Caregiver Mental Health and Child Physical Health in HIV-Affected Families in Uganda
Murray, Sarah McIvor
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Background. Increasing evidence from low- and middle-income countries indicates that maternal depression is associated with poor child health and growth. Few studies have explored this relationship in the context of HIV. This dissertation investigated the relationship between caregiver mental health and child physical health among women and their HIV-infected children in rural Uganda. Specifically, we examined the longitudinal impact of caregiver depression and anxiety on child growth and potential reciprocal impacts of child growth on caregiver mental health. Caregivers’ own understandings of this relationship were also explored qualitatively. Methods. Data was collected over two years from 60 caregiver-child dyads randomized to the treatment as usual control arm (a general health training program) in a trial of a parenting intervention. Caregiver mental health was assessed using the 25-item Hopkins Symptom Checklist (HSCL-25), which includes separate scales for depression and anxiety. Child growth was operationalized as height for age (HAZ) and weight for age (WAZ) z-scores. Quantitative data were analyzed using mixed-effects regression and structural equation modeling. Qualitative data were collected from a purposive subsample of caregivers (n=9) and their health trainers (n=4) in 20 semi-structured interviews. Thematic analysis generated a conceptual framework of the relationship between caregiver mental health and child well-being. Results. In mixed-effects regressions, worsening caregiver depression and anxiety resulted in minimal and non-significant changes in child HAZ (β =-0.01, 95% CI: -0.27, 0.25) and WAZ (β =0.13, 95% CI: -0.17, 0.43). Compared to episodic or consistently low symptoms, chronic symptoms exhibited a non-significant dose response relationship with poorer child growth. In cross-lagged panel analyses, caregiver distress predicted lower WAZ (12-months: β=-0.142, p-value=0.011; 24-months: β=-0.171, p-value=0.010) but not HAZ. Child growth (HAZ: β=-0.275, p-value=0.004; WAZ: β=-0.275, p- value=0.008) predicted caregiver distress at 24-months. From the qualitative study, caregivers described their mental health as primarily affecting children emotionally and behaviorally. They also discussed how being unable to provide or care for their children brought them distress, particularly when children were sick. Conclusions. A potentially bidirectional relationship between caregiver mental health and child growth indicates a need to provide multifaceted and integrated mental and physical health services to HIV-affected families.