WEPDD0106 - Poster Discussion Session
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
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
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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