A Longitudinal Study of the Impact on Young Children of Maternal HIV Serostatus Disclosure

Abstract

A B S T R A C TA longitudinal analysis of the psychological well-being of 81 young children ages 6-11 living with their HIV symptomatic or AIDS diagnosed mothers was conducted. Specifically, the relationship among mothers' disease severity, maternal disclosure of HIV, and children's psychological well-being was investigated. The children were assessed over three time points (i.e. baseline assessment, 6-month and 1-year follow-up). Two categories of maternal disclosure (disclosed before baseline, no disclosure at any of the three time points over 1-year), and two categories of disease severity (< 500 T-cell count across all assessments, 500+) were created. A series of 2 ϫ 2 ϫ 3 repeated measures MANOVAs was used to assess the effects of the maternal disclosure and disease severity across time on children's psychological well-being. Results showed significant within-group time effects for child depression, suggesting a decrease in depression over time. Interaction results of time and maternal disclosure revealed only a few significant changes over time. However, significant decreases over time for child depression were noted among children whose mothers' CD4 cell counts remained at 500+ across the three assessment periods. Implications for future research and for psychosocial needs of these families are discussed. K E Y W O R D SHIV, longitudinal analysis, maternal disclosure, psychological well-being

Disclosure of Maternal HIV Status to Children: To Tell or Not To Tell … That is the Question

“…Consonant with results from several studies of the relationship between illness disclosure and child psychosocial adjustment (Armistead et al, 1997(Armistead et al, , 2001Murphy et al, 2001;Murphy, Marelich et al, 2002), disclosure was not related to teacher, mother, or child reports of child functioning. As suggested by Armistead and colleagues (2001), the presence of potentially positive consequences of disclosure (e.g., lower maternal stress), as well as unsalutary effects (e.g., increased child stress) may balance each other out thereby explaining the null finding.…”

“…Various rates of disclosure of parental HIV/AIDS to children have been reported, ranging from 0% (Esposito et al, 1999) to 74% (Armistead et al, 1997(Armistead et al, , 2001Bauman et al, Camacho et al, 2002;Forsyth et al, 1996;Lee & Rotheram-Borus, 2002;Murphy et al, 2001;Murphy, Marelich et al, 2002;Nagler et al, 1995;Niebuhr et al, 1994;Nostlinger et al, 2004;Ostrom et al, 2006;Pilowsky et al, 1999;Rotheram-Borus et al, 1997;Schrimshaw & Siegel, 2002;Shaffer et al, 2001;Sowell et al, 1997;Tompkins et al, 1999;Wiener et al, 1998), and likely depend on such factors as child age, disease progression, quality of the parent-child relationship, and general cultural influences on disclosure-and child-related beliefs. Although parents commonly cite protection from distress as a major reason for withholding illness-related information from children, clinical observation indicates that children typically have some sense that something is wrong anyway (Melvin, 1996).…”

“…Others (Rotheram-Borus et al, 1997) have revealed heightened and relatively stable (Lee & Rotheram-Borus, 2002) rates of problem behaviors among adolescents who were informed of their parents' diagnosis. Several studies suggest the importance of considering additional moderating factors, such as time since disclosure (Murphy, Marelich et al, Hoffman, 2002;Schrimshaw & Siegel, 2002), maternal illness severity (Murphy, Marelich et al, 2002), and informant differences (Shaffer et al, 2001). …”

“…In general, these studies demonstrated lower levels of child maladjustment among children who were informed (Murphy, Marelich et al, 2002), especially when children's self-reports of behaviors were considered (Shaffer et al, 2001) and when child functioning was assessed after a period of initial adjustment (Murphy, Marelich et al, 2002;Schrimshaw & Siegel, 2002).…”

Child Psychosocial Adjustment and Parenting in Families Affected by Maternal HIV/AIDS

“…Although recent research has suggested that disclosure of disease status may influence youth mental health, results have been mixed in terms of whether awareness is associated with higher (e.g., Lee & Rotheram-Borus, 2002) or lower (e.g., Murphy, Marelich, & Hoffman, 2002) rates of negative child/adolescent outcomes. For example, using the current sample of participants, Tompkins (in press) found no differences in child functioning between the 61% of the HIV-affected families whose children were aware of their mothers' illness and those who were not informed.…”