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Abstract:
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Background: HIV affects the entire family. Depressive symptoms in the caregiver can place the child at risk for neurodevelopmental delays. Conversely, the relationship between caregiver depression symptoms and child neurodevelopment and behavior could be bi-directional due to the negative impact of the child’s behavior on family functioning and perceived parental competence of the caregiver, leading to an increase in caregiver depressive symptoms. Limited research has focused on these influences in Sub-Saharan countries, where pediatric HIV concentrates and impacts child’s neurodevelopment and caregiver’s mental health. Statistical methodology of longitudinal dyadic interdependence analyses has had limited applications in international health research.
Purpose: The primary aim of this investigation was to test a model of dyadic interdependence in depression symptoms experienced by female caregivers living with HIV in Uganda and behavioral problems of their HIV-infected and perinatally HIV-exposed uninfected (HEU) children to determine if each influences the other. Methods: The sample for this secondary analysis included 288 women who participated in a randomized controlled trial assessing a year-long parenting intervention. Children were between ages 2-5 at enrollment, 196 children were HIV-exposed uninfected, and 92 HIV- uninfected, 148 boys, 140 girls. Children were evaluated at intake, 6, 12, and 24 months with the Behavior Rating Inventory of Executive Functioning (BRIEF-parent reported behavioral assessment) and the Mullen Scales of Early Learning. Caregiver depression was assessed at the same time points using the Hopkins Symptom Checklist. Longitudinal analyses of dyadic data were performed in accordance with the actor-partner interdependence model implemented using linear mixed modeling with first order heterogeneous autoregressive covariance structure. Actor and partner effects were specified as time-varying lagged effects (e.g., Tn predicting Tn+1).Three repeated measures of caregiver and child outcomes at 6, 12, and 24 months were related to their own outcomes at a previous time point to model actor affects, and the outcomes of the other member of the dyad to model partner effect. Between-dyad variables included socio-economic status, child HIV status, and intervention arm.
Results: In the analysis of caregiver depression and BRIEF, actor effects were significant: caregiver depression at Tn predicted caregiver depression at Tn+1 (coefficient = 0.62 , SE = 0.03, p < .001); child behavioral problems at Tn predicted child behavioral problems at Tn+1 (coefficient = 0.68 , SE = 0.03 , p < .001). In addition, caregiver depression and child behavioral problem were interdependent over the 24 months of observation. Over and above actor effects, both partner effects were significant. Caregiver depression at Tn predicted child’s behavioral problems at Tn+1 (coefficient = 0.1220, SE = 0.0313, p < .01); child behavioral problems at Tn predicted maternal depression at Tn+1 (coefficient = 0.0984 , SE = 0.0253, p < .01). In the analysis of caregiver depression and child MSEL, both actor effects were significant: caregiver depression at Tn predicted caregiver depression at Tn+1 (coefficient = 0.80 , SE = 0.03, p < .001); child MSEL composite at Tn predicted child MSEL composite at Tn+1 (coefficient = 0.72, SE = 0.03 , p < .001). None of the partner effects were significant.
Conclusions: These findings are consistent with emotional contagion processes and point to the potential importance of caregiver psychological well-being to the welfare of children affected by HIV. The impact of maternal depression symptoms on child executive behavior over and above other factors suggests the importance of developing and funding services to address behavioral needs of affected children and mental health of their mothers.
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