba, Boniswa Mvumvu, Ntombiyakhe Zepe, Nozuko Matiso, Nomfusi Ngalimane and Ntombizethu Tyoko to the study. We would also like to thank our partners, UNICEF, Save the Children, HelpAge, Firelight Foundation, Comic Relief, AIDS Alliance, Stop AIDS Now, The Diana Princess of Wales Memorial Fund, World Vision, Bernard van Leer Foundation, REPSSI, RIATT, The Coalition for Children affected by HIV/AIDS, the Economic and Social Research Council (UK) and the National Research Foundation (South Africa) [grant number UNICEF, the National Department of Social Development (South Africa), the Claude Leon Foundation, the Nuffield Foundation, the Health Economics and AIDS Research Division of the University of KwaZulu-Natal, the John Fell Fund, the Leverhulme Trust, the University of Oxford{\textquoteright}s ESRC Impact Acceleration Account and the European Research Council under the European Union{\textquoteright}s Seventh Framework Programme [FP7/2007-2013] as well as the community-based organisations, carers and children for their participation. We thank our fieldwork teams and all participants and their families. Funding Information: The authors want to acknowledge the contribution of Zena Jacobs, Natasha Croome, Kathryn Roberts, Fiona Lampe, Phathiswa Mhlebi, Zanele Siqabatiso, Nomandla Mhlaba, Boniswa Mvumvu, Ntombiyakhe Zepe, Nozuko Matiso, Nomfusi Ngalimane and Ntombizethu Tyoko to the study. We would also like to thank our partners, UNICEF, Save the Children, HelpAge, Firelight Foundation, Comic Relief, AIDS Alliance, Stop AIDS Now, The Diana Princess of Wales Memorial Fund, World Vision, Bernard van Leer Foundation, REPSSI, RIATT, The Coalition for Children affected by HIV/AIDS, the Economic and Social Research Council (UK) and the National Research Foundation (South Africa) [grant number UNICEF, the National Department of Social Development (South Africa), the Claude Leon Foundation, the Nuffield Foundation, the Health Economics and AIDS Research Division of the University of KwaZulu-Natal, the John Fell Fund, the Leverhulme Trust, the University of Oxford?s ESRC Impact Acceleration Account and the European Research Council under the European Union?s Seventh Framework Programme [FP7/2007-2013] as well as the community-based organisations, carers and children for their participation. We thank our fieldwork teams and all participants and their families. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: YC was funded by the UK Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Additional support was provided to LC by European Research Council (ERC) under the European Union?s Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n?313421 and the Philip Leverhulme Trust (PLP-2014-095). KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP. CCC was funded by Sweden/Norad through a nesting agreement with HelpAge. Partner organisations for CBO recruitment included World Vision, Bernard van Leer Foundation, Firelight Foundation, Save the Children, UNICEF, REPSSI, Help Age, Stop AIDS Now, AIDS Alliance, The Diana Memorial Fund, and Comic Relief. The Coalition for Children affected by AIDS provided support in the study initiation. UNICEF provided funding to partially support the creation of a combined database. The upcoming follow-up studies are supported by the UKRI GCRF Hub on Accelerating Achievement for Africa?s Adolescents. No funder, from either study, played a role in data collection, analysis, interpretation, writing the report, or the decision to submit the article for publication. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: YC was funded by the UK Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Additional support was provided to LC by European Research Council (ERC) under the European Union{\textquoteright}s Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n°313421 and the Philip Leverhulme Trust (PLP-2014-095). KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP. CCC was funded by Sweden/Norad through a nesting agreement with HelpAge. Partner organisations for CBO recruitment included World Vision, Bernard van Leer Foundation, Firelight Foundation, Save the Children, UNICEF, REPSSI, Help Age, Stop AIDS Now, AIDS Alliance, The Diana Memorial Fund, and Comic Relief. The Coalition for Children affected by AIDS provided support in the study initiation. UNICEF provided funding to partially support the creation of a combined database. The upcoming follow-up studies are supported by the UKRI GCRF Hub on Accelerating Achievement for Africa{\textquoteright}s Adolescents. No funder, from either study, played a role in data collection, analysis, interpretation, writing the report, or the decision to submit the article for publication. Publisher Copyright: {\textcopyright} The Author(s) 2020.",

