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ADVERSITIES AND MENTAL HEALTH OF HIV/AlDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERtEIVED SOCIAL SUPPORT 
PALESA MORUBANE 
18047130 
Mini-dissertation (article format) submitted in partial fulf lment of the requirements for the 
degree in Masters of Social Sciences in Clinical Psycholc gy of the North West University 
(Mafikeng Campus) 
LIBRARY 
fl/LC-.:=IKENG CAMPUS 
CALL NO.: 
2019 -07- 1 5 
~C.NO.: I\ 
f...!OIFrn-t;-WEST UNIVERSl7 y 
Supervisor: Prof E. S.Idem ndia 
Co-Supervisor: Dr M. P. M ltepa 
Page 13 
TABLE OF CONTENTS 
Dedication 4 
Acknowledgement 5 
Preface 6 
Letter of consent 7 
Instructions to authors 8 
Manuscript 12 
Abstract 13 
Introduction 14 
Theoretical background 18 
Literature review 23 
Hypotheses 29 
Methodology 30 
Results and Tables 36 
Discussion 41 
Conclusion 44 
Implications 45 
Limitations 45 
Recommendations 46 
References 47 
Appendices 63 
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DEDICATION 
This study is dedicated to my family, especially my mother, Motlalepula Morubane, 
Whose unfaltering love, encouragement, sacrifices and support over many years has always 
been a great inspiration 
Page IS 
ACKNOWLEDGEMENTS 
I will like to give a huge gratitude to many people who have influenced and contributed to the 
completion of this thesis: 
• First and foremost, I would like to thank the Almighty God, who is the source of life 
and strength of knowledge and wisdom. I thank Him for His unconditional love, 
mercy and unmerited favour that He has shown me through the process of this study 
and for giving me patience, endurance and strength to complete this study. 
• Prof E.S. Idemudia, I thank you for teaching me the fundamentals of research, the 
knowledge you instilled in me is invaluable. I appreciate and value your patience, 
kindness support, guidance and a willing heart to teach. Without your support this 
would not have been possible. May God grant you more wisdom and grow you in all 
spheres of your life. 
• Dr M.P. Maepa, I thank you for helping me give birth to this study and helping me 
nurture it till its completion. I appreciate and value your firm hand that constantly 
pushed me to work harder, thank you. Without your support this would not have been 
possible. May God grant you more wisdom and grow you in all spheres of your life. 
• Dr Oluyinka, Ojedokun, I thank you for your patience and endurance while assisting 
with the statistical analysis, you were always ready to help and explain further. May 
God bless you for that. 
• I am grateful for my family, especially Motlalepule, Katlego and Boitumelo 
Morubane; I thank God for you. I truly value your tremendous support and words of 
encouragement, may the Almighty God richly bless you. 
• To all my friends and acquaintances, Golekane Pule, Benjamin Morena, Wily 
Seerane, Keatlaretse Moamogwe, Masego Moobi, Fisiwe Tshabangu, Goitseona 
Mathibe, and Matshidiso Modisaotsile; your words kept me going. 
• A special thanks to all the staff members of the Department of Psychology (Ipelegeng 
Centre) who contributed to the completion of this study, DrMhlongo, Miss N. 
Mokgosi, Miss P. Kolobe, Mrs N. Matamela, Dr P. Erasmus, Miss M. Erasmus, and 
Miss N. Mogotsi. 
• A heartfelt appreciation to all the institutions that participated in the study, 
Department of Education, High School principals and learners, orphanage centres and 
the children, without your voluntary participation and assistance, this thesis would not 
have been possible. 
• To the following funders: NSF AS, NWU post graduate bursary I am truly grateful for 
assisting me financially to complete this study. 
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PREFACE 
Article format 
For the purpose of this dissertation, as part of the requirements for a professional master' s 
degree, the article format, as described by General Regulation A.7.5.1.b of the North West 
University, was chosen. 
Selected Journal 
The targeted journal for submission of the current manuscript is Journal of AIDS Care. For 
the purpose of examination, Tables are included in the text. 
Letter of consent 
The letter of consent from the co-authors, in which they grant permission that the manuscript 
"ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERCEVED SOCIAL SUPPORT", may be 
submitted for purposes of the thesis, is attached. 
Page numbering 
In this thesis, page numbering is from the first page to the last. For submission to the above 
mentioned journal, the manuscript is numbered according to the requirements of the South 
African Journal of Psychology. Hence, all pages are numbered consecutively. Thus, the 
numbering starts on the title page of the manuscript. 
Referencing 
In this dissertation, referencing is done according to the instructions of the South African 
Journal of Psychology 
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LETTER OF CONSENT 
We, the undersigned, hereby give consent that Palesa Morubane may submit the manuscript 
entitled, "ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS 
IN MAFIKENG: THE MODERATING ROLE OF PERCEVED SOCIAL SUPPORT", for 
the purpose of a dissertation in partial fulfilment for a master's degree. 
Prof E.S. Idemudia Dr M.P. Maepa 
Supervisor Co-supervisor 
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MANUSCRIPT 
ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERCEVED SOCIAL SUPPORT 
Palesa Morubane*, Erharbor, S. Idemudia*& M.P. Maepa* 
Faculty of Human and Social Sciences, North West University (Mafikeng Campus), 
South Africa 
Correspondence to: 
Palesa Morubane (morubanep@gmail.com/ 071 355 2104) 
Prof. E.S. Idemudia (Erhabor.idemudia@nwu.ac.za/ 018 389 2425) 
Dr M.P. Maepa (Mokoena.maepa@nwu.ac.za/ 018 389 2237) 
Department of Psychology (Ipelegeng Child and Family Center) 
School of Social Sciences 
North West University (Mafikeng Campus) 
Private Bag X 2046 
Mmabatho 
2735 
South Africa 
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ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERCEVED SOCIAL SUPPORT 
Abstract 
Aim: The study aimed at exploring the moderating role of perceived social support in the 
relationship between mental health and adversities of HIV/A IDS- related orphans in 
Mafikeng. 
Method: A cross-sectional research was conducted and three hundred and twenty one 
participants were purposively selected from two orphanage centres and two secondary 
schools in Mafikeng (orphans and non- orphans).Orphans were 121 (male= 66, female= 55), 
and non-orphans were 200 (male= 115, female= 85) between 10 to 20 years of age.Data was 
collected using Child Abuse Trauma Scale (CAT- Scale), General Health Questionnaire 
(GHQ28), and Multi-Dimensional Perceived Social Support Scale (MPSS). 
Results: The findings of the study indicated that there was a statistically significant negative 
relationship between child abuse and trauma (r= -.492, p= .01); and perceived social 
support.Results also indicated that there was a significant positive relationship between child 
abuse and trauma (r= .423 , p= .01); and mental health. As predicted, perceived social support 
moderated the relationship between adversities and mental health (R2 = 0.09, DF(l , 320) = 
7.697, p< 0.001). Therefore, as perceived social support increases, it lessens the probability 
of high mental health scores, even when adversitiesis high or low. 
Conclusion: Adversities have a significant negative relationship with perceived social 
support, and adversities also have a significant positive relationship with mental health. 
Perceived social support moderate the relationship between adversities and mental health. 
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Introduction and problem statement 
According to UNAIDS (2014), there are approximately 35 million people worldwide living 
with HIV/AIDS. More than two-thirds (70%) of all people living with HIV, 24.7 million, live 
in sub-Saharan Africa- including 91 % of the world's HIV-positive children (UNAIDS Gap 
Report, 2014). Statistics South Africa (2014), indicates that the total number of persons living 
with HIV in South Africa increased from an estimated 4,09 million in 2002 to 5,51 million by 
2014. UNAIDS fact sheet (2014), revealed that an estimated 1.1 million adults and children 
died of AIDS, accounting for 73% of the world's AIDS deaths in 2013. It is estimated that 
17.8 million children under 18 have been orphaned by AIDS (AIDS Orphan, 2013). In 
addition, the United Nations Children's Fund (UNICEF, 2013), reported that 15.1 million of 
these orphaned children live in sub-Saharan Africa, with 63% in South Africa. 
