Behavior and psychological functioning of young children of HIV-positive mothers in South Africa

Adults with HIV are living longer due to earlier diagnosis and increased access to antiretroviral medications. Therefore, fewer young children are being orphaned and instead, are being cared for by parents who know they are HIV positive, although they may be asymptomatic. Presently, it is unclear whether the psychological functioning of these young children is likely to be affected or, alternatively, whether it is only when a mother is ill, that children suffer adverse effects. We, thus, aimed to compare the behavior and psychological functioning of young children (aged 6–10 years) of HIV-positive and HIV-negative mothers. We also aimed to examine the association between HIV status disclosure and child outcomes. This study uses cross-sectional data from the baseline assessment of a randomized controlled trial conducted in Tshwane, South Africa. Participants (n=509) and their children were recruited from area health clinics. Among the 395 mothers with HIV, 42% reported symptoms of HIV disease. Multivariate linear regression models suggested that after adjusting for socio-demographic characteristics, children of HIV-positive mothers had significantly greater externalizing behaviors than children of HIV-negative mothers. Importantly, children whose mothers were symptomatic had greater internalizing and externalizing behaviors compared with children of HIV-negative mothers, but this was not true for children of asymptomatic mothers. Additionally, among children of HIV-positive mothers, those who had been told their mothers were sick compared with children who had been told nothing had less internalizing and externalizing behaviors and improved daily living skills. This study, therefore, provides evidence that maternal HIV disease can affect the behaviors of young children in South Africa but, importantly, only when the mothers are symptomatic from their disease. Furthermore, results suggest that disclosure of maternal illness but not HIV status was associated with improved behavior and psychological functioning among young children.     

HIV risk behavior and internalizing/externalizing psychopathology among adolescents in court-ordered treatment

ABSTRACT

Background: The confluence of drug use behaviors, sexual risk, and psychopathology may complicate human immunodeficiency virus (HIV) prevention intervention for adolescents engaging in substance use and criminal behavior. However, few studies have examined these risk associations. Objective: This study identified HIV risk behavior subgroups among adolescents in court-ordered substance abuse treatment and examined linkages with dimensions of internalizing and externalizing psychopathology. Methods: Internalizing and externalizing behaviors were assessed with the Millon Adolescent Clinical Inventory (MACI). Latent class analysis was used to identify subgroups on the basis of involvement in substance use proximal to sex, number of partners, and consistency of condom use. Results: Participants (n = 301) were identified as demonstrating high, medium, or low levels of sexual risk behavior. Greater externalizing psychopathology distinguished the high risk class from the medium risk class and from the low risk class. Conclusion: Detained youth with particularly serious oppositional-defiant behavioral characteristics, substance use, and sex risk behavior likely require intensive interventions that address the multiple systemic factors that contribute to the development and maintenance of this pattern.     

Profiles of caregiving behaviors among children and adolescents with perinatally acquired HIV

Although parenting behaviors are widely considered an important factor in the adjustment of children and adolescents with chronic physical health needs, few studies have addressed this topic as it pertains to youth with perinatally-acquired human immunodeficiency virus (PHIV). We examined profiles of child-centeredness, control through guilt, consistent discipline, and detachment, and whether these profiles differed in terms of parent- and youth-reported psychiatric disorder symptoms in a cohort of HIV infected youth (N?=?314). Latent profile analyses of caregiving behaviors were conducted separately for children (6–12 years) and adolescents (13–18 years). Two profiles were identified among children: (a) moderate caregiving (87%, n?=?130) and (b) high detachment caregiving (13%, n?=?19), and three profiles were identified among adolescents: (a) moderate caregiving (55%, n?=?88), (b) high detachment caregiving (19%, n?=?30), and (c) high control through guilt caregiving (26%, n?=?42). The high detachment and high control through guilt caregiving profiles displayed higher levels of parent-and youth-reported symptoms than the moderate caregiving profile. These findings suggest that caregiver behaviors of PHIV youth vary as a function of children’s developmental period and differ in terms of youth psychological symptoms.     

