mental health AIDS

Spring 2007 Newsletter / Volume 8, Issue 3

HIV Assessment News

Parent-Child Assessment

Brackis-Cott, Mellins, Dolezal, and Spiegel (2007) conducted interviews with a convenience sample of 220 mother/child dyads living in lower-income, inner-city, primarily ethnic-minority neighborhoods, to assess symptoms of anxiety and depression. About half of the mothers were living with HIV, while all of the children (who were between the ages of 10 and 14 years) were uninfected.

Overall, mothers with HIV exhibited more depressive symptomatology than uninfected mothers. There were no significant differences, however, in depressive symptomatology between children of mothers who were HIV-positive and children of mothers who were HIV-negative. Among families directly affected by HIV, mothers who disclosed their status to their children endorsed greater depressive symptomatology than those who did not disclose and children who had been disclosed to were more likely to score in the clinically depressed range on the Child Depression Inventory than those who did not know. Latina mothers and their children were at increased risk for both depression and anxiety symptoms, particularly in families where the mother was not born in the United States. (p. 67)

Brackis-Cott and colleagues drew on these data in making a number of intervention recommendations:

Not surprisingly, mothers with HIV-infection exhibited relatively more depressive symptomatology than did mothers without HIV infection. ... [E]valuation for depression and other mental health problems should [therefore] become a routine part of ... care for HIV-infected women ... . Furthermore, for HIV-infected mothers, the stress of living with a chronic, stigmatized, often fatal disease is compounded by issues of disclosure and tremendous parenting responsibilities, including having a plan for their children's future care if the mother becomes too ill or dies. Mental health interventions to address ... permanency planning for children, as well as [a range of] clinical issues[,] are thus necessary.

Secondly, ... [the] finding that Latina women scored higher on depression and anxiety scales ... [suggests that c]linicians working with Latina women need to be bilingual and familiar with the dominant culture of the population they are treating. In addition to culturally sensitive psychotherapy, clinicians can encourage these women to access social support within their community and help them to preserve cultural values from their country of origin, as these may be protective against depression and anxiety symptomatology.

Last, service providers of HIV-affected families are increasingly recommending parental disclosure of HIV status to children ... . However, as indicated in ... [this] study as well as others, knowledge of maternal HIV status may be associated with increased symptoms of depression and anxiety. When or if disclosure is advocated, proper supports should be in place for both mothers and children. Disclosure of a family member's HIV status to a child is often misunderstood as a discrete event that can be accomplished in a single communication. Rather, disclosure is an ongoing process, and new information should be provided with any change in parental health status ... . Parents and other adult caregivers of the HIV-affected child should be counseled about the importance of developmentally appropriate communication regarding the parent's health, the child's need for the information, and his or her readiness to receive it ... . Adults should be counseled to provide children with realistic reassurance about the parent's health, and about their own future care and security. (pp. 84-85)

In another study assessing mothers living with HIV and their children, Murphy, Austin, and Greenwell (2006) examined both the degree and impact of HIV-related stigma among a convenience sample of 118 mothers living with HIV, as well as their early- and middle-adolescent children (averaging 13 years of age) who were not infected. Murphy and colleagues report that "[m]others who perceived greater HIV-related stigma also reported higher levels of depression, health-related anxiety, number of illness symptoms, and poorer functioning on medical outcomes (including physical health, bodily pain, fatigue, social functioning, and mental health). They also reported more alcohol use. The only scales for which mothers perceiving greater stigma did not differ from mothers perceiving lower levels of stigma were social support and family functioning" (p. 36). The investigators suggest that "[s]upport groups and interventions for HIV-infected women need to focus on normalizing HIV as a chronic disease, and on cognitive-behavioral strategies to deal with perceived stigma, stigma-related thoughts, and guilt towards stigma by association for their children" (p. 38). With regard to the adolescents studied, "[n]o significant differences were found in children's depression by perceived level of stigma; however, adolescents who perceived high levels of stigma because of their mothers' HIV status were more likely to participate in delinquent behavior, compared with those reporting low HIV-related stigma" (p. 20). "Adolescents perceiving higher levels of stigma were significantly more likely to exhibit externalizing behaviors, including bullying and physical violence" (p. 37). The investigators draw on earlier research and, in agreement with Brackis-Cott and colleagues, suggest that "[p]roviding ongoing support and information to the children of HIV-infected mothers may attenuate the stigma associated with HIV infection and thus decrease externalizing behavior problems" (p. 37).4

Sampling a younger cohort of children, New, Lee, and Elliott (2007) screened for emotional and behavioral health among 57 children (between the ages of 6 and 12 years) living with HIV, as well as their 54 primary caregivers. Among the 16 children who met screening criteria for behavioral or emotional health problems, 6 (38%) met criteria for a psychiatric diagnosis based on standardized interviews. Of the 15 caregivers who met screening criteria, all 13 who completed a computerized psychiatric interview met criteria for a psychiatric diagnosis. Importantly, while mental health needs were identified among these families living with HIV, a decided majority of these families did not exhibit psychiatric disorders. To New and colleagues, "[t]hese findings are surprising and contrary to what was expected and might suggest that children with HIV and their caregivers are remarkably resilient in the face of a multitude of challenges to their own and to their child's physical and mental health" (p. 128). Yet, "while the overall findings might suggest that there are lower than expected rates of emotional distress among this population, the fact that a proportion of these families do experience significant distress cannot be ignored. HIV is truly a family illness. Screening, ongoing support, and family-friendly, culturally sensitive mental health services should be an integral part of whole childcare for families living with HIV" (p. 129).

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