The United Nations Children's Fund (UNICEF, 1999) and the Joint United Nations 
Programme on HIV and AIDS (UNAIDS, 2008), define an orphan as any child below the age 
of 18, that has lost at least one parent. This loss of parent makes a child who is orphaned 
more vulnerable, and in need of adult care (Akwara et al., 2010). In consistence with the 
definition of UNAIDS (2008) and UNECA (2011), HIV/AIDS orphan is defined for the 
purpose of this study as a child under 20 years of age who has lost one or both parents to 
HIV/A IDS-related illness. 
Nyberg et al. (2012) indicated thatthe impact of losing a parent due to HIV/ AID Smay include 
a series of stressful life events such as the loss of parental care and protection, decreased 
access to schooling and health care, food security, increased child labour, increased risk of 
abuse, exploitation, risk of HIV infection, psychosocial distress, stigma, discrimination, and 
impoverishment. 
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Orphanhood can be traumatic for a child, and this can expose a child to countlessadversities. 
Adversity can be defined as an extremely unfavourable experience or event; a difficulty, 
danger or state of affliction, which implies a lack of well-being (Gehrling & Memmott, 
2008). For children, adversity can be the experience of life events and circumstances which 
may combine to threaten healthy development (Daniel, 2010). According to Kimani, Mutua, 
Chesire and Chebet (2012), the death of a parent is often followed by inadequate guidance, 
emotional support, socialization, educational support, nutrition, material and financial 
support. For these reasons, HIV/AIDS orphans end up in several destinations like extended 
families , guardians' homes, orphanages and some turning to the streets (Guo, Li & Sherr, 
2012). 
As already indicated, adversities faced by HIV/AIDS orphans due to the parents ' death, may 
have negative consequences for their psychosocial well-being (Kaggwa and Hindin, 2010). It 
can therefore be argued that orphans are susceptible to more mental health challenges than 
non- orphans. These mental health problems related to HIV/A IDS orphans include 
psychological symptoms such as posttraumatic stress, anxiety and depression (Nyamukapa et 
al., 2010; Cluver,Orkin, Gardner, & Boyes, 2012). In support of that, many studies have 
identified high levels of mental health problems among HIV/ AIDS orphans, and showed that 
there is an increasing evidence that mental health problem is associated with adversities they 
are faced with due to parental loss (Doku, 2010; Traube et al., 2010; Cluver, Gardner & 
Operario, 2009). Furthermore, studies reveal that AIDS-orphaned children have higher 
depression, anxiety and posttraumatic stress disorder as compared to other orphans and non-
orphans, and that HIV/AIDS-related stigma is a risk factor for those outcomes (Boyes & 
Cluver, 2013; Cluver, Orkin, Gardner & Boyes, 2012). De Witt and Lesling (2010) 
highlighted that many orphans did not cope as well as could be expected despite their 
material needs being met and this suggested that psychological problems may be responsible. 
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It is clear that existing research on mental health of HIV/A IDS orphans highlights that these 
children need intervention. It is important that alternative strategies that will serve as 
protective factors for their mental health, are discovered and brought in to assist in preventing 
or minimising the risks of mental health problems. 
Among the variables that are positively associated with children's mental health, perceived 
social support is gaining increasing attention. There is good evidence that social support plays 
an important role in mental health. For example, Wang et al. , (2012) reported that perceived 
social support such as future expectations and trusting relationship with caregivers, 
significantly mediated links between risk factors such as stigma and exposure to adverse 
situations, and depression. Moreover, a study conducted by Desilva et al. , (2012) indicated 
that perceived social support played a protective role, as it was associated with lower risks of 
anxiety and depression symptoms, lower oppositional levels, and heightened self-esteem and 
resilience. 
Although the moderating role of social support on adversities is evident in previous studies, 
much less studies have focused on identifying social support as it moderates the relationship 
between adversities and mental health among HIV/AIDS-related orphans; and thus the 
present study aims to close the identified gap. 
Aim of the study 
The aim of the study was to explore the moderating role of perceived social support in the 
relationship between adversities and mental health of HIV/A IDS orphans in Mafikeng, 
North-West Province. 
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Objectives 
• To explore the difference between orphans and non- orphans onadversities, mental 
health, and perceived social support. 
• To explore the moderating role of perceived social support on adversities and mental 
health of orphans. 
• To assess gender differences of orphans on adversities, mental health and perceived 
social support. 
Significance of the study 
Conclusions drawn from this moderating study will have practical significance for the 
orphanage centres, caregivers, community, children and adolescents who are orphaned by 
HIV/A IDS by increasing awareness of how adversities they face may predispose them to 
mental health problems, as well as the influence of perceived social support. Thereby, it will 
assist the orphanages. 
The study will also be beneficial to the orphanage centers, caregivers, community, children 
and adolescents who are HIV/AIDS orphans by giving insight on whether or not perceived 
social support can act as a moderator between the relationship between adversities and mental 
health. By doing so, the study will contribute towards the planning of future intervention 
strategies that focus more on strengthening social support. 
Recommendations from this study may assist in the development of policies and strategies to 
minimize the mental health needs of HIV/A IDS- related orphans. Psychologists will be able 
to identify and diagnose mental health needs of this vulnerable population when providing 
psychological services to them. 
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Theoretically, it will add on to the existing literature on mental health by introducing the role 
of perceived social support as a moderator of the relationship between adversities and mental 
health, as many researchers have not yet explored this area. The study will also project 
various adversities endured by HIV/A IDS- related orphans in Mafikeng and their perception 
of social support. Limitations of this study will give direction to future researchers by 
identifying other gaps that still need to be researched. 
Methodologically, this study will increase knowledge and the use of moderation approach in 
the methodology of future studies by demonstrating the relevance and applicability of 
moderation analysis when studying adversities and mental health. By so doing, researchers 
will not only focus on the influence of one variable on another, but will also look at variables 
that are likely to act as moderators between two variables. 
Theoretical background 
The study was conceptualized within the following theories: Adversity theory, The 
Biopsychosocial model, Buffer theory, and Gender theory. The theories are explained in 
detail below. 
• Adversity theory 
The study adopted the adversity theory by Haidt (2006), to give an explanation of how 
adversity may play a role in the proneness of mental health problems.The theory postulates 
that people are able to experience posttraumatic growth rather than post-traumatic stress after 
they experience significant adversity. Haidt (2006), posits that people can experience post 
traumatic growth following adversity and that people must endure adversity for growth. 
Furthermore, the theory postulates that adversity in the twenties and thirties may best position 
an individual for growth, however, adversity experienced earlier or laterin life,has the 
likelihood to result in post-traumatic stress (Haidt, 2006). 
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This study is directly linked to the last statement of the theory which says, when one 
undergoes major stress early or late in life, then it is likely not to result in growth but post-
traumatic stress. Walsh et al. (2014 ), also agreethat an adverse psychosocial environment in 
the childhood years significantly increases the risk for later psychopathology. 
HIV/A IDS orphans used in this study are younger than twenty years. Thus, according to 
Haidt (2006), they are more likely to experience post -traumatic stress and other emotional 
and psychological scarring following adversity. These adversities may be: abuse, poverty, 
neglect, exploitation, and heading households. Therefore, this theory supports our assumption 
that, adversities negatively affect the mental health of HIV/AIDS-related orphans. 
With this theory, we argue that HIV/A IDS orphans will report higher scores on adversities 
and therefore score high on the mental health measure, than non-orphans. This would be 
because orphans experience many challenges, losing a parent being an adversity on its own; 
as compared to non-orphans and that would increase their likelihood of developing 
psychological problems later in life. 
• The Biopsychosocial model 
As the WHO (2012) puts it, many factors come together to affect the well-being of 
individuals and societies. Health is determined by circumstances and environment people find 
themselves in. Factors such as our genetic makeup,where we live, surroundings,economic 
status and educational level, and the relationships we have with friends and family all have 
significanteffects on health (Marya, 2011 ). The biopsychosocial model of disease can better 
explain how these factors affect one's mental health. 
