Factors affecting resilience in Namibian children exposed to parental divorce: a Q-Methodology study.

Introduction: Divorce is a contributor to family instability within sub-Saharan Africa, and specifically within Namibia, an increasing number of children are exposed to its impact. However, not all children react uniformly to the impact of parental divorce, and many children may be resilient. Understanding what promotes resilience in children post-divorce in African contexts is vital, given the unique socio-cultural context. Therefore, this study aimed to understand how some children are capable of resilience despite exposure to parental divorce in Namibia. Methods: A multiple case study design was employed to assess the lived experiences of children aged 9-12 post-parental divorce in Windhoek. Using the Child and Youth Resilience Measurement (CYRM-12) scale, 24 children exposed to parental divorce were screened for resiliency. The Q-Methodology, with visual material, was utilized with a sub-sample of 12 children who scored high on the CYRM (50% girls, mean age = 11) to eliminate some of the challenges associated with gathering qualitative data from younger children. The PQ Method 2.35 software program was used for data analysis. Results: By-person factor analysis identified four statistically significant profiles. A third (33%) of participants loaded on a factor emphasizing "quality parent-child relationships" and a further 33% emphasizing "effective parent conflict resolution." The final two factors emphasized "healthy school attachment" (17%) and "strong community attachment" (17%). All children emphasized a stable, loving familial environment, and frequent visitation with the non-custodial father. Discussion: Our findings suggest that multiple social ecologies nurture resilience in children exposed to parental divorce in Namibia. Support should be extended beyond the perimeters of the nuclear family, and relationships with extended family members, peer groups, school, and the wider community can play an important role in children's adjustment. The study highlights the importance of contextually grounded resilience as some factors that are emphasized for children from more Western communities do not reflect as strongly in the results of this study. Other factors, including a stronger reliance on community and factors such as the school, peers, and extended family members, may play a bigger role in child resilience post-divorce in Namibia.

The role of individual-, family-, and school-level resilience in the subjective well-being of children exposed to violence in Namibia.

BACKGROUND: Children exposed to violence are at risk of a range of adverse outcomes. Given the unique cultural and social context, understanding what fosters children's resilience in resource-limited areas such as sub-Saharan Africa, is vital. OBJECTIVES: Using data from the International Survey of Children's Well-Being (ISCWeB), this paper explores individual-, family-, and school-level factors associated with positive outcomes for children who have experienced some form of violence in Khomas region, Namibia. METHOD AND PARTICIPANTS: Using a cross-sectional survey design, the ISCWeB questionnaire, assessing cognitive, affective, and psychological dimensions of well-being, child protection factors and violence exposure was administered to 2124 Grade four and six children. RESULTS: Our sample had a mean age of 11.2 years. Overall, 56.8 % of children reported at least one incident of violence from an adult caregiver at home and 86.0 % of children reported some form of peer violence at school. Materially deprived children experienced higher incidence of both family and peer violence. The quality of children's relationships at home (ß = 0.17, p < 0.001), and school (ß = 0.07, p < 0.001) emerged as important protective factors for children's well-being for both types of violence, suggesting that supportive family and school relationships may be more important to the subjective well-being of children who experienced violence than material wellbeing, violence severity, and individual child factors. CONCLUSIONS: Providing positive social interaction and emotional security in contextually and culturally appropriate ways within children's proximal systems should be prioritized while challenging norms that support violence in Namibian families and schools.

Experiences of forced sterilisation and coercion to sterilise among women living with HIV (WLHIV) in Namibia: an analysis of the psychological and socio-cultural effects.

The forced and coerced sterilisation of women living with HIV (WLHIV) is a phenomenon reported in several countries. In Namibia, litigation efforts for cases of forced and coerced sterilisation were successful, yet the psychological and socio-cultural well-being of those affected has not been adequately investigated and addressed. To determine the psychological and socio-cultural effects of involuntary sterilisation on WLHIV in Namibia, qualitative data from seven WLHIV were collected through face-to-face interviews. Our analysis showed that, firstly, there are negative psychological effects manifesting in psychological symptoms associated with anxiety and depression. Secondly, there are negative socio-cultural effects including discrimination, victimisation and gender-based violence. Patriarchal cultural values regarding reproduction, marriage and decision-making contribute to negative psychological and socio-cultural effects. Finally, negative psychological and socio-cultural effects of involuntary sterilisation are long-lasting. For participants, coping remains difficult, even over a decade after the sterilisations. Given the considerable long-lasting negative psychological and socio-cultural effects, psychological interventions to expedite positive coping and well-being must be prioritised.

"How Can We Help You": Mental Health Practitioners' Experiences of Service Provision in Northern Namibia.

