Trauma, anxiety and depression outcomes in caregivers of orphaned and separated children

The World Health Organization has declared mental health a critical focus area in global health. An estimated 4.5% of the global and Indian populations suffer from depression. Orphaned and separated children (OSCs) and their caregivers are both vulnerable populations and at risk for poor mental health-often due to potentially traumatic life histories. Caregiver and OSC mental health are inextricably linked, with caregiver mental health often influencing child mental health. Currently, India has over 25 million OSCs, and a variety of groups, including our community partner-Udayan Care-provide residential care for this population. In 2018, 33 residential caregivers-8 males and 25 females-were interviewed in Delhi, India. This study provides details on mental health outcomes for these caregivers using data collected from three psychometric measures: Beck Anxiety Inventory, the Center for Epidemiological Studies Depression Scale-Revised and the Trauma Symptoms Checklist-40. In addition, qualitative life history questionnaires were also administered to understand potentially traumatic events experienced by participants. Findings revealed that 6% of caregivers endured five potentially traumatic experiences (PTEs) in their lifetimes, 12% had experienced none, and 42% had experienced three, four or five PTEs. Although we originally expected to see the highest depression and anxiety scores among caregivers who had experienced three, four or five PTEs, there was much more variability in how mental health outcomes presented, with 50% of these caregivers showing no clinical screens for depression and reporting a range of anxiety levels-minimal, mild and severe. Results draw attention to the complicated life histories of residential caregivers such as intimate partner violence and extreme financial difficulty. Our findings also highlight the complex relationships that can exist between significant past trauma, depression and anxiety outcomes. Exploring the coping strategies as well as protective and risk factors for those experiencing adverse mental health outcomes will help us better understand the complex trajectories of mental health in vulnerable groups and create effective intervention methods to further support OSCs and their caregivers.