The biopsychosocial model of disease is a framework developed by Engle (1980), which 
states that biological, psychological, and social factors are all involved in the causes of health 
Page I 20 
and disease. In other words, it is the interaction between one's genetic makeup, behaviour, 
and sociocultural environment that contribute to both health and disorder. 
Many disorders have a biological basis in the form of genetic vulnerability or disposition. For 
example, some children are most likely to develop a mental disorder such as schizophrenia 
mainly because there is a history of the disorder in the family. As research also reveals, if one 
monozygotic twin develops schizophrenia, there is at least a 60% chance the co-twin will also 
develop the disorder (Churbanov, 2013). The psychological part looks for potential 
psychological bases for a health problem such as emotional disturbance and distorted 
thinking (Nursing Theories, 2013). According to Liu (2011), psychosocial factors can cause a 
biological effect by predisposing an individual to risk factors. An example is that the death of 
a beloved may not cause liver damage by itself, but a grieving person may be more likely use 
excessive alcohol as a coping mechanism, and therefore end up with liver damage. 
As for the social part of the model, it investigates how vanous social aspects such 
as socioeconomic standing, religion, values and principlescan influence health (Upton, 
2012). For instance, losing parents may place one at risk of poverty, financial stress and 
illness. The purpose of this model is simply to make us understand that each one of these 
factors is not sufficient to bring about health or illness, but the interaction between them is 
what determines health or illness. In the case of HIV/A IDS orphans, in relation to the theory, 
we argue that because health and wellness are caused by a complex interaction of biological, 
psychological, and sociocultural factors therefore, adversities will have an impact on one's 
mental health. 
According to this study, HIV/AIDS- related orphans may find challenges in almost all aspects 
of their lives. They may be emotionally and psychologically traumatized by the loss of their 
Page I 21 
parents, end up in poverty, sufferchild abuse and neglect, get exploited and be vulnerable to 
other illnesses, and all of this may negatively impact the mental health of the orphans. 
• Buffering hypothesis theory 
The buffer theory proposes that social support moderates the power of psychosocial adversity 
to cause incidences of illness (Alloway, 1987). Social support, according to the buffering 
hypothesis, acts as a resource with the ability to ease or prevent a stress reaction by making 
threatened individuals feel more capable of dealing with the stressor in their lives (Cohen & 
McKay, 1984). 
Lack of social support and lower perceived ability of social support have been associated with 
symptoms of depression among HIV/AIDS orphans (Uchino, Bowen, Carlisie, & 
Birmingham,2012; Zhao et al., 2011). In addition, social support has proved to be a 
moderator of mental health symptoms among HIV/AIDS related orphans (Puffer et al. , 2012). 
According to Cohen and Wills (1985), social support provided by families, friends and 
significant others can protect an individual from those stressful events which are potentially 
capable of causing a disease.Orphans may be lacking in social support due to ill parents and 
death of loved ones.Theymay also have negative perceptions of themselves and others and 
that may lead to lower perceptions of social support (Cluver, Fincham & Seedat, 2009). 
Cohen and Wills (1985), further posited that support is needed from people within the social 
environment when there are elevatedstress levels to assist with coping. It could be support 
from an intimate friend, school-friend, teacher or a family member. 
According to Tomich and Helgeson (2002), something as simple as social relationships can 
elevate the mood, make one feel like they belong, and be a source of companionship to share 
events of our lives with, which in turn can lead to animproved quality of life. In addition, 
Cohen & Wills (1985),hypothesized that lack of positive social relationships leads to poor 
Page I 22 
psychological well-being such as depression and anxiety. In tum, anxiety and depression may 
impact physical health, either in a direct effect orthrough physiological processes that 
influence susceptibility to disease. This theory is used to support the assumption that 
HIV/A IDS-orphans are most likely to face adverse situations, following their parents ' death, 
which may impact their mental health, but if they have suitable perceived social support, their 
stress effect willbe moderated,as compared to those who may not have any social support. 
• Gender Schema theory 
The study uses gender schema theory to explain the gender variable. The gender schema 
theory by Bern (1981) stipulates that males and females learn to process new information in 
their environment based on masculinity or feminism.Once children have developed this 
schema, society also expects them to behave in ways consistent with traditional gender roles. 
Children internalise these messages and grow up with the notion that, what males can do 
females cannot do; or what is applicable and suitable for the other sex does not apply on the 
other counterpart. They also believe that masculinity is more highly valued than feminism. 
For example, gender disparities have been reported regarding the spread of HIV. Women 
reported that men refused to use condoms and they respected and accepted their decision as 
they are superior to them, and that puts them in a powerless position of being unable to 
protect themselves from the disease (Joubert-Wallis & Fourie, 2009).Therefore, the theory 
indicates that the impact of orphanhood may differ by gender due to the socialization of a 
child. Thus we hypothesize that females are more vulnerable to poor mental health than 
males. 
Page I 23 
Literature Review 
Adversities faced by HIV/A IDS orphans 
A wide range of adversities, including physical, emotional and sexual abuse, are known to be 
predictors of many forms of mental ill health (Read & Bentall, 2012). According to Pacione 
et al., (2012), adversity can take various forms for orphans, such as vulnerability, family 
dysfunction and environmental stressors. All of these may threaten children's development 
and impact their mental health. Becoming orphaned, child- headed households and child 
labour, all expose children to possibly harmful environmental stress (Nyamukapa, Gregson, 
Wambe & Mushore, 2010). The death of a parent to AIDS can often leave children 
vulnerable to illness, abuse, neglect, and mistreatment. In addition, it also exposes them to 
economic burden, stigma, and withdrawal from school (Cluver & Orkin, 2009). 
After parents' death, these children are now faced with new responsibilities and work. Tom 
and Mudhovozi (2014), highlighted that responsibilities and work, both within and outside of 
the household, increaseintensely when parents die. Due to these new responsibilities, some 
children are forced into dangerous labour, exploitation, abuse and neglect while others 
migrate to threatening environments, such as street dwellings and urban centres (Nyberg et 
al., 2012). Furthermore, orphaned children are often forced into abusive situations and 
exploitative employment in an attempt to negotiate their survival (Cluver, Gardner & 
Operario, 2008). Many children are forced into sex work, thereby exposing themselves to 
significant physical and psychological risks (Cluver, Orkins, Boyes, Gardner & Francizka, 
2011). 
According to Motene (2009), children can suffer child abuse and neglect, long before they are 
orphaned as a result of the ill parent. Eventually, when their parents die, they are then 
Page I 24 
supposed to adapt to a new life, with little and at times no social support, and may suffer 
exploitation and abuse. 
• Child abuse 
Several factors leading to poor psychological functioning of HIV/AIDS orphans include 
abuse (Lata & Verma, 2013).According to Meinck et al. , (2015), there is evidence from 
Africa that indicates high rates of child abuse, with rates being ashigh as 64% for physical 
abuse. Other studies also confirm that orphaned children report experiences of physical 
abuse.For example, disclosures of physical abuse among HIV/AIDS-orphans were indicated 
in several studies (Harms et al., 201 O; Seloilwe & Thupayagale-Tshweneagae, 2009; 
Thurman & Kidman, 2011; Ballet, Sirven, Bhukuth & Rousseau, 2011). Cluver et al., (2011) 
and Meinck, Cluver, Boyes & Ndhlovu, (2013), investigated severe physical abuse of 
vulnerable children in areas with high HIV incidence in South Africa. Their findings revealed 
that physical abuse was6% among AIDS-orphaned children, which was evidence of high 
levels of child abuse in families affected byAIDS. In contrast, in a systematic review and 
meta- analysis (Nichols et al., 2014) it was revealed that orphans were 4% less likely to 
experience physical abuse compared to non-orphans. 
Emotional abuse was indicated in a study conducted by Marantz et al., (2013). The findings 
revealed that 27% of orphaned children experienced emotional abuse which included being 
humiliated, threatened by caregivers,bullying and rejection by the biological children of the 
caregiver, and exposure to domestic violence. Orphans reported being threatened and made to 
feel like a burden (Harms et al., 2010). Furthermore, it is revealed that this abuse was often 
directed towards the loss of their parents. 