Although 12-13% of Namibians are reported to struggle with psychological distress, very few practitioners are available to provide mental health services in Namibia. Those practitioners who are available are often trained from Western counseling and psychiatric perspectives that may not readily align to beliefs about illness held constructed in Namibian cultures. Institutional effort is invested in the education and use of mental health practitioners, including counselors, social workers, nurses, psychologists, and psychiatrists. However, little is known about the experiences of these providers. Therefore, this study, a grounded theory ethnography, was undertaken as part of broader ethnographic work to understand how mental health practitioners (N = 7) in Northern Namibia view their work with Aawambo Namibians given that Namibian mental health practitioners are few but embedded in the country's health care system. Four categories were identified in analyses: Provision of Mental Health Services in the North, Practitioners' Conceptualizations of Psychological Distress: Western and Aawambo Influences, Beliefs about Mental Health Services in the North, and Integration of Traditional Treatment and Counseling. Results are discussed with respect to cultural competence in Namibian mental health practice and potential for integrating traditional practices and mental health services.

Differential effects of unemployment on depression in people living with HIV/AIDS: a quantile regression approach.

Unemployment is associated with depression in people living with HIV (PLWH). However, few studies have examined the effects of unemployment on PLWH with different levels of depression. The current study explores the plausible differential effects of unemployment on the different percentiles of depression in PLWH employing a quantile regression (QR) approach, based on a recent survey of 411 PLWH in China. Among participants, 47.7% had elevated depressive symptoms, and 23.8% were unemployed. The effects of unemployment on depression were statistically significant with a trend of initial increase followed by a decline at the quantile levels of 0.51-0.90 of depression. The maximum effect of unemployment status on depression was statistically significant at the 70th and 75th percentiles of depression (coefficient = 7.0, p < .01). Tailored strategies and interventions should be implemented to address the differential needs of PLWH with various levels of depressive symptoms.

Mental health among adolescents living with HIV in Namibia: the role of poverty, orphanhood and social support.

The mental health needs of children and adolescents living with HIV (ALHIV) in Namibia are poorly understood, despite the dramatic improvement in their survival. ALHIV in resource poor contexts face particular risk factors, such as poverty, orphanhood, and poor social support. This study examines the mental health of ALHIV in Namibia, and the factors that contribute to mental health problems. A case-control design assessed emotional and behavioural symptoms of distress, risk and protective factors among adolescents aged 12-18 years. Case participants were 99 HIV-positive adolescents. Case controls were 159 adolescents from the same community who were not known to be HIV seropositive at the time of the study. Control group participants were selected from schools using a stratified random sampling. A larger proportion of HIV-positive adolescents were orphaned (62.6% vs. 20.8%, p < .001); the groups showed no differences in poverty factors. HIV-positive adolescents scored lower than the control group on total perceived social support (p < .05) and caregiver support (p < .05), but no differences in perceived friend support and support from a self-selected person were present. HIV-positive adolescents reported significantly more total emotional and behavioural difficulties (p = .027) and conduct problems (p = .025), even after controlling for socio-demographic factors. However, after controlling for the effects of orphanhood, group differences in mental health outcomes were no longer significant. Furthermore, mediation analysis suggested that social support completely mediated the relationship between HIV status and mental health (standardised pathway coefficients = .05, p = .021). Policies and programmes that aim to strengthen social support and take orphanhood status into consideration may improve the mental health of adolescents living with HIV.

Predictors of mental health problems in adolescents living with HIV in Namibia.

BACKGROUND: Little research in sub-Saharan Africa has looked at factors that predict mental health problems in adolescents living with HIV (ALHIV). This study examines the psychological impact of HIV in adolescents in Namibia, including risk and protective factors associated with mental health. METHODS: Ninety-nine fully disclosed ALHIV between the ages of 12 and 18 were interviewed at a State Hospital in Windhoek. A structured questionnaire assessed mental health, using the SDQ (Goodman, 1997), sociodemographic factors, poverty, social support, adherence and stigma. RESULTS: Mean age was 14.3 years, 52.5% were female and most were healthy. Twelve percent scored in the clinical range for total mental health difficulties and 22% for emotional symptoms. Poverty was associated with more total mental health difficulties, t(96) = -2.63, p = .010, and more emotional symptoms, t(96) = -3.45, p = .001, whereas better social support was a protective factor, particularly caregiver support (r = -.337, p = .001). Adherence problems, HIV-related stigma and disclosing one's own HIV status to others were also associated with more total mental health difficulties. Poverty (ß = -.231, p = .023) and stigma (ß = .268, p = .009) were the best predictors for total mental health difficulties, whereas stigma (ß = .314, p = .002) predicted emotional symptoms. Social support had a protective effect on peer problems (p = .001, ß = -.349). CONCLUSIONS: Several contextual factors associated with poorer mental health in ALHIV are identified.