Alcohol use,externalizing problems,and depressive symptoms among American Indian youth: The role of self-efficacy

Background: There is a need to understand resiliency factors which can be used to inform and design interventions to prevent externalizing problems, substance use, and depressive symptoms among American Indian (AI) youth. Objectives: The present study examined the role of self-efficacy in externalizing problems, alcohol use, and depressive symptoms among AI youth from the North American plains. Methods: Participants for this study included 146 (53 boys and 93 girls) adolescents, with an age range of 13–18 (M?=?14.5) years of age. Results: High self-efficacy for resisting negative peer influences predicted both lower rates of alcohol use and fewer externalizing behaviors. Furthermore, higher levels of both academic and social self-efficacy predicted fewer depressive symptoms. The hypothesis that academic self-efficacy would predict depressive symptoms was not supported. Conclusion: As expected, the best-fitting path model showed self-efficacy for resisting negative peer influences predicting both alcohol use and externalizing problems, and social self-efficacy (as well as being female) predicting depressive symptoms among AI youth. Therefore, this study supports the importance of self-efficacy beliefs for alcohol use and externalizing problems, as well as depressive symptoms, among AI youth.     

The influence of comorbid asthma on the severity of symptoms in children with attention-deficit hyperactivity disorder

Objective: The current study examined the association between asthma and attention-deficit hyperactivity disorder (ADHD) symptoms in a clinical pediatric sample. Methods: Demographic and neuropsychological data for children with a billing diagnosis of ADHD were extracted from a clinical database. Families completed standard rating scales. Seventy-one patients with a co-morbid asthma diagnosis were identified and matched by age to a group of 71 patients with only ADHD. Results: Children with asthma and ADHD were more likely to display clinically elevated levels of hyperactivity, externalizing behaviors, anxiety, and hyperactive/impulsive behaviors compared to children with ADHD alone. Boys with asthma and ADHD had more symptoms than boys with only ADHD of somatization and emotional internalizing, while girls with asthma and ADHD had more symptoms of hyperactivity/impulsivity, conduct problems, anxiety, and emotional internalizing compared to girls with only ADHD. Conclusions: Findings suggest that in children with ADHD, co-morbid asthma is associated with increased behavioral and internalizing symptoms, with distinct gender differences present. Increased behavioral and internalizing symptoms seen in children with both asthma and ADHD may be due to the burden of their medical condition. No difference was found on cognitive variables, suggesting chronic hypoxia may be less influential in explaining these differences. Future research should determine the specific mechanisms of these differences.     

Mindfulness instruction for HIV-infected youth: a randomized controlled trial

HIV-infected youth experience many stressors, including stress related to their illness, which can negatively impact their mental and physical health. Therefore, there is a significant need to identify potentially effective interventions to improve stress management, coping, and self-regulation. The object of the study was to assess the effect of a mindfulness-based stress reduction (MBSR) program compared to an active control group on psychological symptoms and HIV disease management in youth utilizing a randomized controlled trial. Seventy-two HIV-infected adolescents, ages 14–22 (mean age 18.71 years), were enrolled from two urban clinics and randomized to MBSR or an active control. Data were collected on mindfulness, stress, self-regulation, psychological symptoms, medication adherence, and cognitive flexibility at baseline, post-program, and 3-month follow-up. CD4+ T lymphocyte and HIV viral load (HIV VL) counts were also pulled from medical records. HIV-infected youth in the MBSR group reported higher levels of mindfulness (P?=?.03), problem-solving coping (P?=?.03), and life satisfaction (P?=?.047), and lower aggression (P?=?.002) than those in the control group at the 3-month follow-up. At post-program, MBSR participants had higher cognitive accuracy when faced with negative emotion stimuli (P?=?.02). Also, those in the MBSR study arm were more likely to have or maintain reductions in HIV VL at 3-month follow-up than those in the control group (P?=?.04). In our sample, MBSR instruction proved beneficial for important psychological and HIV-disease outcomes, even when compared with an active control condition. Lower HIV VL levels suggest improved HIV disease control, possibly due to higher levels of HIV medication adherence, which is of great significance in both HIV treatment and prevention. Additional research is needed to explore further the role of MBSR for improving the psychological and physical health of HIV-positive youth.     

