The data in the current study demonstrated excellent psychometric properties for TRQ among rural Chinese children. Given the collectivism cultural orientation of Chinese society, the attachment or trusting relationship with caregivers is an important contextual factor for the psychosocial development of Chinese children. The culturally adapted version of TRQ should provide researchers with a reliable and valid tool for the assessment of such a factor. The scale also seemed appropriate for children of a wide range of ages and family socioeconomic status, of different gender, and in different care or living situations (e.g., in institutional care, living with parents or other non-parent caregivers).
The current study revealed a higher trusting relationship scores among older children than younger children, which may be because of the better adaptability of these children. Likewise, the better adaptability may also contribute to the higher TRQ scores among girls than boys. In general, children affected by AIDS (AIDS orphans and vulnerable children) reported a lower trusting relationship with their current caregivers than comparison children. This may be because of the non-parental relationship, or short-duration of the relationship, or shadow of parental loss/illness among children affected by AIDS. The lower TRQ scores among orphans also may reflect difficulties establishing trust with a new caregiver after having had lost one or both parents.
Because the HIV epidemic in the study area was caused by the poverty-driven blood sale, most the families affected by HIV/AIDS had a lower socioeconomic status. However, the trusting relationship showed a different pattern with family SES from that with orphan status. In general, children from lower SES families reported a higher level of trusting relationship than children from higher SES families. Most of these families with lower SES were families with parents engaging in farming activities and these parents might stay home more often than parents in other occupation groups (e.g., migrants). Therefore, children in these families might have more interaction with their parents and consequently felt closer to their parents. Future study is needed to understand the determinants of the TRA scores.
The TRQ scores showed a stronger association with externalizing behaviors and future orientation than with internalizing symptoms such as anxiety and depression which were highly associated with AIDS orphan status (Fang et al., 2009
; Lin et al., 2010
). Future study is needed to explore the possible reasons for the lack of association between trusting relationship and internalizing symptoms among rural Chinese children, especially those children affected by AIDS. Apparently, the establishment of a new trusting relationship is not enough to overcome the hardships of losing a parent to HIV/AIDS as orphan status continued to predict negative outcomes for children over and above the effects of a current trusting relationship. The current data do suggest a potential mediation effect of trusting relationship on the effects of family HIV/AIDS on children's rule compliance and future orientation. The relationships between family HIV/AIDS and rule compliance and future orientation were significant in prior work (Lin et al., 2010
) but were not significant when trusting relationship was included in the multivariate analysis.
One of the most important findings in the current study was that the association between trusting relationship and psychosocial adjustment was independent of children's family HIV/AIDS experience (parental loss, parental illness, or HIV-free), gender, age, and family SES. This finding suggests a robust and global role of trusting relationship in children's psychosocial adjustment. This finding highlights the importance of the subsequent caregiving relationship after the death of a parent in understanding children's adaptation to losing their parent. Moreover, this finding has a strong intervention implication. While the programs aiming to improve child-caregiver attachment relationship have to be culturally and developmentally appropriate, a positive attachment relationship or trusting relationship with caregivers could benefit children from different family backgrounds, in various living situations, across different developmental stages, and facing different challenges in their lives.
The current study has several potential limitations. First, the sample in the current study might not be representative of children affected by AIDS in other areas of China. While efforts were taken to ensure the representativeness of the sample, our sample was recruited from two rural Chinese counties with a unique cause of HIV transmission (i.e., poverty-driven blood-selling) and dominantly Han ethnicity (99%). Second, some psychological scales in the current study had relatively low reliability estimates (e.g., Cronbach α <.70 for self-esteem, perceived control over future, and all four RCS subscales). Future research would be improved through inclusion of more reliable measurement scales.
Despite these potential limitations, to the best of our knowledge, this study is one of the first efforts to study the trusting relationship and its association with psychosocial adjustment among children affected by HIV/AIDS in China or other developing countries. The findings support the use of trusting relationship scale in Chinese cultural settings and with children affected by HIV/AIDS. The findings also underscore the important role of trusting relationship in the psychosocial adjustment among children affected by HIV/AIDS and call for culturally and developmentally appropriate efforts to help both children and caregivers to nurture a positive attachment relationship which can help mitigate the devastating effects of HIV/AIDS in their families and communities.