For sexual abuse, some studies (Meinck et al. , 2015 ; Nyamukapa et al. , 2008, 2010; Pascoe et 
al. , 2010), revealed that orphans are vulnerable to sexual abuse. They reported experiences 
Page I 25 
ofsexual abuse by family members, as well as being forced into prostitution by caregivers or 
because of poverty (Cluver& Gardner, 2007; Mmari, 2011; Mojola, 2011; Seloilwe & 
Thupayagale-Tshweneagae, 2009). 
• Maltreatment 
Orphans are most often cared for by their relatives and may have been subjected to child 
maltreatment by family members (Morantz and Heymann, 2010; Cluver & Gardner, 
2007).The findings indicated intra-household discrimination being the main maltreatment 
among orphans,including being treated less well than other children by the caregivers' 
biological children. This involved being deprived of resources such as food, clothing and 
schooling or being made to engage in excess chores or paid work. In addition, some studies 
also reported severe material deprivation of HIVAIDS orphans, such as hunger, tattered 
clothing and inadequate conditions (Funkquist, Eriksson & Muula, 2007). Furthermore, 
research also indicate experiences of explicit neglect (Cluver & Gardner, 2007;Nyamukapa et 
al., 2010), with reports including being left alone at home or locked in a shack. 
Mental health of orphans 
The death of parents introduces major changes in the life of a childincluding disrupted family 
functioning, moving in with relatives, child-heading households,socioeconomic status, and 
poverty.All these changes easily affect the psychological well-being of a child. According to 
Guterman, Cameron & Hahon (in Doku, 2012), parental deaths are traumatic for anyone, but 
it becomes worse for children as it is relatedto negative physical and psychosocial problems. 
For HIV/AIDS orphans, the impact could be even worse because HIV/AIDS is a highly 
stigmatized phenomenon (Gilbert& Walker, 2010; Cluver & Gardner, 2007). The literature 
indicate that possible factors such as abuse, family malfunctioning, stigma and discrimination 
pose psychological problems on HIV/AIDS orphans (Lata & Verma, 2013; & Lin et al., 
Page I 26 
2010). Further, childhood abuse and maltreatment are linked to poor mental health (Read & 
Bentall, 2012). As already indicated above, abuse among orphans is reported high and acts as 
a risk factor for the likelihood of mental health problems later in life. 
A systematic review of empirical studies on HIV/AIDS and orphans found that orphaned 
children often have negative psychological and physical outcomes (Chi et al., 2013). In 
addition,elevated levels of psychological distress in orphans, including anxiety, depressive 
symptoms, anger, loneliness, low self- esteem, social withdrawal, hopelessness, suicidality, 
post-traumatic stress symptoms and sleep problems(Lin et al., 2010;Cluver et al., 2007; Ruiz-
Casares, Thombs, & Rousseau, 2009; Zhaoet al., 2009; Cluver & Gardner, 2007)were 
reported. Recent studies also revealed high levels of anxiety, post-traumatic stress and 
depression among HIV/AIDS orphans (Kumar et al., 2014; Chi et al., 2014; Sharer, Cluver & 
Shields, 2015; Kuo et al., 2013 ). Furthermore, Y endork and Somhlaba (2015) revealed that 
orphans reported high anxiety symptoms compared to non-orphans but there were no 
differences between orphaned children and non-orphans on symptoms of depression. On the 
other hand, Desilva et al., (2012) and Govender et al., (2014),found anxiety and depression to 
be low for both AIDS orphans and non- orphans. 
In another study conducted by Cluver and Gardner (2006), HIV/A IDS orphans were more 
likely to have marked concentration difficulties and to report frequent somatic symptoms.In 
addition, Zhao et al., (2010) and Atwine et al., (2005) indicated that HIV/AIDS orphans 
scored high for feelings of loneliness, hopelessness and suicidal ideation. Furthermore, 
Desilva (2012) also revealed that orphans were more likely to report being very ill compared 
to non-orphans. 
Page I 27 
Gender 
There is a disparity in the levels of suffering that orphans face according to their gender. 
Nabunya and Ssewamala (2014) report that within the household, both boys and girls 
experienceincreased responsibilities. They both reported having to do more household chores, 
however, orphaned girls were more likely to report taking care of small children than 
boys.Evans (2007) also indicated that both girls and boys experience decreased school 
participation following parents' death. 
Francis-Chizororo (2010), revealed that girls are more disadvantaged because they are 
usually the first in the household to drop out of school, care for younger siblings and take on 
many adult tasks.In the case of childhood abuse,Zapata et al., (2013) reported that physical 
and sexual abuse is more prevalent in girl orphans compared to boy orphans. 
Some studies on mental health and gender differences were inconsistent. For example, 
Desilva et al., (2012) and Thurman and Kidman (2014), found girls to report more anxiety, 
depression and behavioural symptoms as compared to boys; while Kaggwa and Hindin, 
(2010) and He and Ji (2007), reported heightened depression and hopelessness among boys 
but not girls.However, some studies did not find any gender difference (Nyamukapa et al., 
2010; Onuoha & Munakata, 2010; Li et al., 2009). Furthermore, Nyamukapa et al., (2008), 
concluded that HIV/AIDS orphanhood is negatively associated with children's psychological 
wellbeing regardless of gender. 
Page I 28 
Perceived social support 
Social support acts as a buffer against stressful life events, that is, if an individual has a 
perception that they arecared for, esteemed, loved, valued and belong to jointly equal 
relationships (Cohen & Wills, 1985). Cobb (1976), also suggests that social support indirectly 
strengthensa sense of well-being by lessening the effects of stress and enhancing coping 
skills.In support of that, there are several studies conducted in South Africa that indicate that 
social support can help individuals cope better with different challenges. For example: 
Casale, (2012); and Ndlovu, Jon & Carvalhal, (2010), revealed that social support helps 
families manage with socioeconomic and emotional challenges related to HIV/AIDS. Other 
studies highlighted higher levels of social support to be linked with low death rates, and 
enhanced quality of life among the bereaved (Holt- Lunstad, Smith& Layton, 2010; Ke, Liu 
& Li, 2010). 
Integration in a social network helps one to manoeuvre through traumatic experiences and 
therefore reducing the chances of poor well-being. Caregivers, siblings and special people in 
AIDS orphans' lives can be effective sources of social support for them, which may help to 
promote psychological well-being (Okawa et al., 2010). This is supported by the study 
conducted byCluver, Fincham & Seedat, (2009), which revealed that perceived social support 
has been linked with less symptoms of post-traumatic stress among AIDS orphans.Adamson 
and Roby, (2011) also reported thatperceived social support is positively linked with the 
mental health of AIDS orphans. 
The literature indicates that there is availability of social support for orphans. For example, 
Hong et al. (2010) examined the relationship between perceived social support and 
psychosocial wellbeing among HIV/AIDS orphans. The results suggested that vulnerable 
children had the lowest level of perceived social support compared to HIV/A IDS orphans and 
Page I 29 
non-orphans. This could be because most orphans are cared for by their grandparents, and it 
is revealed that extended families serve as an important source of care and support for them 
(Avabratha, Kodavanji & Vaid, 2011). However, the grandparents are said to be in their mid-
60s in age which may raise concern about their ability to physically and financially care for 
young fostered children (Beegle, et al. 2010). Therefore, it is essential that orphans receive 
adequate social support as it is reported by Orban et al., (2010) that orphans also view social 
support as the most helpful coping strategies. 
Hypotheses 
1. There will be a significant difference betweenorphans 
and non- orphans on adversities, mental health and perceived social support. 
2. Perceived social support will moderate the relationship 
between adversities and mental health of orphans. 
3. Female orphans will report high adversities and therefore, 
report high on mental health than male orphans. 
Page I 30 
Methodology 
Study Design 
This study was based on a cross sectional design within a quantitative research approach. 