year = "2020",

month = oct,

day = "1",

doi = "10.1177/1359104520935502",

language = "English",

volume = "25",

pages = "984--1001",

journal = "Clinical Child Psychology and Psychiatry",

issn = "1359-1045",

publisher = "Sage Publications Ltd",

number = "4",

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TY - JOUR

T1 - Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors

AU - Sherr, Lorraine

AU - Yakubovich, Alexa R.

AU - Skeen, Sarah

AU - Tomlinson, Mark

AU - Cluver, Lucie D.

AU - Roberts, Kathryn J.

AU - Macedo, Ana

N1 - Funding Information: The authors want to acknowledge the contribution of Zena Jacobs, Natasha Croome, Kathryn Roberts, Fiona Lampe, Phathiswa Mhlebi, Zanele Siqabatiso, Nomandla Mhlaba, Boniswa Mvumvu, Ntombiyakhe Zepe, Nozuko Matiso, Nomfusi Ngalimane and Ntombizethu Tyoko to the study. We would also like to thank our partners, UNICEF, Save the Children, HelpAge, Firelight Foundation, Comic Relief, AIDS Alliance, Stop AIDS Now, The Diana Princess of Wales Memorial Fund, World Vision, Bernard van Leer Foundation, REPSSI, RIATT, The Coalition for Children affected by HIV/AIDS, the Economic and Social Research Council (UK) and the National Research Foundation (South Africa) [grant number UNICEF, the National Department of Social Development (South Africa), the Claude Leon Foundation, the Nuffield Foundation, the Health Economics and AIDS Research Division of the University of KwaZulu-Natal, the John Fell Fund, the Leverhulme Trust, the University of Oxford’s ESRC Impact Acceleration Account and the European Research Council under the European Union’s Seventh Framework Programme [FP7/2007-2013] as well as the community-based organisations, carers and children for their participation. We thank our fieldwork teams and all participants and their families. Funding Information: The authors want to acknowledge the contribution of Zena Jacobs, Natasha Croome, Kathryn Roberts, Fiona Lampe, Phathiswa Mhlebi, Zanele Siqabatiso, Nomandla Mhlaba, Boniswa Mvumvu, Ntombiyakhe Zepe, Nozuko Matiso, Nomfusi Ngalimane and Ntombizethu Tyoko to the study. We would also like to thank our partners, UNICEF, Save the Children, HelpAge, Firelight Foundation, Comic Relief, AIDS Alliance, Stop AIDS Now, The Diana Princess of Wales Memorial Fund, World Vision, Bernard van Leer Foundation, REPSSI, RIATT, The Coalition for Children affected by HIV/AIDS, the Economic and Social Research Council (UK) and the National Research Foundation (South Africa) [grant number UNICEF, the National Department of Social Development (South Africa), the Claude Leon Foundation, the Nuffield Foundation, the Health Economics and AIDS Research Division of the University of KwaZulu-Natal, the John Fell Fund, the Leverhulme Trust, the University of Oxford?s ESRC Impact Acceleration Account and the European Research Council under the European Union?s Seventh Framework Programme [FP7/2007-2013] as well as the community-based organisations, carers and children for their participation. We thank our fieldwork teams and all participants and their families. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: YC was funded by the UK Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Additional support was provided to LC by European Research Council (ERC) under the European Union?s Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n?313421 and the Philip Leverhulme Trust (PLP-2014-095). KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP. CCC was funded by Sweden/Norad through a nesting agreement with HelpAge. Partner organisations for CBO recruitment included World Vision, Bernard van Leer Foundation, Firelight Foundation, Save the Children, UNICEF, REPSSI, Help Age, Stop AIDS Now, AIDS Alliance, The Diana Memorial Fund, and Comic Relief. The Coalition for Children affected by AIDS provided support in the study initiation. UNICEF provided funding to partially support the creation of a combined database. The upcoming follow-up studies are supported by the UKRI GCRF Hub on Accelerating Achievement for Africa?s Adolescents. No funder, from either study, played a role in data collection, analysis, interpretation, writing the report, or the decision to submit the article for publication. Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: YC was funded by the UK Economic and Social Research Council and South African National Research Foundation (RES-062-23-2068), HEARD at the University of KwaZulu-Natal, the South African National Department of Social Development, the Claude Leon Foundation, the John Fell Fund, and the Nuffield Foundation (CPF/41513). Additional support was provided to LC by European Research Council (ERC) under the European Union’s Seventh Framework Programme (FP7/2007-2013)/ ERC grant agreement n°313421 and the Philip Leverhulme Trust (PLP-2014-095). KJR is supported by an Economic Social Research Council (ESRC) PhD studentship through the UBEL DTP. CCC was funded by Sweden/Norad through a nesting agreement with HelpAge. Partner organisations for CBO recruitment included World Vision, Bernard van Leer Foundation, Firelight Foundation, Save the Children, UNICEF, REPSSI, Help Age, Stop AIDS Now, AIDS Alliance, The Diana Memorial Fund, and Comic Relief. The Coalition for Children affected by AIDS provided support in the study initiation. UNICEF provided funding to partially support the creation of a combined database. The upcoming follow-up studies are supported by the UKRI GCRF Hub on Accelerating Achievement for Africa’s Adolescents. No funder, from either study, played a role in data collection, analysis, interpretation, writing the report, or the decision to submit the article for publication. Publisher Copyright: © The Author(s) 2020.