Association between perceived HIV stigma,social support,resilience, self-esteem,and depressive symptoms among HIV-positive men who have sex with men (MSM) in Nanjing,China

Among Chinese HIV-positive men who have sex with men (MSM), high levels of depression are common. The association between HIV and depression is attributed to several factors, particularly HIV-related stigma. However, to date, how HIV-related stigma leads to depression among Chinese HIV-positive MSM is still unclear. As such, this study aims to examine the relationships between perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms among HIV-positive MSM in China. We conducted a cross-sectional survey study among 347 HIV-positive MSM from July to August 2016 in Nanjing, China. Measurements were sociodemographic and psychological constructs including perceived HIV stigma, social support, resilience, self-esteem, and depressive symptoms. Structural equation modeling (SEM) was used to examine the relationships among these constructs. Overall,134 (38.6%) participants had depressive symptoms. Perceived stigma was directly associated with depressive symptoms (β?=?.196, p?<?.001). Perceived stigma also indirectly affected depressive symptoms (β?=?.200, p?<?.001)through social support and self-esteem. Social support (β?=??.124, p?=?.004) and self-esteem (β?=??.536, p?=?.001), but not resilience, were direct predictors of depressive symptoms. Resilience was directly associated with self-esteem (β?=?.512, p?<?.001). Perceived HIV stigma could directly and indirectly impact depressive symptoms in HIV-positive MSM. Improving personal self-esteem, resilience and social support might reduce impact of perceived stigma on depressive symptoms among HIV-positive MSM in China.     

Psychological functioning among vertically infected HIV-positive children and their primary caregivers

The current study sought to explore the association between primary caregiver depressive symptoms and the psychological functioning in children vertically infected with human immunodeficiency virus (HIV) living in Eastern Cape, South Africa. A cross-sectional data were collected using the Beck Depression Inventory and Strength and Difficulties Questionnaire in a sample of 152 caregiver/child dyads. The results revealed that poorer psychological functioning in children was significantly associated with depressive symptoms in caregivers. This relationship existed whether or not the child was raised by a biological or non-biological caregiver as well as for both genders. Younger children's psychological functioning was more negatively influenced than that of older children raised by a caregiver with depressive symptoms. In the context of a large treatment gap for common mental disorders in South Africa, there is a need for interventions to address maternal mental health in families infected and affected by the HIV/AIDS pandemic as a mental health promotion strategy given that HIV-infected children are a particularly vulnerable population for poor mental and behavioural health outcomes.     

Individual and contextual factors of sexual risk behavior in youth perinatally infected with HIV

This study prospectively examines the effects of maternal and child HIV infection on youth penetrative and unprotected penetrative sex, as well as the role of internal contextual, external contextual, social and self-regulatory factors in influencing the sexual behaviors of HIV-infected (PHIV+), HIV-affected (uninfected with an HIV+ caregiver), and HIV unaffected (uninfected with an HIV- caregiver) youth over time. Data (N=420) were drawn from two longitudinal studies focused on the effects of pediatric or maternal HIV on youth (51% female; 39% PHIV+) and their caregivers (92% female; 46% HIV+). PHIV+ youth were significantly less likely to engage in penetrative sex than HIV- youth at follow-up, after adjusting for contextual, social, and self-regulatory factors. Other individual- and contextual-level factors such as youth alcohol and marijuana use, residing with a biological parent, caregiver employment, caregiver marijuana use, and youth self-concept were also associated with penetrative sex. Youth who used alcohol were significantly more likely to engage in unprotected penetrative sex. Data suggest that, despite contextual, social, and self-regulatory risk factors, PHIV+ youth are less likely to engage in sexual behavior compared to HIV- youth from similar environments. Further research is required to understand delays in sexual activity in PHIV+ youth and also to understand potential factors that promote resiliency, particularly as they age into older adolescence and young adulthood.     

