XIX International AIDS Conference

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WEPDD0106 - Poster Discussion


When time doesn't heal: complicated grief among orphans in rural Zambia

Presented by Lisa Langhaug (Zimbabwe).

A. Gschwend1,2, K. Wespi1, P. Amman1, L. Langhaug3


1Swiss Academy for Development, Biel-Bienne, Switzerland, 2University of Bern, Institute of Psychology, Section of Social Pscychology, Bern, Switzerland, 3REPSSI, Harare, Zimbabwe

Background: Across sub-Saharan Africa, the HIV pandemic has orphaned millions of children. Evidence from high-income settings on complicated grief, which precipitates psychologically and medically debilitating symptoms, is growing. However research on how orphans in rural Africa cope with their loss remains scarce. We report on prevalence and predictors of complicated grief among a rural Zambian cohort.
Methods: 376 rural Zambian orphans 10-18 years, (46.3%=female, 44.1%=orphaned by AIDS) were interviewed five times. Respondents were included if they had lost their parent(s) at least two years prior to the final survey. Validated scales from Western settings were translated and culturally adapted. Complicated grief was defined as experiencing above average levels of grief symptoms in the last four weeks. Cross-sectional data assessed prevalence of complicated grief and tested multiple regression models. Bootstrapping supported robust regression coefficients estimates.
Results: Approximately one-third (30.3%; n=114) of these orphans reported complicated grief symptoms. Independent predictors (p< 0.05) included peer bullying, daily stress (e.g. excessive household chores, looking after ill family) poor primary-caregiver relations, within household discrimination, number of primary caregiver losses, and time since loss. Together these explain a fifth of the grief found two or more years after parental death (Radj2 =0.21). Other theoretical predictors of complicated grief including age, sex, sudden or violent death, living with the deceased parent or experiencing their prolonged illness prior to death were not associated.
Expected comorbidities with depression, suicidal thoughts, PTSD, and functional impairment in everyday tasks were confirmed, underscoring construct validity.
Conclusions: One-third of orphans exhibit debilitating grief two or more years after parent death. While these data highlight the centrality of community-based initiatives that sensitise caregivers of orphans to alleviate stigma and discrimination, additional research on children with complicated grief suggests benefits from more focussed interventions. Screening tools and effective counselling interventions adapted for this rural African population are urgently needed.

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