The impact of common mental disorders among caregivers living with HIV on child cognitive development in Zimbabwe

Abstract

Common mental disorders (CMD) among caregivers living with HIV may affect their young children. The aim of this paper is to analyse the impact of maternal CMD among caregivers living with HIV on the cognitive functioning of their child.Data were collected at baseline and 12 months follow-up from mother-child dyads recruited as part of an ongoing trial among participants on the HIV-exposed infant register from 2 rural districts in Zimbabwe. Symptoms of CMD were assessed using the Shona Symptom Questionnaire (SSQ-8), with a cut-off point of >6. Mixed-effects linear regression was used to assess child cognitive scores at follow-up (assessed using the Mullen Scales of Early Learning) in relation to caregiver CMD prevalence over 12 months.Of the 574 caregivers enrolled in the trial, 514 (90.1%) were followed-up at 12 months. At baseline, caregivers reporting CMD (n=230; 40.1%) were less likely to have completed higher education (46.9% vs. 56.9%; p=0.02), more likely to be unmarried (27.8% vs. 16.0%; p<0.01), and experience food insecurity (50.0% vs. 29.4%; p<0.01) compared to the group without CMD (n=344).There were 4 CMD patterns over time: i) Emerging CMD (n=101; 19.7% of caregivers) defined as those who were below the cut-off at baseline, and above it at 12 months; ii) Improving CMD (n=76; 14.8%) defined as those who reported CMD at baseline, and were below the cut-off by follow-up; iii) No CMD (n=206; 40.1%) defined as those who did not report CMD symptoms at either time point; and iv) Chronic CMD (n=131; 25.5%) defined as those who reported CMD above the cut-off at both time points. There was no evidence of a difference in the overall cognitive score of the children by caregiver CMD categories.However, children of caregivers with chronic CMD (n=131, 25.5%) had lower receptive language scores (aMD:-2.81, 95%CI -5.1 to -0.6; p=0.05) compared to the reference group with no CMD (n=206, 40.1%).Exposure to caregiver CMD over a prolonged period may affect child receptive vocabulary skills. This highlights the importance of the maternal mental health inclusion in HIV management as well as in child intervention programmes especially in environments compounded with adversities.

Maternal Common Mental Disorders and childhood malnutrition in two rural provinces of Zimbabwe: A case-control study

“…This paper con rms presence of a signi cant relationship between maternal CMD and childhood malnutrition in Zimbabwe. There is a paucity of studies that assessed maternal CMD in Zimbabwe with a majority of studies mainly disease speci c for example CMDs among HIV infected mothers (30). We found a high burden of maternal CMDs in Zimbabwe in our study population (29.5%).…”

“…Validation of the Shona Symptom Questionnaire established that using a cut-off of 5 a rmative responses from the 14 items is an accurate diagnosis of maternal CMD (29). We used the cut-off of 8 a rmative responses out of the 14 items as it is more commonly used in the literature reviewed (30,31)…”

Exploring the cognitive development of children born to adolescent mothers in South Africa

“…Children were classified as scoring Average and above (summed [standardized] t‐ score: 85–155) and Below Average (summed [standardized] t‐ score: 49–84). The Mullen Scales of Early Learning have been found to have good psychometric properties, have been adapted for use in South Africa, and have been utilized widely within sub‐Saharan Africa (Boivin et al, 2019 ; Bornman et al, 2018 ; Mebrahtu et al, 2020 ; Milosavljevic et al, 2019 ).…”

Editorial: Mental health of disadvantaged children

“…Mebrahtu et al ( 3 ) focused on the potential risk and protective factors on children's cognitive development and found that increased maternal education levels protected against lower child developmental scores while increasing child age was a risk factor for lower developmental scores. Zhang Y. et al showed that perceived social support and trust could positively predict social wellbeing among youths affected by parental HIV/AIDS, implying trust appears to be the most proximate protective factor for social wellbeing.…”