Caregiver perceptions of environment moderate relationship between neighborhood characteristics and language skills among youth living with perinatal HIV and uninfected youth exposed to HIV in New York City

Despite the increased recognition of how neighborhood conditions bear on cognitive and academic outcomes, no studies have examined the influences of objective and subjective neighborhood indices on specific areas of cognitive functioning among youth living with perinatal HIV (PHIV). In the United States (US), this is of particular concern as HIV has disproportionately affected African American youth living in economically disadvantaged and racially segregated communities. Thus, based on a longitudinal cohort study of psychosocial and behavioral health outcomes in 340 perinatally HIV-exposed but uninfected (PHEU) and PHIV youth residing in New York City, ages 9–16 years at enrollment, we analyzed data from baseline and multiple follow-up (FU) quantitative interviews with youth and their primary caregivers, from when they were at least 13-years-old (approximately 4–6 years post enrollment). We examined the association between baseline neighborhood indices (2000 US census data and caregiver’s perception of neighborhood stressors) and youth receptive language skills (PPVT; Peabody Picture Vocabulary Test) at FU2 and FU3. Census data (percentage of families in neighborhood living below the national poverty rate, median neighborhood household income, and percentage of residents professionally employed) were not independently associated with PPVT scores at both follow-ups. However, in the logistic regression model, the more caregivers perceived their neighborhood as stressful and subjected to violence, the stronger the relationship between census data indicators of low resource neighborhoods and lower PPVT scores for both groups. Findings support “place-based” policies and practices that alleviate caregiver experiences of neighborhood stressors which may contribute to improved cognitive outcomes for youth living with and affected by PHIV.     

Stress and Coping in HIV-Positive Former Plasma/Blood Donors in China: A Test of Cognitive Appraisal Theory

Throughout the 1990s, many villagers in rural China were infected with HIV through commercial plasma/blood donation. These former plasma/blood donors (FPDs) experienced many HIV-related stressors. This study tested a cognitive appraisal model of stress and coping in a sample of HIV-positive adult FPDs. Participants (N = 207) from multiple villages completed a battery of questionnaires assessing HIV-related stress, HIV symptoms, cognitive appraisal, coping behaviors, and psychological distress. Participants reported high levels of HIV-related stress, depression, and anxiety. In a structural equation model, greater HIV-related stress, HIV symptoms, and threat appraisal were directly associated with psychological distress. HIV-related stress was also indirectly associated with psychological distress through threat appraisal. In a second model, coping was found to mediate the relationship between challenge appraisal and psychological distress. Results support the utility of cognitive appraisal theory. Stress management interventions targeting HIV-positive FPDs in China are indicated.     

Timing of Paternal Substance Use Disorder Cessation and Effects on Problem Behaviors in Sons

The developmental timing of paternal substance use disorder (SUD) offset on internalizing and externalizing problem behaviors was examined in prepubertal sons. Analyses revealed a significant main effect of the developmental timing of SUD offset on both internalizing and externalizing problems. No differences were found between sons of control-subject fathers and SUD+ fathers whose offsets occurred before the son's sixth birthday. However, when paternal SUD extended beyond the boys' sixth year, significant increases in internalizing and externalizing problem behaviors were found. The results suggest the importance of early parental SUD intervention in prevention of the intergenerational transmission of behavioral problems.     

Exploring youth and caregiver preferences for asthma education video content

Objective: This study examines (1) whether youth and their caregivers have different preferences for asthma education video topics and (2) if education topic preferences vary by youth and caregiver sociodemographic characteristics. Methods: Youth (n?=?83) ages 7–17 years with persistent asthma and their caregivers were recruited at two pediatric practices in North Carolina. Sociodemographic information and youth and caregiver preferences for nine asthma video education topics were collected during in-person interviews. Bonferroni-corrected Chi-square or McNemar tests (α?=?0.0056) were used to compare youth and caregivers differences in topic preferences and topic preferences by youth and caregiver sociodemographic characteristics, including gender, race, ethnicity, and age. Results: Youth were primarily male (52%) and from low-income families (74%; caregiver annual income less than $30 000) and many were Hispanic (45%). Youth and parents expressed the most interest in the following two topics: “how to deal with triggers” (90% and 95%, respectively) and “how to keep asthma under control” (87% and 96%, respectively). Caregivers and children were discordant for two topics: “the difference between a rescue and controller medicine” and “how to [help your child] talk to your [his/her] friends about asthma.” No differences were found between youth and caregiver sociodemographic characteristics and video topic preferences. Conclusions: Youth with persistent asthma and their caregivers differed in their asthma education topic preferences, but preferences did not vary by caregiver or youth sociodemographic characteristics. Studies examining the effectiveness of interventions tailored to differences in educational preferences of youth with asthma and their caregivers are needed.     

