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Resilience and psychosocial outcomes among South African adolescents affected by HIV

Kuo, Carolinea,b,c; LoVette, Ashleigha; Pellowski, Jennifera; Harrison, Abigaila; Mathews, Catherined; Operario, Dona; Beardslee, Williame,f,g; Stein, Dan J.h,i; Brown, Larryj

doi: 10.1097/QAD.0000000000002177
Supplement Articles

Objective: In South Africa, adolescents account for the largest share of new HIV infections. Given the scale of the epidemic, millions of adolescents cope with familial HIV illness and AIDS orphanhood. Developing an understanding of adolescent resilience is vital for informing HIV and mental health prevention efforts.

Design: A cross-sectional survey of N = 195 South African adolescents, 13–15 years, and living in communities with high prevalence of HIV and poor mental health, was used to gather data on resilience, psychosocial factors, and mental health.

Methods: Participants were recruited through systematic community-based household sampling. Analysis was conducted on a subsample of adolescents identified as potentially vulnerable (n = 82); potential vulnerability was defined as adolescents living with HIV, residing with parents or caregivers living with HIV, or experiencing orphanhood. Differences on behavioral and psychosocial outcomes in those with higher and lower resilience were evaluated using SPSS software.

Results: Among adolescents identified as potentially vulnerable (n = 82), those with higher resilience scores reported significantly lower behavioral problems using the total difficulties Strength and Difficulties Questionnaire score (P < 0.01) with a mean score difference of 2.76 (standard error = 1.02). Multivariate linear regressions were conducted with total difficulties Strength and Difficulties Questionnaire score as the dependent variable. Higher resilience among vulnerable youth was significantly associated with fewer behavioral problems (β = −0.229, P < 0.05), even after adjusting for variables that could also contribute to poor behavioral outcomes.

Conclusion: Resilience is related to the behavioral health of vulnerable HIV-affected adolescents. Resilience-focused interventions hold promise for improving the behavioral health of adolescents living in high HIV prevalence settings.

aDepartment of Behavioral and Social Sciences, Brown University School of Public Health

bProvidence/Boston Center for AIDS Research, Providence, Rhode Island, USA

cDepartment of Psychiatry and Mental Health, University of Cape Town

dHealth Systems Research Unit, South African Medical Research Council, Cape Town, South Africa

eBoston Children's Hospital

fJudge Baker Children's Center

gDepartment of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA

hSouth African MRC Unit on Risk and Resilience in Mental Disorders

iDepartment of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

jDepartment of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.

Correspondence to Caroline Kuo, Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main Street, Providence, RI 02903, USA. E-mail:

Received 10 April, 2018

Revised 25 October, 2018

Accepted 4 February, 2019

Copyright © 2019 Wolters Kluwer Health, Inc.