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      The psychological well-being of children orphaned by AIDS in Cape Town, South Africa

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      1 , 2 , 1 ,
      Annals of General Psychiatry
      BioMed Central

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          Abstract

          Background

          An estimated 2 million children are parentally bereaved by AIDS in South Africa. Little is known about mental health outcomes for this group.

          Methods

          This study aimed to investigate mental health outcomes for urban children living in deprived settlements in Cape Town. 30 orphaned children and 30 matched controls were compared using standardised questionnaires (SDQ) on emotional and behavioural problems, peer and attention difficulties, and prosocial behaviour. The orphan group completed a modified version of a standardised questionnaire (IES-8), measuring Post-Traumatic Stress symptoms. Group differences were tested using t-tests and Pearson's chi-square.

          Results

          Both groups scored highly for peer problems, emotional problems and total scores. However, orphans were more likely to view themselves as having no good friends (p = .002), to have marked concentration difficulties (p = .03), and to report frequent somatic symptoms (p = .05), but were less likely to display anger through loss of temper (p = .03). Orphans were more likely to have constant nightmares (p = .01), and 73% scored above the cut-off for Post-Traumatic Stress Disorder.

          Conclusion

          Findings suggest important areas for larger-scale research for parentally-bereaved children.

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          Most cited references67

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          Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka.

          A computerised algorithm was developed to predict child psychiatric diagnoses on the basis of the symptom and impact scores derived from Strengths and Difficulties Questionnaires (SDQs) completed by parents, teachers and young people. The predictive algorithm generates "unlikely", "possible" or "probable" ratings for four broad categories of disorder, namely conduct disorders, emotional disorders, hyperactivity disorders, and any psychiatric disorder. The algorithm was applied to patients attending child mental health clinics in Britain (N = 101) and Bangladesh (N = 89). The level of chance-corrected agreement between SDQ prediction and an independent clinical diagnosis was substantial and highly significant (Kendall's tau b between 0.49 and 0.73; p < 0.001). A "probable" SDQ prediction for any given disorder correctly identified 81-91% of the children who definitely had that clinical diagnosis. There were more false positives than false negatives, i.e. the SDQ categories were over-inclusive. The algorithm appears to be sufficiently accurate and robust to be of practical value in planning the assessment of new referrals to a child mental health service.
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            Posttraumatic stress disorder following medical illness and treatment.

            Studies describing posttraumatic stress disorder (PTSD) as a result of physical illness and its treatment were reviewed. PTSD was described in studies investigating myocardial infarction (MI), cardiac surgery, haemorrhage and stroke, childbirth, miscarriage, abortion and gynaecological procedures, intensive care treatment, human immunodeficiency virus (HIV) infection, awareness under anaesthesia, and in a group of miscellaneous conditions. Cancer medicine was not included as it had been the subject of a recent review in this journal. Studies were reviewed in terms of the prevalence rates for PTSD, intrusive and avoidance symptoms, predictive and associated factors and the consequences of PTSD on healthcare utilization and outcome. There was considerable variability both in the study methodology and design and in the results. The highest prevalence rates were identified in patients treated in intensive care units (ICUs) and those with HIV infection. Irrespective of the physical illness, posttraumatic symptomatology is more common than PTSD caseness. Existing characteristics of the patient may well predispose individuals to the development of PTSD as do other factors such as poor social support and negative interactions with healthcare staff. Generally, the severity of the illness itself is not predictive of PTSD. Issues relating to sampling, attrition, diagnosis, the course of symptoms, aetiological pathways, and the consequences of the disorder are discussed. The presence of PTSD most probably influences the patient's use of healthcare resources and may affect their clinical outcome.
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              Mental health of refugee children: comparative study.

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                Author and article information

                Journal
                Ann Gen Psychiatry
                Annals of General Psychiatry
                BioMed Central (London )
                1744-859X
                2006
                19 July 2006
                : 5
                : 8
                Affiliations
                [1 ]Department of Social Policy and Social Work, University of Oxford, UK
                [2 ]Cape Town Child Welfare, Gatesville, Cape Town, South Africa
                Article
                1744-859X-5-8
                10.1186/1744-859X-5-8
                1557503
                16848910
                f1a7c8ba-a70c-40d2-a5f6-d96cd5844171
                Copyright © 2006 Cluver and Gardner; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 November 2005
                : 19 July 2006
                Categories
                Primary Research

                Clinical Psychology & Psychiatry
                Clinical Psychology & Psychiatry

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