Violence, Suicidality, and Alcohol/Drug Use Involvement in Adolescent Females with a Psychoactive Substance Use Disorder and Controls

This study had three aims: (1) to determine the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence and suicidality (i.e., severity of ideation and attempts) in a sample of adolescent females with a psychoactive substance use disorder and controls; (2) to determine whether these relations are mediated by internalizing (depression/anxiety) and externalizing (nonviolent antisocial behavior) symptomatology; and (3) to determine whether severity of alcohol/drug use involvement moderates the relations between the mediating variables with violence and suicidality. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, familial impairment, internalizing and externalizing symptomatology, and violence and suicidality in one hundred sixty-one 14- to 18-year-old adolescent females with a psychoactive substance use disorder and in 80 controls. Structural equation modeling was used to determine the proposed relations. Results indicated that behavioral dysregulation, negative affectivity, and familial impairment were related to violence, whereas only familial impairment was related to suicidality. Internalizing symptomatology mediated the relation between familial impairment and suicidality, and was related to violence, whereas externalizing symptomatology mediated the relations between behavioral dysregulation, negative affectivity, and familial impairment with violence. Severity of alcohol/drug use involvement did not moderate the relations between internalizing or externalizing symptomatology with suicidality or violence. Nevertheless, the relation between internalizing symptomatology and suicidality was stronger in females with a greater degree of alcohol/drug use involvement, compared with those with a milder degree of involvement Therefore, from a prevention standpoint, behavioral dysregulation, negative affectivity, familial impairment, as well as internalizing and externalizing symptoms, may serve as clinical ?points of intervention” for altering the development of violence and suicidality in high risk and substance abusing youth.     

Prevalence and correlates of HIV testing among Caribbean youth

Little is known about the HIV testing behaviours among Caribbean youth. The purpose of this study was to determine the prevalence of and the factors associated with HIV testing in Caribbean youth. Data were used from population-based surveys in three Caribbean countries: Guyana, Haiti and the Dominican Republic. Chi-square tests and multiple logistic regression models were fitted to examine the associations between independent correlates and ever being tested of HIV. The proportion of youth reporting HIV testing ranged from 17% in Haiti to 48% in the Dominican Republic. Across all countries increased odds of ever being tested for HIV was associated with ever being married, having five or more lifetime partners, and knowing someone who was living with or had died from HIV. Male gender and rural residence were correlated with decreased odds of HIV testing. Low levels of HIV testing were observed among sexually experienced youth in three Caribbean countries. Men, younger and never married youth were less likely to be have been tested for HIV. Outreach and public health messages targeting these youth should be implemented. Programmes that assist youth in accurately assessing their risk behaviours are also required to improve HIV testing.     

Depression and anxiety among HIV-positive men who have sex with men and men who have sex with women in China

ABSTRACT

China is experiencing an emerging HIV epidemic among men who have sex with men (MSM). Minority stress theory posits that marginalized populations experience additional stress, which influences experiences of psychological distress and health outcomes. This study aimed to understand psychological distress of MSM relative to men who have sex with women (MSW) in an urban Chinese setting. Cross-sectional survey data were collected from 162 HIV-positive Chinese men receiving HIV treatment at Beijing’s Ditan Hospital. Multiple linear regression with imputation was used to identify correlates of psychological distress. Relative to MSW, MSM were younger, more educated, and less likely to be in a relationship or have children. While both groups reported clinically elevated levels of depression and anxiety, sexual behavior was not associated with either outcome. Higher endorsement of depression symptomology was associated with worse reported physical health (β?=??1.37, p?<?.05) and greater endorsement of maladaptive coping (β?=?2.39, p?<?.05), whereas higher endorsement of anxiety symptomology was associated with greater endorsement of adaptive coping (β?=?0.78, p?<?.05), diminished physical health (β?=??0.86, p?<?.05), and a high school or greater level of education (β?=?4.13, p?<?.05). These findings suggest that interventions targeting coping strategies may address psychological distress among HIV-positive Chinese men.     

