Caring and thriving: An international qualitative study of caregivers of orphaned and vulnerable children and strategies to sustain positive mental health


© 2018 Background: Child well-being is associated with caregiver mental health. Research has focused on the absence or presence of mental health problems, such as depression, in caregivers. However, positive mental health – defined as the presence of positive emotions, psychological functioning, and social functioning – likely prevents depression and in caregivers may benefit children more than the mere absence of mental health problems. Little attention has been given to how caregivers sustain positive mental health, particularly when doing challenging work in impoverished settings. Objective: The study's objective was to determine what successful caregivers of orphaned and vulnerable children (OVC) in diverse countries do to sustain their positive mental health. Methods: Using a mixed-methods, cross-sectional study design, trained local interviewers recruited a convenience sample of OVC caregivers through residential care institutions from five geographic regions (Kenya; Ethiopia; Cambodia; Hyderabad, India; and Nagaland, India). Participants completed surveys and in-depth interviews about strategies used to sustain their mental health over time or improve it during challenging times. Results: Sixty-nine OVC caregivers from 28 residential care institutions participated. Positive mental health survey scores were high. We organized the strategies named into six categories ordered from most to least frequently named: Religious Practices; Engaging in Caregiving; Social Support; Pleasurable Activities; Emotion Regulation; and Removing Oneself from Work. Prayer and reading religious texts arose as common strategies. Participants reported promoting positive emotions by focusing on their work's meaning and playing with children. The similar findings across diverse regions were striking. Some differences included more emphasis on emotion control in Ethiopia; listening to music/singing in Kenya and Hyderabad; and involving children in the tasks the participants enjoyed less (e.g., cleaning) in Cambodia. Conclusions: Under real-world conditions, small daily activities appeared to help sustain positive mental health. In addition, fostering structures that allow caregivers to engage regularly in rewarding caregiving tasks may be an affordable and scalable idea which could potentially benefit caregivers, children, and employers.





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Publication Info

Proeschold-Bell, RJ, NJ Molokwu, CLM Keyes, MM Sohail, DE Eagle, HE Parnell, WA Kinghorn, C Amanya, et al. (2019). Caring and thriving: An international qualitative study of caregivers of orphaned and vulnerable children and strategies to sustain positive mental health. Children and Youth Services Review, 98. pp. 143–153. 10.1016/j.childyouth.2018.12.024 Retrieved from

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Rae Jean Proeschold-Bell

Research Professor of Global Health

Rae Jean Proeschold-Bell is interested in the interplay between mental and physical well-being and has designed and tested interventions that integrate care for people with obesity and depression; HIV/AIDS and substance use; and hepatitis C and alcohol use.

Most recently, Rae Jean has been studying positive mental health as a way to prevent depression and promote caring for one's physical health. Her work currently focuses on caregivers, including clergy in North Carolina and caregivers of orphaned and vulnerable children in Kenya, Ethiopia, India, and Cambodia.

Soon, she will be testing four interventions to reduce stress symptoms.

As someone trained in both clinical and community psychology, Rae Jean is interested in the impact of systems and environmental contexts on individuals.


David E Eagle

Assistant Research Professor of Global Health

I am an Assistant Research Professor the Center for Health Policy and Inequalities Research and the Duke Global Health Institute. I am an expert on the health of religious clergy, the changing shape of churches in North American society, and the implications of these trends for the professional training of ministers.

More recently, my research has begun to branch out internationally. I am doing research on clergy in the Eastern Democratic Republic of the Congo, and studying the mental health of sexual and gender minorities around the world.

Methodologically, I am skilled in the collection and analysis of survey data, including longitudinal and social network data.


Warren A. Kinghorn

Associate Professor of Psychiatry and Behavioral Sciences

Medical Professionalism
Religion, Spirituality, and Psychiatry
Philosophy of Psychiatry

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