This method is a study design in which data are collected for all the variables of interest using 
one sample at one time (Adler & Clark, 2015). According to Aparasu and Bentley (2015), 
this study design is often used descriptively to capture information about a population, but 
may also be used to examine associations between an independent and dependent variable. 
The independent variable in this study is adversities (child abuse and trauma) and dependent 
variable is mental health. The moderating variable is perceived social support. 
Sampling 
Purposive sampling was used to select both groups, the reason being that, it is the only viable 
sampling technique in obtaining information from a very specific group of people such as 
orphaned adolescents. It is a limited number of individuals who possess the trait of interest, 
such as age and gender ( orphans/non- orphans). 
From the register list at orphanage centres and schools, where the participants were drawn, 
the sample size was purposefully selected by age, sex and those who have parents or not, to 
ensure the representation of these important demographic variables. Those who had lost 
parents due to other reasons besides HIV/AIDS were excluded. The age cutoff was based on 
the ability to answer questionnaires as it was 4th grade English. The representation of both 
sexes was insured as the study wanted to check for gender differences. 
Participants 
A total sample of 321 participants (Orphans = 121 and Non-orphans= 200) were selected to 
participate in the study. The participants were 'HIV/ AIDS- related orphans' from the two 
Page I 31 
orphanage centres in Mafikeng; and non- orphans were leaners from two Secondary schools, 
located in Mafikeng, in the North West Province, South Africa. 
The demographic representations of the participants are as follows: orphans were (N=121) 
while Non- orphans (200). Non-orphans had more males: 115 (57.5%) and females : 85 
(42.5%), as compared to orphans who had males 66 (54.5%) and females 55 (45.5%). 
Participants, according to age, orphans' mean age is 14.1 (SD= 2.09) with the Range = 10 -
20 years while non- orphans' mean age is 15.2 (SD= 1.75) with the Range = 10 -18 years. 
The majority of the orphans come from the rural areas (81 % ), while non-orphans also have a 
majority number (91.5%) staying in rural areas. Orphans have at least a grade eight level of 
education (66.9%) as well as non- orphan (51.5%). All the orphans did not have biological 
fathers and very few (2.5%) have biological mothers, while non-orphans who have biological 
fathers are 55.5% with a majority 85.0% having biological mothers. 
Orphans reported that they at least have brothers (63 .6%) and sisters (62.0%). Very few of 
them reported to have a paternal grandfather (14% ), paternal grandmother (28.1 % ), maternal 
grandfather (23.1 %) or maternal grandmother (38.8%). They at least have uncles (40.5%) and 
aunts (43 .0%). Non- orphans reported that they at least have brothers (64.5%) and sisters 
(63.5%). Very few of them reported to have a paternal grandfather (15%), paternal 
grandmother (20.5%), maternal grandfather (20.0%) or maternal grandmother (14.5%). They 
at least have uncles (34.0%) and aunts (28.0%). Orphans who have the highest number of 
people staying in a household are (38.8%) while non- orphans are (40.5%). 
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Instruments and psychometric properties 
The instruments that were used to measure variables of interest were the Child Abuse Trauma 
Scale (CAT- Scale), General Health Questionnaire (GHQ28), and Multi-Dimensional 
Perceived Social Support Scale (MPSS). The description of each instrument follows next. 
• The Childhood Abuse and Trauma Scale (CAT-scale) 
This questionnaire was developed by Sanders and Becker-Lausen (1995). The scale consists 
of thirty-eight items to assess various forms of childhood physical, sexual, emotional, and 
maltreatment abuse. The frequency of each experience is rated on a 5- point Likert scale, 
ranging from 0= "never" to 4= "always". The measure contains three subscales: Negative 
Home Environment/Neglect (NEG), Sexual Abuse (SA) and Punishment (PUN). 
A total score can be derived by summing item frequency scores and dividing by the total 
scores range from 0- 4, with higher scores reflecting greater childhood trauma (Schember, 
2007). The Cronbach's alpha for the scale was found to be .90 and test-retest reliability was 
.89 (Sanders & Becker-Lausen, 1995).The reliabilityof this scale was tested for the present 
study and the Cronbach's alpha was .88. 
• General Health Questionnaire (GHQ-28) 
The General Health Questionnaire (GHQ-28) by Goldberg and Allison (1995), was used to 
assess mental health. It is a 28 items scale which consists of four subscales (somatic 
complaints, anxiety and insomnia, social dysfunction and depression), using a 4 point likert 
scoring format (strongly disagree = to strongly agree = 4). It is used to assess psychological 
well-being in the general population and within community. Any individual that scores 
between 0-42 is regarded as having good mental health while the ones that score between 43-
84 are considered as having poor mental health.The reliabilityof this scale was tested for the 
present study and the Cronbach's alpha was .79. 
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• Multidimensional scale of perceived social support (MPSS) 
The Multidimensional scale of perceived social support(MSPSS) by Zimet, Dahlem, Zimet, 
and Farley (1988) is used to measure social support. It consists of 12 items that provide 
assessment of three sources of support: family (FA), friends (FR), and significant other (SO). 
The items directly addressing social support are divided into factor groups relating to the 
source of the support (i.e. , Family, Friends, or significant others), each of these group consists 
of four items.Cronbach's coefficient alphafor the whole scale was found to be 0.94. The 
reliabilityof this scale was tested for the present study and the Cronbach's alpha was .75. 
Procedure 
The schools and orphanage centres were contacted telephonically to request a meeting with 
the managers. Appointment dates were set for a personal meeting to explain what the study 
was about and how they could be of assistance. Consent was obtained from the school 
authorities and orphanage manager, dates and time of data collection were communicated to 
all concerned. On the dates of collection, learners and orphans who were selected from the 
information list by the researcher together with the School Heads and Centre Managers, 
according to the requirements ( age, gender and if they are orphans/non- orphans) of the study 
were invited to participate in the study. As far as the orphans are concerned, before they were 
invited for participation in the study, the manager of the centres screened the questionnaire to 
avoid harmful questions and no such questions were found. 
Data collection took six (6) days because collection was done at two centres and children 
came on different days depending on their age group. Each centre filled questionnaires for 
three (3) days. Administration of the questionnaires took place from 09h00-13h30, under the 
supervision of 2 guardians from both centers, four research students who were assisting with 
data collection and the researcher. 
Page I 34 
At the schools, data collection took place from 8h30-llh00. Administration of the 
questionnaires took place during regular classes under the supervision of the researcher, two 
research assistants, and two teachers appointed by the school principal to assist. Data 
collection took eight (8) days and each school filled questionnaires for four (4) days. 
Ethical considerations 
Ethical approval was granted by the North-West University Ethics Committee (NWU-
00028- 14- A9), and the permission to collect data was obtained from the orphanage center's 
manager and the Department of Education. 
Consent was obtained from the center manager, on behalf of the orphans. As far as the non-
orphans (learners) are concerned; before they could take part in the study they were given 
consent forms to take home to parents. On the dates of collection, questions were thoroughly 
explained by the researcher. The participants were assured that the information they provide 
would be treated with confidentiality and that they may not disclose their identity anywhere 
in the questionnaires. Participants were informed that they may withdraw from the study 
anytime if they want to and they will not be penalized in any way. 
Furthermore, there was a debriefing session arranged for participants who may have been 
emotionally provoked by the completion of the questionnaires in order to deal with any 
emotional reactions that could arise, as a means of protecting participants from harm. After 
completion of questionnaires, all participants were thanked for their cooperation and 
participation. 
Page I 35 
Data analysis 
In this study, data was analyzed using Statistical Package of Social Sciences Software (SPSS) 
version 9.5. An independent sample t-test was used to test hypothesis 1, while hypothesis 2 
was tested using a moderated hierarchical multiple regression analyses and correlation 
analysis. Hypothesis 3 also used independent sample t-test. 
Page I 36 
Results 
This study was intended to investigate the relationship between adversities and mental health 
and the moderating role of perceived social support among HIV/AIDS-related orphans in 
Mafikeng. An independent t-test (Table 2) was conducted to test hypothesis one and the 
results are presented below. 
