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Background:  By 2008, 12 million children in sub‐Saharan Africa were orphaned by AIDS. Cross‐sectional studies show psychological problems for AIDS‐orphaned children, but until now no longitudinal study has explored enduring psychological effects of AIDS‐orphanhood in the developing world.

Methods:  A 4‐year longitudinal follow‐up of AIDS‐orphaned children with control groups of other‐orphans and non‐orphans. 1021 children (M = 13.4 years, 50% female, 98% isiXhosa‐speaking) were interviewed in 2005 and followed up in 2009 with 71% retention (49% female, M = 16.9 years), in poor urban South African settlements. Children were interviewed using sociodemographic questionnaires and well‐validated standardised scales for assessing depression, anxiety, and post‐traumatic stress. Data were analysed using mixed‐design ANOVA and backward‐stepping regression.

Results:  AIDS …