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This Article Figures Only Full Text Full Text (PDF) All Versions of this Article: AJPH.2007.116038v1 98/1/133    most recent Submit a response Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nyamukapa, C. A. Articles by Jukes, M. C.H. Search for Related Content PubMed PubMed Citation Articles by Nyamukapa, C. A. Articles by Jukes, M. C.H. Related Collections Adolescent Health Epidemiology HIV/AIDS

Constance A. Nyamukapa, MSc, Simon Gregson, DPhil, Ben Lopman, PhD, Suzue Saito, MSc, Helen J. Watts, MSc, Roeland Monasch, MSc and Matthew C.H. Jukes, PhD

Constance A. Nyamukapa, Simon Gregson, Ben Lopman, Helen J. Watts, and Matthew C. H. Jukes are with the Department of Infectious Disease Epidemiology, Imperial College London, London, England. Suzue Saito and Roeland Monasch are with UNICEF, Harare, Zimbabwe.

Correspondence: Requests for reprints should be sent to Constance Nyamukapa, Department of Infectious Disease Epidemiology, Imperial College London, Norfolk Place, London W2 1PG, UK (e-mail: c.nyamukapa03{at}imperial.ac.uk).

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.

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