Results for mediation analyses.

The relationship between parental HIV/AIDS status or death and child mental health is well known, although the role of child maltreatment as a confounder or mediator in this relationship remains uncertain. This study examined the potential path mechanism through child maltreatment mediating the link between HIV/AIDS family dysfunction trajectories and psychosocial problems. A cross-sectional survey was conducted in the Lower Manya Municipal Assembly of Ghana. A questionnaire which consisted of the Strengths and Difficulties Questionnaire (SDQ), Social and Health Assessment (SAHA), Rosenberg Self-Esteem Scale (RSES) and the Conflict Tactics Scale (CTS) was completed by 291 adolescents. Controlling for relevant sociodemographic confounders, mediation analyses using linear regression were fitted to examine whether the association between family dysfunction and psychosocial problems is mediated by child maltreatment. The results indicate that, among adolescents, child maltreatment fully mediated the association between being orphaned by AIDS and self-esteem (b = .59 [95%CI .32, .91]), delinquency and risky behaviours (b = .56 [95%CI .31, .86]) and peer problems (b = .74 [95%CI .48, 1.03]). Similarly, child maltreatment fully mediated the association between living with an HIV/AIDS-infected parent and self-esteem (b = .78 [95%CI .43, 1.23]), delinquency and risky behaviours (b = .76 [95%CI .45, 1.11]), depression/emotional problems (b = .64 [95%CI .40, .92]) and peer problems (b = .94 [95%CI .66, 1.26]). Partial mediation was found for hyperactivity. Child maltreatment mediates the association between the family dysfunction trajectories of parental HIV/AIDS or death and psychosocial problems among adolescents. This implies that efforts to address child maltreatment among families affected by HIV/AIDS may be helpful in the prevention of psychosocial problems among these children, thus enhancing their wellbeing. The findings therefore underscore the need for comprehensive psychosocial interventions that addresses both the unique negative exposures of HIV/AIDS and maltreatment for children affected by HIV.父母HIV/AIDS感染状况或离世与儿童心理健康之间的关联已广为人知，尽管儿童虐待作为该关联中的混杂因素或中介变量的作用仍不明确。本研究以儿童虐待为中介变量，探究HIV/AIDS相关家庭功能失调轨迹与心理社会问题之间的潜在路径机制。研究在加纳下曼亚市政区开展横断面调查，共291名青少年完成了包含长处与困难问卷（Strengths and Difficulties Questionnaire, SDQ）、社会与健康评估量表（Social and Health Assessment, SAHA）、罗森伯格自尊量表（Rosenberg Self-Esteem Scale, RSES）以及冲突战术量表（Conflict Tactics Scale, CTS）的调查问卷。在控制相关社会人口学混杂因素的前提下，本研究采用线性回归进行中介分析，以检验家庭功能失调与心理社会问题之间的关联是否由儿童虐待所中介。结果显示，在青少年群体中，儿童虐待完全中介了艾滋病致孤与自尊（b = 0.59 [95%CI 0.32, 0.91]）、品行问题与危险行为（b = 0.56 [95%CI 0.31, 0.86]）以及同伴交往问题（b = 0.74 [95%CI 0.48, 1.03]）之间的关联。同样，儿童虐待完全中介了与HIV/AIDS感染父母共同生活与自尊（b = 0.78 [95%CI 0.43, 1.23]）、品行问题与危险行为（b = 0.76 [95%CI 0.45, 1.11]）、抑郁/情绪问题（b = 0.64 [95%CI 0.40, 0.92]）以及同伴交往问题（b = 0.94 [95%CI 0.66, 1.26]）之间的关联。多动症状仅存在部分中介效应。儿童虐待在父母HIV/AIDS感染或离世相关的家庭功能失调轨迹与青少年心理社会问题之间发挥中介作用。这意味着，针对受HIV/AIDS影响家庭中的儿童虐待问题开展干预，或有助于预防该群体儿童出现心理社会问题，进而改善其福祉。因此，本研究结果强调，需要制定综合性社会心理干预方案，同时应对受HIV影响儿童所面临的独特负面暴露因素——包括HIV/AIDS相关困境与虐待问题。