Adolescent mothers and their children affected by HIV—An exploration of maternal mental health, and child cognitive development

Abstract

Background Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development. Methods Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores. Results The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores. Conclusions This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.

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“…Ever since the beginning of the COVID-19 pandemic there has been an increasing concern about the negative effects of the pandemic on individuals' mental health, with the greatest effect seen among women living in under-sourced contexts, such as low-and middle-income countries (LMICs) [4]. Among women living in LMICs, mothers in charge of children under five years old are considered a key group to study and intervene in [5], as CMHD may limit not only their ability to care for themselves, but may also subsequently impact their children's development, contributing to the South-North poverty gap [6][7][8].…”

Testing the Feasibility, Acceptability and Effectiveness of the Problem Management Plus for Moms: Protocol of a Randomized Control Trial

“…4 Among women living in LMICs, mothers in charge of children under five years old are considered a key group to study and intervene in, 5 as CMHD may limit not only their ability to care for themselves but may also subsequently impact their children's development, contributing to the South-North poverty gap. [6][7][8] The COVID-19 pandemic has increased the risk of developing CMHD among mothers living in sub-Saharan Africa. 5,9 In Zambia, where women are primarily responsible for caring for young children were already suffering from high rates of distress, the COVID-19 pandemic and its consequences in society (e.g.…”