The effects of HIV/AIDS family dysfunction trajectories and psychosocial wellbeing among adolescents in Ghana: the mediating role of child maltreatment

Abstract Background The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial wellbeing. Method A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES) and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Results Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial wellbeing is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem (b = .59 [95%CI .32, .91], delinquency and risky behaviours (b = .56 [95%CI .31, .86] and peer problems (b = .74 [95%CI .48, 1.03]. Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem (b = .78 [95%CI .43, 1.23], delinquency and risky behaviours (b = .76 [95%CI .45, 1.11], depression/emotional problems (b = .64 [95%CI .40, .92] and peer problems (b = .94 [95%CI .66, 1.26]. Partial mediation was found for hyperactivity. Conclusion Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial wellbeing among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychological distress among these children, thus enhancing their wellbeing. The findings therefore underscore the need for comprehensive psychosocial interventions that addresses both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.