摘要：Objectives. We examined the associations between social support and mental and behavioral outcomes among adolescents whose parents were infected with or died of HIV/AIDS. Methods. Families (parents who were HIV infected and their adolescent children) were randomly assigned to a coping skills intervention or a standard care group. After completing the intervention, the parents and adolescents were assessed for 2 years. Results. Adolescents who had more social support providers reported significantly lower levels of depression and fewer conduct problems; adolescents who had more negative influence from role models reported more behavior problems. Reductions in depression, multiple problem behaviors, and conduct problems were significantly associated with better social support. Conclusions. Our findings underscore the complex relations between social support and mental and behavioral outcomes among adolescents affected by HIV/AIDS. Future prevention programs must focus on increasing social support to reduce negative outcomes among adolescents affected by HIV/AIDS as well as the need to reduce influence from negative role models. During the last decade, researchers and health care practitioners have suggested that parents who are infected with or have died from HIV/AIDS are associated with specific, detrimental effects on their adolescent children (aged 11–18 years). 1 , 2 Adolescents whose parents are infected with or have died of HIV/AIDS are subject to stigmas associated with poverty and the disease. 1 In the case of adolescents orphaned as a result of HIV/AIDS, the stigma associated with the disease heightens the likelihood of persistent, unresolved grief. 3 Such grief may be expressed through fantasies of reunion, absence of overt expression, and persistent feelings of anger. 1 Symptoms of adolescents’ unresolved grief include low tolerance for frustration, acts of rage, fighting in school, and truancy. 4 Rotheram-Borus et al. mounted an intervention study aimed at improving the mental and behavioral outcomes of adolescents affected by HIV/AIDS and their parents. 5 The parents of the adolescents in that study were vulnerable to drug abuse and poverty, which placed them at risk for depression, 4 conduct problems, and other risk factors. 6 , 7 We used the same study sample in an extension of the Rotheram-Borus study, to examine the effect of social support on adolescents’ mental and behavioral outcomes. Adolescents in the intervention group reported significantly lower levels of emotional distress, fewer multiple problem behaviors, and fewer conduct problems. 5 Adolescents in the intervention group also reported higher levels of self-esteem, which suggests that interventions may reduce the long-term negative effect of parents’ HIV status on adolescents. Social support is defined as the existence or availability of people who let an individual know that they care about, value, and love them. 8 The link between social support and psychological well-being is well established, dating back to Durkheim. 9 Lack of social support and lower perceived adequacy of social support have been linked to symptoms of depression. 10 – 12 One of the main challenges to objective research on adolescent social support has been the lack of a reliable, general, and convenient index of social support. 8 Despite a diversity of measures of social support, which is matched by the diversity of conceptualizations, 8 existing research among adolescents has been treated as a homogeneous mass. 13 – 18 Researchers have examined the size of social support (number of support providers), 19 frequency of contact with support providers, 20 perception of social support, 21 influence from negative role models, 22 and positive social support (positive behaviors by support providers), 23 but much more empirically derived evidence is needed to provide a basis for theoretical advances. Among a group of adolescents who suffered a stressful event, Bal et al. found that a higher perceived availability of social support was directly associated with fewer symptoms related to trauma. 24 Building on the findings of Rotheram-Borus et al., 5 we considered the effect of the individual dimensions of social support. Because there are few empirical data on the relation between the mental and behavioral outcomes of adolescents affected by HIV/AIDS and social support, our primary objective was to study the association of adolescent mental and behavioral outcomes with the dimensions of social support for 2 years.