Caregiver Coping Strategies

Abstract

Wife (n= 39) and daughter (n= 32) caregivers completed the Revised Ways of Coping Checklist and measures of caregiver burden, perceived stress, depressive symptoms, and anger expression. Although wives and daughters did not differ in psychological variables, daughters were more likely than wives to use problem-focused coping, blame of others, and self blame. However, the proportion of effort devoted to each of the eight coping strategies did not differ by caregiver relationship. The relationships between coping strategies and psychological measures were stronger for wives, with avoidance, blame of others, and wishful thinking related to higher levels of caregiver burden, stress, depression, and anger- in, and lower levels of anger control. For daughters, self-blame was associated with greater anger in and problem-focused coping was associated with greater anger control. Depressive symptoms were significantly associated with perceived stress, subjective burden, anger-out, anger-in, and anger-control. Our results underscore that daughters and wives experience and cope with caregiving differently and may have different needs for assistance. Other factors that were not assessed, including role strain and role satisfaction, may have a greater impact on caregiving daughters' psychological well being.     

Relationship between viral load and self-report measures of medication adherence among youth with perinatal HIV infection

Poor adherence to antiretroviral therapy (ART) contributes to disease progression and emergence of drug-resistant HIV in youth with perinatally acquired HIV infection (PHIV +), necessitating reliable measures of adherence. Although electronic monitoring devices have often been considered the gold-standard assessment in HIV research, they are costly, can overestimate nonadherence and are not practical for routine care. Thus, the development of valid, easily administered self-report adherence measures is crucial for adherence monitoring. PHIV+youth aged 7–16 (n = 289) and their caregivers, enrolled in a multisite cohort study, were interviewed to assess several reported indicators of adherence. HIV-1 RNA viral load (VL) was dichotomized into >/≤400 copies/mL. Lower adherence was significantly associated with VL >400 copies/mL across most indicators, including ≥1 missed dose in past seven days [youth report: OR = 2.78 (95% CI, 1.46–5.27)]. Caregiver and combined youth/caregiver reports yielded similar results. Within-rater agreement between various adherence indicators was high for both youth and caregivers. Inter-rater agreement on adherence was moderate across most indicators. Age ≥13 years and living with biological mother or relative were associated with VL >400 copies/mL. Findings support the validity of caregiver and youth adherence reports and identify youth at risk of poor adherence.     

Risk for Childhood Internalizing and Externalizing Behavior Problems in the Context of Prenatal Alcohol Exposure: A Meta‐Analysis and Comprehensive Examination of Moderators

Prenatal alcohol exposure (PAE) is associated with a constellation of physical, neurocognitive, and behavioral abnormalities in offspring. The presence of internalizing (e.g., anxiety, mood disorders) and externalizing (e.g., oppositional defiant and conduct disorders) behavior problems has devastating and often long‐lasting impacts on children, adolescents, and their families. The present meta‐analysis explored the strength of the association between PAE and behavior problems, as well as factors that increase or mitigate risk. The current meta‐analysis included 65 studies comparing children and adolescents with PAE to non‐ or light‐exposed controls and attention‐deficit/hyperactivity disorder (ADHD) samples, on a variety of internalizing and externalizing behavior outcomes. Results indicated that individuals with PAE are at increased risk for internalizing (d = 0.71, medium effect) and externalizing (d = 0.90, large effect) problems compared to control samples. The occurrence of total behavior problems was similar to that seen in ADHD samples. The strength of the association between internalizing and externalizing behavior problems and PAE was significantly moderated by several distinct sample characteristics, such as sample age, socioeconomic status, severity of exposure, and type of behavior problem. These findings further our understanding of the behavior problems experienced by children and adolescents with PAE.