Maternal post-traumatic stress disorder, depression and alcohol dependence and child behaviour outcomes in mother–child dyads infected with HIV: a longitudinal study

Abstract

ObjectivesHIV and psychiatric disorders are prevalent and often concurrent. Childbearing women are at an increased risk for both HIV and psychiatric disorders, specifically depression and post-traumatic stress disorder (PTSD). Poor mental health in the peripartum period has adverse effects on infant development and behaviour. Few studies have investigated the relationship between maternal PTSD and child behaviour outcomes in an HIV vertically infected sample. The aim of this study was to investigate whether maternal postpartum trauma exposure and PTSD were risk factors for child behaviour problems. In addition, maternal depression, alcohol abuse and functional disability were explored as cofactors.SettingThe study was conducted in Cape Town, South Africa.Participants70 mother–child dyads infected with HIV were selected from a group of participants recruited from community health centres.DesignThe study followed a longitudinal design. Five measures were used to assess maternal trauma exposure, PTSD, depression, alcohol abuse and functional disability at 12 months postpartum: Life Events Checklist (LEC), Harvard Trauma Scale (HTS), Alcohol Use Disorders Identification Test (AUDIT), Center for Epidemiological Studies Depression (CESD) Scale and the Sheehan Disability Scale (SDS). Child behaviour was assessed at 42 months with the Child Behaviour Checklist (CBCL).ResultsThe rate of maternal disorder was high with 50% scoring above the cut-off for depression, 22.9% for PTSD and 7% for alcohol abuse. Half of the children scored within the clinical range for problematic behaviour. Children of mothers with depression were significantly more likely to display total behaviour problems than children of mothers without depression. Maternal PTSD had the greatest explanatory power for child behaviour problems, although it did not significantly predict child outcomes.ConclusionsThis study highlights the importance of identifying and managing maternal PTSD and depression in mothers of children infected with HIV. The relationship between maternal PTSD and child behaviour warrants further investigation.

Adjustment of a Population of South African Children of Mothers Living With/and Without HIV Through Three Years Post-Birth

“…Child outcomes were informed by maternal reports, the government Road-to-Health card, and interviewers’ assessments. The standardized measures of childhood adjustment have been used previously in South Africa (43,50). It would have been desirable to have more biological measures of children's current health and to validate the hospital records of children to know the types of illnesses children had.…”

Representações Maternas No Contexto Do Hiv: Gestação Ao Segundo Ano Da Criança

“…Seguindo as concepções de Stern (1997), de que as representações maternas influenciam a relação mãe-bebê, percebeu-se que as mesmas eram encenadas nas interações de maneiras diversas entre as mães, incluindo esvaziamento ou idealizações do bebê imaginário, isolamento materno e cuidados excessivos com o bebê. A presença de cuidados superprotetivos já havia sido evidenciada na literatura (Gonçalves & Piccinini, 2008) e associada ao temor de infecção do bebê, bem como atitudes mais evitativas da mãe com o bebê que, se persistentes, podem prejudicar o desenvolvimento infantil (Nothling et al, 2013;Trocme et al, 2013).…”

“…Outro aspecto que merece atenção é a associação entre depressão materna e HIV, já evidenciada na literatura (Nothling et al, 2013;Oswalt & Biasini, 2012;Trocme et al, 2013) e, também, no presente estudo. No caso em que esteve mais presente (Caso 3), a depressão materna se revelou mais intensa no segundo ano do filho, após o diagnóstico ter sido reconhecido pela mãe sob o ponto de vista emocional.…”

“…No caso em que esteve mais presente (Caso 3), a depressão materna se revelou mais intensa no segundo ano do filho, após o diagnóstico ter sido reconhecido pela mãe sob o ponto de vista emocional. Considerando-se que a depressão materna oferece risco potencial à relação mãe-bebê e ao desenvolvimento infantil (Nothling et al, 2013), reforça-se a necessidade de se atentar ao impacto do HIV sobre a saúde emocional materna e de se oferecer atendimento a estas mães.…”

“…Sintomas depressivos também são frequentes entre essas mães (Nothling, Martin, Laughton, Cotton, & Seedat, 2013), que tendem a perceber seus cuidados com o bebê de forma mais negativa (Oswalt & Biasini, 2012), podendo ser este um fator de risco para futuros problemas de comportamento infantil (Trocme et al, 2013). Entende-se que muitos sentimentos referidos na literatura não são específicos do contexto do HIV, e podem estar presentes entre mães que vivenciam outras condições de risco para o bebê.…”