Where is the evidence base? Mental health issues surrounding bereavement and HIV in children

Parental illness can affect child and adolescent psychosocial well‐being. Mental health effects of parental bereavement generally and HIV‐related bereavement specifically have been poorly explored in children. HIV‐related illness has a number of specific features that may directly affect mental health considerations. Infection is clustered in families. Bereavement is often multiple. Death is often preceded by severe illness and multiple opportunistic infections. AIDS is stigmatised, which may impede disclosure, social support and adjustment. In low‐income countries where HIV infection is concentrated, access to palliative care as well as medical care may be limited. This review systematically identifies studies on HIV and bereavement in children. Searches of electronic databases for relevant articles revealed 14 studies examining bereavement with sufficient measurement and controlled methodology providing standardised behavioural and emotional outcome measures. Scrutiny of the results revealed the majority (12: 86%) recorded an adverse behavioural or emotional impact on the child. A detailed analysis of the studies provides insights to risks as well as protective factors that may inform future interventions. Only one systematic intervention was identified whereby a coping skills intervention had positive and long‐lasting effects. This paper examines urgent future needs and the requirement for evidence‐based policy and provision.