Hypothesis 1: There will be a significant difference between orphans and non-orphans 
onadversities, mental health, and perceived social support. 
TABLE 1: Comparison of adversities, mental health and perceived social support 
between orphans and non- orphans 
Variables Orphans Non-Orphans 
(N=l21) (N=200) 
X-bar SD X-bar SD t df p 
Child Abuse and Trauma 30.0 20.5 30.5 20.2 .194 319 ns 
Mental Health 58.8 11.2 56.7 12.2 -1.54 319 ns 
Perceived Social Support 66.0 11.1 64.8 11.3 -.952 319 ns 
The results did not reveal a significant statistical difference on adversities (t = 194; df =319; p 
= n.s), mental health (t = -1.54; df =319; p = n.s), and perceived social support (t = -.952; df 
=319; p = n.s) between HIV/AIDS orphans and non-orphans. However, looking into the 
descriptive statistics, HIV/AIDS orphans scored lower on adversities ( X = 30.0, SD = 
20.05), than non- orphans who scored higher on adversities ( X = 30.5, SD= 20.2). On mental 
health, HIV/AIDS orphans scored higher ( X = 58.8, SD = 11.2), than non-orphans who 
scored lower on mental health ( X = 56.7, SD= 12.2). HIV/AIDS orphans scored higher on 
Page I 37 
perceived social support ( X = 66.0, SD = 11.1 ), than non- orphans who scored lower on 
perceived social support ( X = 64.8, SD= 11.3).The study hypothesis was thus rejected. 
Hypothesis 2: Perceived social support will moderate the relationship between adversities 
and mental health of orphans. 
A correlational analysis was used for the prediction of values which will be appointed in 
hierarchical multiple moderated regression analysis. See Table 2A 
TABLE 2A: Inter-correlation between study variables (n= 321) 
Variables 1 (PSS) 2(MH) 3 (CAT) 4 (SEX) M SD 
PSS -.136 -.492** .164 66.011.1 
1. MH .423** .131 58.8 
11.2 
2. CAT .116 30.0 
20.5 
3. Sex 
1.6 2.1 
KEY: 
PSS= Perceived Social Support; MH= Mental Health; CAT= Child Abuse and Trauma. 
The results in Table 3A above revealed that mental health (r= -.136) showed a non-significant 
relationship with perceived social support. This means, being a high or low scorer on mental 
health does not decrease perceived social support. Additionally, the results showed that there 
was a significantnegative relationship between child abuse and trauma (r= -.492, p= .01),and 
perceived social support. This means, as child abuse and trauma increase, perceived social 
Page I 38 
support decreases. However, sex (r= .164), showed a non-significant relationship with 
perceived social support. This means being male or female does not decrease or increase 
perceived social support. 
The results also indicated that there was a significant positive relationship between child 
abuse and trauma (r= .423, p= .01); and mental health. This means as child abuse increases, 
mental health also increases. Additionally,sex (r= . 131) showed no significant relationship 
with mental health, meaning being male or female does not decrease or increase mental 
health. Furthermore, the results indicated that sex (r= .116) showed no significant relationship 
with child abuse and trauma. This means,being male or female does not decrease or increase 
child abuse and trauma. 
Hypothesis two expected perceived social support to moderate the relationship between 
adversities and mental healthand hence, a correlational analysis was firstly conducted (Table 
2A), then a hierarchical multiple regression was carried out to test these hypotheses. The 
variables were entered step wise and the results generated three models. The results are 
presented below (Table 2B). 
Page I 39 
TABLE 2B: Moderated Hierarchical Multiple Regression 
Models R Adj liF B Std. Err Beta t 
Modell .446 .199 .178 .178 8.26* * 9.66** 
Adversities .255 .052 .47 4.92** 
Model2 .431 .185 .172 .185 13.43** 9.43** 
Social Support .096 .096 .10 .99** 
Model 3.468 .219 .191 .009 7.697** 2.737** 
Adversities x Social Support -.005 .004 -.56 -1.38* 
In the first step, mental health was regressed on adversities. In the second step, mental health 
was regressed on perceived social support. The last step was the product of adversities and 
perceived social support (i.e., the interaction term) was entered. The standardized regression 
coefficient for the interaction term was statistically significant, ~ = -0.56, p< 0.05 . The 
change in R2 was also statistically significant, R2 = 0.09, DF(l, 320) = 7.697, p< 0.001 , 
indicating that, after controlling for adversities and perceived social support, the interaction 
term explained about 1%  of unique variance in mental health. This means that perceived 
social support significantly moderated the relationship between adversities and mental health 
of HIV/A IDS- related orphans. Thus, hypothesis 2 was accepted. 
Page 140 
Hypothesis 3: Female orphans will report high adversities and therefore, report higher on 
mental health than male orphans. 
TABLE 3: Gender differences on adversities (child abuse and trauma) and mental 
health of orphans. 
Variables Male Orphans Female Orphans [yBJ3fAl~-lY  
(N=66) (N=SS) 
X-bar SD X-bar SD t df p 
Child Abuse and Trauma 27.8 19.2 32.6 21.8 -1.275 119 ns 
Mental Health 57.5 9.2 60.4 13.1 -1.445 119 ns 
The results did not reveal a significant statistical difference between male and female 
HIV/AIDS orphans on adversities (t = -1.275; df = 119; p = n.s), and mental health(t = -
1.445; df = 119; p = n.s). However, looking into the descriptive statistics, HIV/AIDS female 
orphans scored higher on adversities ( X = 32.6, SD = 21.8), than HIV/AIDS male orphans 
who scored lower on adversities ( X = 27.8, SD= 19.2). On mental health, HIV/AIDS female 
orphans scored higher on mental health ( X = 60.4, SD= 13.1), than HIV/AIDS male orphans 
who scored lower on mental health ( X = 57.5, SD = 9.2). Hypothesis 3 was thus rejected. 
Page I 41 
Discussion of results 
Hypothesis one: Differences between orphans and non- orphanson adversities, mental health, 
and perceived social support 
The study did not find any difference between orphans and non-orphans on adversities, 
mental health and perceived social support as hypothesized. Even though the current research 
results did not reach an acceptable level of statistical significance, the descriptive statistics 
indicated that orphans reported low on adversities, but they reported high levels of poor 
mental health and perceived social support compared to non-orphans.Orphans reported low 
level of adversities compared to non- orphans. This finding is in line with previous research 
(Nichols et al., 2014), which revealed that orphans were 4% less likely to experience physical 
abuse comparedto non- orphans. 
Orphans also reported high mental health compared to non-orphans. This is in line with Chi 
et al., (2013), who revealed that orphans have high levels of poor mental health compared to 
non- orphans. The findingsindicated that orphaned children often have negative 
psychological and physical outcomes.As in the current study, HIV/A IDS orphans reported 
high levels of mental health compared to non- orphans. But because HIV/AIDS orphans 
reported low on adversities, it was expected that they would report low levels of poor mental 
health as it is commonly known that less adversities suggests low risk for poor mental health. 
The reason that might best explain why orphans reported high levels of poor mental health 
could be because they are vulnerable in nature and as such are susceptible to poor mental 
health. 
Moreover, HIV/AIDS orphans reported high on perceived social support. This finding is in 
line with the work of Hong et al. , (2010), who reported that orphans scored higher perceived 
social support than orphans. In the current study, the results could be clarified by the fact that 
Page I 42 
more orphans reported that they live with their brothers, sisters, uncles and aunts. This is 
consistent with the work of Avabratha, Kodavanji and Vaid(2011), which revealed that 
extended families serve as an important source of care and support for AIDS orphans. 
Hypothesis two: The moderating role of perceived social support in the relationship between 
adversities and mental health problems. 
The second hypothesis which stated that perceived social support will moderate the 
relationship between adversities and mental health of HIV/A IDS related orphaned 
adolescents was accepted. This means that perceived social support buffers the relationship 
between adversities and mental health of HIV/AIDS- related orphans. The findings of this 
study are similar to those of Casale (2011), and Ndlovu, Jon and Carvalhal (2010), which 
revealed that social support helps families cope with financial and emotional challenges 
related to HIV/A IDS and other stressors. This finding is also consistent with the work of 
Adamson and Roby (2011), which indicated that perceived social support is positively 
associated with the psychological well-being of AIDS orphans. 