PY - 2020/10/1

Y1 - 2020/10/1

N2 - Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children’s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p '.001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p =.682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p '.001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p =.977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.

AB - Children in Southern Africa are exposed to high rates of structural and family adversities. This study tests whether services from Community Based Organisations (CBOs) in South Africa can promote children’s resilience against depression exposed to such adversities. Two linked longitudinal studies were conducted, comprising n = 1848 children aged 9 to 13 years. One group received CBO services, whilst the other (quasi-control) did not. Analyses used interaction terms in regression models to test for potential moderation effects of CBO attendance, and marginal effects models to interpret significant interactions. Two interaction effects were shown, demonstrating moderation effects of CBO attendance on common structural disadvantages. First, children exposed to community violence showed increased depression (contrast = 0.62 [95%CI 0.43, 0.82], p '.001), but this association was removed by CBO access (contrast = 0.07 [95%CI −0.28, 0.43], p =.682). Second, children living in informal housing showed increased depression (contrast = 0.63 [95%CI 0.42, 0.85], p '.001), however, this association was removed by CBO access (contrast = 0.01 [95%CI −0.55, 0.56], p =.977). CBO attendance is associated with fewer depressive symptoms, and can buffer against important structural adversities of poor housing and violence that are common in high HIV-prevalence areas. However, CBO attendance was not able to remove the increased psychosocial distress associated with some family-level vulnerabilities such as orphanhood and abuse. These findings highlight the centrality of CBO-provided psychosocial support for children in Southern Africa, and suggest areas for bolstering provision.

KW - Children

KW - depressive symptomology

KW - LMIC

KW - mental health

KW - South Africa

U2 - 10.1177/1359104520935502

DO - 10.1177/1359104520935502

M3 - Article

C2 - 32571077

AN - SCOPUS:85086770891

SN - 1359-1045

VL - 25

SP - 984

EP - 1001

JO - Clinical Child Psychology and Psychiatry

JF - Clinical Child Psychology and Psychiatry

IS - 4

ER -

Depressive symptoms among children attending community based support in South Africa – pathways for disrupting risk factors

Abstract

Bibliographical note

Keywords

ASJC Scopus subject areas

UN SDGs

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