摘要：Objectives. We measured the psychosocial effect of orphanhood in a sub-Saharan African population and evaluated a new framework for understanding the causes and consequences of psychosocial distress among orphans and other vulnerable children. Methods. The framework was evaluated using data from 5321 children aged 12 to 17 years who were interviewed in a 2004 national survey in Zimbabwe. We constructed a measure of psychosocial distress using principle components analysis. We used regression analyses to obtain standardized parameter estimates of psychosocial distress and odds ratios of early sexual activity. Results. Orphans had more psychosocial distress than did nonorphans. For both genders, paternal, maternal, and double orphans exhibited more-severe distress than did nonorphaned, nonvulnerable children. Orphanhood remained associated with psychosocial distress after we controlled for differences in more-proximate determinants. Maternal and paternal orphans were significantly more likely than were nonorphaned, nonvulnerable children to have engaged in sexual activity. These differences were reduced after we controlled for psychosocial distress. Conclusions. Orphaned adolescents in Zimbabwe suffer greater psychosocial distress than do nonorphaned, nonvulnerable children, which may lead to increased likelihood of early onset of sexual intercourse and HIV infection. The effect of strategies to provide psychosocial support should be evaluated scientifically. HIV epidemics in sub-Saharan Africa are giving rise to ever larger numbers of orphaned children. Between 1990 and 2010, the Joint United Nations Programme on HIV/AIDS estimates that the total number of children younger than 18 who have lost 1 or both parents to AIDS will increase from 550 000 (1.9% of all orphans) to 18.4 million (36.8%). 1 The devastating sociodemographic effects of HIV epidemics 1 – 3 have raised widespread concern about the psychosocial effects of orphanhood, 4 – 6 and substantial funds are being invested in programs to provide psychosocial support to orphans. 7 – 9 In a small study of 41 pairs of orphans and nonorphans, Makame et al. 10 found that orphans had higher scores for internalizing problems compared with nonorphans and that nearly 3 times as many orphans as nonorphans had contemplated suicide. However, the empirical basis for understanding the extent, nature, causal mechanisms, and consequences of orphanhood in the context of large-scale HIV epidemics remains extremely weak. 4 , 6 , 11 There has been progress in developing theoretical frameworks on the effects of HIV-associated orphanhood. 12 However, there has been relatively little focus on developing frameworks that identify the causal pathways through which orphan experience can lead to psychosocial distress or the consequences of psychosocial distress for child development. 1 , 13 Such frameworks have not previously been tested with data. Our study had 2 objectives: first, to propose a new theoretical framework for studying the causes and consequences of psychosocial problems among orphans and other children made vulnerable by HIV/AIDS and, second, to test and evaluate aspects of this framework using data from a large-scale, population-based, national survey in Zimbabwe.