Cobb (1976) suggested that social support indirectly strengthens a sense of well-being by 
lessening the effects of stress and enhancing coping skills.The link between social support 
and mental healthis well establishedin existing research. For example, Cluver, Fincham and 
Seedat (2009), reported that perceived social support was associated with fewer symptoms of 
post-traumatic stress disorder among AIDS-orphaned children and adolescents.Lack of social 
support and lower perceived social support have been linked to symptoms of depression. 
Desilva et al., (2012), indicated that perceived social support was a protective factor, as it was 
associated with lower odds of anxiety and depression symptoms, oppositional behaviour, and 
greater self-esteem and resilience. 
( 
Page I 43 
Even though orphans reported high on perceived social support, they still reported 
poormental health as compared to non-orphans. This could be related to the work of Cluver et 
al. , (2009), suggesting that orphans may have distorted thoughts of themselves and others, 
which of itself may lead to reduced perceptions of social support and high mental health. 
Differential-susceptibility theory (Zuckerman, 1999) can also account for these findings.The 
theory argues that some individualsare more susceptible than others to adverse effects of 
negative experiences due to their biological makeup, while others are simply not impacted by 
adversities.Therefore, the reason orphans may have reported higher on poor mental health 
despite reporting high on perceived social support could be because they are biologically 
susceptible to poor psychological well- being. 
Hypothesis three: gender differences on mental health problem, and adversities between male 
and female orphans 
The third hypothesis stated that female orphans will report a high level of adversities and 
mental health compared to male orphans. The findings suggest that HIV/A IDS orphans, 
despite their gender, are on equally comparable levels of mental health, and adversities (i.e., 
trauma and child abuse) . This may be because they have both lost their parents and are 
exposed to the same situation. As highlighted in the work ofNabunya and Ssewamala (2014), 
in the household, both boys and girls experience increased responsibilities. Contrarily, 
Francis-Chizororo (2010), argues that girls are more disadvantaged because they are usually 
the first in the household to drop out of school, care for younger siblings and take on many 
adult tasks. 
Although the findings were not in the predicted direction, nevertheless, there were some 
differences on the measures. Child abuse was reported high among female adolescents as 
compared to male adolescents. This is in line with thefindings from a study conducted by 
Page 144 
Okello et al., (2014), which showed that, female HIV/AIDS orphans reported high levels of 
adversities and poor mental health when compared to male orphans. Zapata et al., (2013), 
also reported that physical and sexual abuse are more prevalent in girl orphans compared to 
boy orphans. This supports the findings which indicated that female orphans reported high 
levels of adversities compared to male orphans. Moreover, the study revealed that female 
HIV/AIDS orphans reported high levels of poor mental health compared to male 
orphans.This finding is consistent with the work of Okawa, Yasuoka, Ishikawa, Poudel, Ragi 
and Jimba (2011) who reported that female orphans reported high levels of perceived social 
support compared to boy orphans. In the current study, the results could be clarified by the 
fact that more participants reported that they have more grandmothers and aunts than 
grandfathers and uncles. It is thus presumed that a girl child could easily relate to 
grandmothers and aunts and therefore receive more support compared to a boy child. 
Page I 45 
Conclusion 
It can be concluded that perceived social support operated as a moderating factor in the 
relationship between adversities and mental health of orphaned adolescents. However, in the 
context of Mafikeng,there is no difference in the above mentioned variables; neither does 
gender play a role. This means that both males and females suffer the same level of mental 
health effects, following adverse situations. And that non-orphans and orphans are not doing 
differently according to adversities and mental health status. 
Implication of findings 
The findings of this study indicate that there is no significant difference between orphans and 
non-orphans on adversities, mental health and social support. The findings also indicate that 
there are no gender differences among HIV/AIDS orphans on adversities and mental health. 
Furthermore, the results indicated that perceived social support moderated the relationship 
between adversities and mental health. Therefore, professionals involved in working with 
HIV/AIDS orphans need to use this information when treating them, so as to develop relevant 
strategies that generate social support for them. The results suggest that interventions aimed 
at helping HIV/A IDS orphans and other children, need to consider that adversities are 
experienced by all children and that poor mental would be the result. The interventions also 
need not be gender specific. Such interventions should include strengthening social support, 
minimising adversities and mental health problems. 
Page I 46 
Limitations 
This study had its own limitations: 
• The length of the questionnaire, which might have 
influenced the high scores or low scores on the measures as the participants seemed 
tired. 
• The study focused on orphanage centres m the 
Mafikeng area and therefore, the study cannot be generalized to other regions. 
• Participants were predominantly male and this affected 
the generalizability of the study's results to the general population regarding gender. 
• The data used was collected from orphans only and 
they could have over reported or under reported on the measures. The study would 
have benefited from additional data from the caregivers. Future research could ensure 
that data be collected from both orphans and their caregivers. 
• Another limitation was that some of the orphans were 
not present at the orphanage centres during the days of data collection, therefore some 
questionnaires were unanswered, reducing the desired population size. 
Page I 47 
Recommendations 
Following the findings discussed above, the following recommendations are made: 
• Results have indicated the importance for perceived social support, thus suggesting 
that not only should AIDS orphans be provided with tools for survival, but for 
orphans and other children as well, to help them pass through the early developmental 
stages more easily. 
• Psychologists, social workers, teachers and other professionals who work closely with 
AIDS orphans and other vulnerable populations, should strengthen social support to 
minimize the risks of these children developing mental health problems in adulthood. 
• Future research may focus on this similar topic following the transition of these 
orphaned adolescents to their young adulthood phase, exploring more on their 
resilience, with data collected from both orphans and theircaregivers. In that case, it 
will be helpful to track how they tum out as adults and if the effects of social support 
were evident. 
Page I 48 
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Page 164 
Appendices 
Appendix 1: Demographic attributes 
1. Sex: Male 
Female 
2. Age: 
3. Place of birth: Urban 
Rural 
4. Race: Black 
White 
Colored/Mixed race 
Indian/A sian 
5. Level of School 
6. Who are the people who live in your household for the better part of the year? 
Please mark all the individuals who live in your household for the better part of the 
year. 
Biological father 
Biological Mother 
Step-father 
Step-mother 
Brothers 
Sisters 
Paternal grandfather 
Maternal grandfather 
Paternal grandmother 
Maternal grandmother 
Uncles 
Aunts 
Lodgers 
Other (specify) 
7. In what type of place do you stay? 
8. How many people stay in the household? 
Page I 65 
Appendix 2: Childhood Traumatic Events Scale 
For the following questions, answer each item that is relevant. Be as honest as you can. 
Each question refers to any event that you may have experienced. 
Write "l" if it wasNot at all 
Write "4" if it wasNeutral 
Write "7" if it was Extreme 
1. Did you experience a death of a very close friend or family member? ____  
If yes, how old were you? ____  
If yes, how traumatic was this? ____  
If yes, how much did you confide in others about this traumatic experience at the time? 
2. Prior to the age of 17, was there a major upheaval between your parents (such as divorce, 
separation)?_ ___  
If yes, how old were you?_ ___  
If yes, how traumatic was this?_ __  
If yes, how much did you confide in others? ___  
3. Prior to the age of 17, did you have a traumatic sexual experience (raped, molested, 
etc.)? ___  
If yes, how old were you? ___  
If yes, how traumatic was this? ___  
If yes, how much did you confide in others? ___  
4. Prior to the age of 17, were you the victim of violence (child abuse, mugged or assaulted, 
any other thing, other than sexual)? ___  
If yes, how old were you? ___  
If yes, how traumatic was this? ---
If yes, how much did you confide in others? ___  
5. Prior to the age of 17, were you extremely ill or injured? ___  
If yes, how old were you?_ ___  
Page I 66 
If yes, how traumatic was this? ___  
If yes, how much did you confide in others? _ _ _ 
6. Prior to the age of 17, did you experience any other major upheaval that you think may 
have shaped your life or personality significantly? ___  
If yes, how old were you?_ _ _ 
If yes, what was the event? ________________________ _ 
If yes, how traumatic was this? ___  
If yes, how much did you confide in others? ___  
Page I 67 
Appendix 3: General Health Questionnaire (GHQ28) 
We would like to know if you have had any medical complaints and how your health has 
been in general, over the last few weeks. Please answer ALL the questions by writing the 
answer which best applies to you in the open space. Remember that we want to know about 
PRESENT and RECENT complaints, not those that you have had in the past. 
