Emotional and Behavioral Problems Among Orphaned Children in Sub-Saharan Africa: The Mediating Role of Support From Extended Family Members

Purpose: In sub-Saharan Africa 55.1 million children are orphans, having lost one or both parents (27% as a result of AIDS, UNICEF, 2012). Orphaned children in sub-Saharan Africa are primarily cared for by extended family members and approximately 1 of every 4 households in Uganda are providing care to an orphaned child (Cheng, 2004). Orphaned children are exposed to multiple traumas, starting from the illness and loss of their parents, discrimination, lack of emotional support to life in poverty and exploitation. Family resilience framework (Fergus & Zimmerman, 2005; Walsh, 2003) suggests that family support can serve as a buffer balancing hardships and adversities that severely undermine mental health functioning of orphaned children. To understand the mechanisms of change, the paper examines whether family support from extended caregivers plays a mediating role in improving mental health functioning of orphaned children.   

Method: We use data from the NIMH-funded study testing the integrated Suubi-Maka (Hope for Families) intervention providing 1) savings accounts to support children’s education; 2) financial management workshops and income generating projects for caregivers; and 3) adult mentorship for orphaned children. The study utilized a group-randomized experimental design with 3 waves and included 297 child-caregiver dyads from 10 comparable primary schools in Southern Uganda. First, using mixed effects regression models adjusting for nesting within schools, we tested the effects of intervention on child’s emotional and behavioral problems as reported by children and caregivers as well as changes in child-caregiver relationships and caregiver support. Second, using mediation analysis (Sobel, 1982; MacKinnon, 2002) we examined if changes in caregiver support mediate changes in children’s mental health outcomes.

Results: Compared to children from the control group, children in the treatment group demonstrated a significant reduction in depression and hopelessness and a significant improvement in self-esteem at 12-month follow-up. The program effect on self-esteem was sustained at 24-month follow-up. Children reported higher levels of perceived instrumental support (B=.20, p<.05) and emotional support from their caregivers (B=.25, p<.01). The caregivers reported improved quality of child-caregiver relationships (B=.23, p<.05). Mediation analysis demonstrates that improvements in perceived emotional support from caregivers mediated the total effect of Suubi-Maka intervention on child’s emotional well-being.

Implications: The integrated family-based economic empowerment intervention has a potential for improving emotional well-being of orphaned children in the sub-Saharan African region. Strengthening extended family networks and improving family stability may be critical in preventing severe mental health problems among orphaned children in low resource settings.