Caregiver socioemotional health as a determinant of child well‐being in school‐aged and adolescent Ugandan children with and without perinatal HIV exposure

Abstract

Objective Caregiver socio‐emotional attributes are major determinants of child well‐being. This investigation in vulnerable school‐aged Ugandan children estimates relationships between children's well‐being and their caregiver's anxiety, depression and social support. Methods Perinatally HIV‐infected, HIV‐exposed uninfected and HIV‐unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA‐polymerase chain‐reaction test; status was confirmed via HIV rapid diagnostic test when children were 6–18 years old. Five indicators of child well‐being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers’ socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well‐being in relation to caregiver's psychosocial status. Results As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self‐esteem/QOL (β = −1.3%/−2.6%; 95%CI: −5.0%,‐0.2%) in their children. Child distress/hopelessness increased (β = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self‐esteem/QOL decreased 2.3% (β = −2.3%/−4.4%; 95%CI: −7.2%, −1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β = 3%; 95%CI:1.4%, 4.5%) in their children. HIV‐infected/exposed children had most caregiver depression‐related QOL deficit (β = −5.2%/−6.8%; 95%CI: −12.4%, −0.2%) and HIV‐unexposed children had most caregiver social support‐related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%). Conclusions Caregiver anxiety, depressive symptoms and low social support were associated with worse well‐being in school‐aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well‐being of vulnerable children and adolescents in this setting.

Toxic Stress and Quality of Life in Early School‐Aged Ugandan Children With and Without Perinatal Human Immunodeficiency Virus Infection

“…The inverse association between child psychosocial stress and childreported QOL is reinforced by (a) observation of corresponding inverse association between objectively measured physiologic stress and child reported QOL and (b) negative associations between dependent children' s QOL and their caregivers' levels of acute, recent, and lifetime stress. These findings are in line with the prior reports establishing the importance of caregivers' socioemotional state for wellbeing of their dependent children (Webster et al, 2019). Of importance, association of toxic stress with child wellbeing in this sample was dose dependent and clinically significant with effect sizes often in excess of 0.5 standard deviations regardless of respondent (Norman et al, 2003).…”

“…This observation is reassuring in the era of universal HAART and confirms previous observation of no caregiver HIV-status related difference in psychosocial adjustment of Ugandan children. (Webster et al, 2019) As would be expected, the vast majority of caregivers in this study were female (mothers). We did not have sufficient number of primary male caregivers to robustly evaluate similarity in wellbeing by male caregiver status.…”

Caries experience and oral health related quality of life in a cohort of Ugandan HIV-1 exposed uninfected children compared with a matched cohort of HIV unexposed uninfected children

“…However, comparative studies for the quality of life of HEU children with HUU children are limited. Two studies from Uganda showed similar quality of life profiles among HUU and HEU children [27,29]. Another study from Uganda found that infection/ exposure predicted low self-esteem and diminished positive outlook in the long term [28].…”

Epidemiology of Non-communicable Diseases and Risk factors in South African Adolescents and Youth Living with HIV: Implications for Integrated Prevention

“…Previous studies in sub-Saharan Africa have described NCD comorbidities in adults living with HIV [44,[109][110][111][112]. Besides mental health [113][114][115][116][117][118][119][120][121] and lung diseases [122][123][124][125][126], few studies have assessed the prevalence of NCDs and particularly NCD risk factors in AYLHIV in SSA other than as incidental ndings [127][128][129][130][131][132][133][134]. Risk behaviour research on AYLHIV in sub-Saharan Africa has predominantly focused on sexual risk behaviour [135].…”