Building resilient families: Developing family interventions for preventing adolescent depression and HIV in low resource settings

Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to re...

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Bibliographic Details
Published in:Transcultural psychiatry 2019-02, Vol.56 (1), p.187-212
Main Authors: Kuo, Caroline, LoVette, Ashleigh, Stein, Dan J., Cluver, Lucie D., Brown, Larry K., Atujuna, Millicent, Gladstone, Tracy R.G., Martin, Jacqueline, Beardslee, William
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Depressive Disorder - prevention & control
Family Health
Female
Focus Groups
HIV Infections - prevention & control
Humans
Interviews as Topic
Male
Mental Health
Middle Aged
Parenting - psychology
Poverty
Resilience, Psychological
Risk Factors
Social Support
South Africa
Young Adult
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Summary:Depression contributes significantly to the global burden of disease in low- and middle-income countries. In South Africa, individuals may be at elevated risk for depression due to HIV and AIDS, violence, and poverty. For adolescents, resilience-focused prevention strategies have the potential to reduce onset of depression. Involving families in promoting adolescent mental health is developmentally appropriate, but few existing interventions take a family approach to prevention of adolescent depression. We conducted a qualitative investigation from 2013–2015 to inform the development of a family intervention to prevent adolescent depression in South Africa among families infected or at risk for HIV. Using focus groups with adolescents and parents (eight groups, n = 57), and interviews (n = 25) with clinicians, researchers, and others providing mental health and related services, we identified context-specific factors related to risk for family depression, and explored family interactions around mental health more broadly as well as depression specifically. Findings indicate that HIV and poverty are important risk factors for depression. Future interventions must address linguistic complexities in describing and discussing depression, and engage with the social interpretations and meanings placed upon depression in the South African context, including bewitchment and deviations from prescribed social roles. Participants identified family meetings as a context-appropriate prevention strategy. Family meetings offer opportunities to practice family problem solving, involve other family members in communal parenting during periods of parental depression, and serve as forums for building Xhosa-specific interpretations of resilience. This study will guide the development of Our Family Our Future, a resilience-focused family intervention to prevent adolescent depression (ClinicalTrials.gov #NCT02432352).
ISSN:1363-4615
1461-7471
DOI:10.1177/1363461518799510