Testing the vulnerability and scar model of the relationship between self-concept, social support and anxiety symptoms among children of HIV-infected parents in China: A 3-year longitudinal study

Phoenix K.H. MO, Meiqi XIN, Joseph T.F. LAU

Research output: Journal article publicationJournal articleAcademic researchpeer-review


Background: Mental illness is a great concern among children of HIV-infected parents (COHIP), who are at their crucial stage of psychosocial development. It has been shown that self-concept (SC) and social support (SS) are important correlates of anxiety symptoms (AS), however, nature of the causality remained unclear. Methods: A 3-year longitudinal study was conducted in rural Central China, where many people were infected with HIV through unhygienic blood donation. A total of 195 COHIP (mean age: 12.6 years, 49.2% male) completed the baseline assessment and were followed for three years. Cross-lagged structural equation modeling analyses were used to test competing theoretical models: vulnerability model (low SC/SS contributes to AS), scar model (AS erodes SC/SS) and reciprocity model (low SC/SS and AS predict each other). Results: At each wave, 104 (53.3%) and 67 (41.6%) participants presented with anxiety disorders respectively. Nested-model comparison supported the superiority of scar models wherein AS significantly predicted subsequent low SC (β=-0.24, p=0.013) and SS (β=-0.31, p= 0.033), controlling for synchronous and autoregressive effects of all measures. The most parsimonious multivariate model that included significant relations was finally identified with a good model fit. Limitations: Findings might be subject to reporting bias; and could not inform the temporal relationship between SC and SS. Conclusion: Prevalence of anxiety was high among Chinese COHIP. The present study provides empirical evidence for scarring effects of AS; thus, highlighted the importance of identifying and treating COHIP's anxiety to mitigate long-term negative impacts on their psychosocial development.

Original languageEnglish
Pages (from-to)441-450
Number of pages10
JournalJournal of Affective Disorders
Publication statusPublished - 1 Dec 2019
Externally publishedYes


  • Adolescence
  • Anxiety symptoms
  • HIV
  • Self-concept
  • Social support

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

Cite this