It is important that you try to answer ALL the questions. 
1. Better than usual 
2. Same as usual 
3. Worse than usual 
4. Much worse than usual 
1. Have you been feeling well and in good health? 
2. Have you been feeling in need of a good energizer? 
3. Have you been feeling run down and out of sorts? 
4. Have you been feeling that you are ill? 
5. Have you been getting pains in your head? 
6. Have you been getting a feeling of tightness or pressure in the head? 
7. Have you been having hot or cold spells? 
8. Have you lost much sleep over worry? 
9. Have you been having difficulty staying asleep once you are in bed? 
10. Have you been feeling constantly under strain? 
11. Have you been feeling edgy and short-tempered? 
12. Have you been getting scared and panicky for no good reason? 
13. Have you been finding everything getting on top of you? 
14. Have you been feeling nervous and strung-up all the time? 
Page I 68 
15. Have you been managing to keep yourself busy and occupied? 
16. Have you been taking longer to finish things you do? 
17. Have you been feeling that overall, you were doing things well? 
18. Have you been satisfied with the way you carry out a task? 
19. Have you been feeling that you are playing a useful part/role in things? _____  
20. Have you been feeling capable of making decisions about things? 
21. Have you been able to enjoy your normal day-to-day activities? _____  
22. Have you been thinking of yourself as a worthless person? 
23. Have you been feeling that life is entirely hopeless? 
24. Have you been feeling that life is not worth living? 
25. Have you thought of the possibility that you might make away with yourself? 
26. Have you been finding that at times you could not do anything because your nerves were 
so bad? 
27. Have you been finding yourself wishing you were dead and away from it all? ----
28. Have you been finding that the idea of taking your own life kept coming into your mind? 
Page I 69 
Appendix 4: Multidimensional Scale of Perceived Social Support 
We are interested in how you feel about the following statements. Read each statement 
carefully. Indicate how you feel about each statement. 
Circle the "1" if you Very Strongly Disagree 
Circle the "2" if you Strongly Disagree 
Circle the "3" if you Mildly Disagree 
Circle the "4" if you are Neutral 
Circle the "5" if you Mildly Agree 
Circle the "6" if you Strongly Agree 
Circle the "7" if you Very Strongly Agree 
1. There is a special person who is around when I am in need. 1234567 
2. There is a special person with whom I can share joys and sorrows. 1234567 
3.My family really tries to help me. 1234567 
4.I get the emotional help & support I need from my family. 1234567 
5. I have a special person who is a real source of comfort to me. 1234567 
6. My friends really try to help me. 1234567 
7. I can count on my friends when things go wrong. 1234567 
8. I can talk about my problems with my family. 1234567 
9. I have friends with whom I can share my joys and sorrows. 1234567 
10. There is a special person in my life who cares about my feelings. 1234567 
11. My family is willing to help me make decisions. 1234567 
12. I can talk about my problems with my friends. 1234567 
Page 11 
ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERCEIVED SOCIAL SUPPORT 
PALESA MORUBANE (18047130) 
2015 
Page 12 
ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERCEIVED SOCIAL SUPPORT 
PALESA MORUBANE 
18047130 
Mini-dissertation (article format) submitted in partial fulfilment of the requirements for the 
degree in Masters of Social Sciences in Clinical Psychology of the North West University 
(Mafikeng Campus) 
Supervisor: Prof E. S.Idemudia 
Co-Supervisor: Dr M. P. Maepa 
Page \3 
TABLE OF CONTENTS 
Dedication 4 
Acknowledgement 5 
Preface 6 
Letter of consent 7 
Instructions to authors 8 
Manuscript 12 
Abstract 13 
Introduction 14 
Theoretical background 18 
Literature review 23 
Hypotheses 29 
Methodology 30 
Results and Tables 36 
Discussion 41 
Conclusion 44 
Implications 45 
Limitations 45 
Recommendations 46 
References 47 
Appendices 63 
Page 14 
DEDICATION 
This study is dedicated to my family, especially my mother, Motlalepula Morubane, 
Whose unfaltering love, encouragement, sacrifices and support over many years has always 
been a great inspiration 
Page \5 
ACKNOWLEDGEMENTS 
I will like to give a huge gratitude to many people who have influenced and contributed to the 
completion of this thesis: 
• First and foremost, I would like to thank the Almighty God, who is the source of life 
and strength of knowledge and wisdom. I thank Him for His unconditional love, 
mercy and unmerited favour that He has shown me through the process of this study 
and for giving me patience, endurance and strength to complete this study. 
• Prof E.S. Idemudia, I thank you for teaching me the fundamentals of research, the 
knowledge you instilled in me is invaluable. I appreciate and value your patience, 
kindness support, guidance and a willing heart to teach. Without your support this 
would not have been possible. May God grant you more wisdom and grow you in all 
spheres of your life. 
• Dr M.P. Maepa, I thank you for helping me give birth to this study and helping me 
nurture it till its completion. I appreciate and value your firm hand that constantly 
pushed me to work harder, thank you. Without your support this would not have been 
possible. May God grant you more wisdom and grow you in all spheres of your life. 
• Dr Oluyinka, Ojedokun, I thank you for your patience and endurance while assisting 
with the statistical analysis, you were always ready to help and explain further. May 
God bless you for that. 
• I am grateful for my family, especially Motlalepule, Katlego and Boitumelo 
Morubane; I thank God for you. I truly value your tremendous support and words of 
encouragement, may the Almighty God richly bless you. 
• To all my friends and acquaintances, Golekane Pule, Benjamin Morena, Wily 
Seerane, Keatlaretse Moamogwe, Masego Maobi, Fisiwe Tshabangu, Goitseona 
Mathibe, and Matshidiso Modisaotsile; your words kept me going. 
• A special thanks to all the staff members of the Department of Psychology (Ipelegeng 
Centre) who contributed to the completion of this study, DrMhlongo, Miss N. 
Mokgosi, Miss P. Kolobe, Mrs N. Matamela, Dr P. Erasmus, Miss M. Erasmus, and 
Miss N. Mogotsi. 
• A heartfelt appreciation to all the institutions that participated in the study, 
Department of Education, High School principals and learners, orphanage centres and 
the children, without your voluntary participation and assistance, this thesis would not 
have been possible. 
• To the following funders: NSF AS, NWU post graduate bursary I am truly grateful for 
assisting me financially to complete this study. 
Page 16 
PREFACE 
Article format 
For the purpose of this dissertation, as part of the requirements for a professional master's 
degree, the article format, as described by General Regulation A.7.5.1.b of the North West 
University, was chosen. 
Selected Journal 
The targeted journal for submission of the current manuscript is Journal of AIDS Care. For 
the purpose of examination, Tables are included in the text. 
Letter of consent 
The letter of consent from the co-authors, in which they grant permission that the manuscript 
"ADVERSITIES AND MENTAL HEALTH OF HIV/AIDS INDUCED ORPHANS IN 
MAFIKENG: THE MODERATING ROLE OF PERCEVED SOCIAL SUPPORT", may be 
submitted for purposes of the thesis, is attached. 
Page numbering 
In this thesis, page numbering is from the first page to the last. For submission to the above 
mentioned journal, the manuscript is numbered according to the requirements of the South 
African Journal of Psychology. Hence, all pages are numbered consecutively. Thus, the 
numbering starts on the title page of the manuscript. 
Referencing 
In this dissertation, referencing is done according to the instructions of the South African 
Journal of Psychology