Abstract:
Introduction The effect of care environment on orphaned and
separated children and adolescents’ (OSCA) mental health is
not well characterised in sub-Saharan Africa. We compared
the risk of incident post-traumatic stress disorder (PTSD),
depression, anxiety and suicidality among OSCA living in
Charitable Children’s Institutions (CCIs), family-based care (FBC)
and street-connected children and youth (SCY).
Methods This prospective cohort followed up OSCA from
300 randomly selected households (FBC), 19 CCIs and 100
SCY in western Kenya from 2009 to 2019. Annual data were
collected through standardised assessments. We fit survival
regression models to investigate the association between care
environment and mental health diagnoses.
Results The analysis included 1931 participants: 1069 in
FBC, 783 in CCIs and 79 SCY. At baseline, 1004 participants
(52%) were male with a mean age (SD) of 13 years (2.37); 54%
were double orphans. In adjusted analysis (adjusted HR, AHR),
OSCA in CCIs were significantly less likely to be diagnosed
with PTSD (AHR 0.69, 95% CI 0.49 to 0.97), depression
(AHR 0.48 95% CI 0.24 to 0.97), anxiety (AHR 0.56, 95% CI
0.45 to 0.68) and suicidality (AHR 0.73, 95% CI 0.56 to 0.95)
compared with those in FBC. SCY were significantly more likely
to be diagnosed with PTSD (AHR 4.52, 95% CI 4.10 to 4.97),
depression (AHR 4.72, 95% CI 3.12 to 7.15), anxiety (AHR 4.71,
95% CI 1.56 to 14.26) and suicidality (AHR 3.10, 95% CI 2.14
to 4.48) compared with those in FBC.
Conclusion OSCA living in CCIs in this setting were
significantly less likely to have incident mental illness, while
SCY were significantly more, compared with OSCA in FBC.
