Running head : Parental bereavement in young children and resilience 1 Parental Bereavement in Young Children Living in South Africa and Malawi : Understanding 2 Mental Health Resilience 3 Target journals : JAIDS 4 5

39 Background: Parental loss is a major stressful event found to i ncrease risk of mental health 40 problems in childhood. Yet, some children show resi lient adaptation in the face of adversity 41 across time. 42 Setting: This study explores predictors of mental health res ilience among parentally bereaved 43 children in South Africa and Malawi, and their cumu lative effect. The study also explores 44 whether predictors of resilience differed between o rphaned and non-orphaned children. 45 Methods: Consecutive attenders of community based organisati ons (children;4-13 years, and 46 their caregivers) were interviewed at baseline and 15-18 month follow up (n=833). Interviews 47 comprised of inventories on demographic information , family data, child mental health, 48 AC CE PT ED Copyright 2018 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. 3 bereavement experience and community characteristic s. Mental health screens were used to 49 operationalise resilience as the absence of symptom s of depression, suicidality, trauma, 50 emotional and behavioural problems. 51 Results: Almost 60% of children experienced parental loss. O ne quarter of orphaned children 52 showed no mental health problems at either wave and were classified as resilient. There were 53 equal proportions of children classified as resilie nt within the orphaned (25%) vs. non54 orphaned group (22%). Being a quick learner, aidin g ill family members, positive 55 caregiving, household employment, higher community support, and lower exposure to 56 domestic violence, physical punishment, or stigma a t baseline predicted sustained resilience. 57 There were cumulative influences of resilience pred ictors among orphaned children. 58 Predictors of resilience did not vary by child age, nder, country of residence or between 59 orphaned and non-orphaned children. 60 Conclusion: This study enhances understanding of resilience in you ger children and 61 identifies a number of potential environmental and psychosocial factors for bolstering 62 resilience in orphaned children. 63 64