Skip to main content
×
×
Home

Psychological morbidity and parenting stress in mothers of primary school children by timing of acquisition of HIV infection: a longitudinal cohort study in rural South Africa

  • T. J. Rochat (a1) (a2) (a3) (a4), B. Houle (a5) (a6) (a7), A. Stein (a4) (a5), R. M. Pearson (a4) (a8), M. L. Newell (a9) (a10) and R. M. Bland (a1) (a10) (a11)...
Abstract

Longitudinal maternal mental health data are needed from high HIV prevalence settings. The Siyakhula Cohort (SC) is a population-based cohort of HIV-positive and negative mothers (n=1506) with HIV-negative children (n=1536) from rural South Africa. SC includes 767 HIV-negative mothers; 465 HIV-positive in pregnancy; 272 HIV-positive since pregnancy (n=2 missing HIV status). A subgroup (n=890) participated in a non-randomized breastfeeding intervention [Vertical Transmission Study (VTS)]; the remaining (n=616) were resident in the same area and received antenatal care at the time of the VTS, but were not part of the VTS, instead receiving the standard of care Prevention of Mother-to-Child Transmission (PMTCT) Programme. In secondary analysis we investigated the prevalence of, and factors associated with, psychological morbidity amongst mothers who were still the primary caregiver of the child (1265 out of 1506) at follow-up (7–11 years post-birth). We measured maternal depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7) and parenting stress (Parenting Stress Index-36), using standardized cut-offs and algorithms. In total, 75 (5.9%) mothers met criteria for depression, 37 (2.9%) anxiety and 134 (10.6%) parenting stress. Using complete case logistic regression (n=1206 out of 1265 mothers) as compared to being HIV-negative, testing HIV-positive in pregnancy doubled odds of depression [adjusted odd ratios (aOR)=1.96 [1.0–3.7] P=0.039]. Parenting stress was positively associated with acquisition of HIV after pregnancy (aOR=3.11 [1.9–5.2] P<0.001) and exposure to household crime (aOR=2.02 [1.3–3.2] P=0.003); negatively associated with higher maternal education (aOR=0.29 [0.1–0.8] P=0.014), maternal employment (aOR=0.55 [0.3–0.9] P=0.024). Compared with the standard of care PMTCT, VTS mothers had reduced odds of parenting stress (aOR=0.61 [0.4–0.9] P=0.016). Integrating parental support into mostly bio-medical treatment programmes, during and beyond pregnancy, is important.

Copyright
Corresponding author
*Address for correspondence: Dr Tamsen Rochat, Human and Social Development Programme, Human Sciences Research Council 5th Floor, The Atrium, 430 Ridge Road, Durban, South Africa, 4001, or: P O Box 37429, Overport, Durban, South Africa, 4067. (Email trochat@hsrc.ac.za)
References
Hide All
1. Howard, LM, Molyneaux, E, Dennis, C-L, et al. Non-psychotic mental disorders in the perinatal period. Lancet. 2014; 384, 17751788.
2. Gelaye, B, Rondon, MB, Araya, R, Williams, MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016; 3, 973982.
3. Stein, A, Pearson, RM, Goodman, SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet.. 2014; 384, 18001819.
4. Herba, CM, Glover, V, Ramchandani, PG, Rondon, MB. Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries. Lancet Psychiatry. 2016; 3, 983992.
5. Bauer, A, Parsonage, M, Knapp, M, Iemmi, V, Adelaja, B. Costs of Perinatal Mental Health Problems. 2014. London School of Economics and Political Science: London.
6. Kingston, D, Tough, S. Prenatal and postnatal maternal mental health and school-age child development: a systematic review. Matern Child Health J. 2014; 18, 17281741.
7. Van Der Waerden, J, Galéra, C, Larroque, B, et al. Maternal depression trajectories and children’s behavior at age 5 Years. J Pediatr. 2015; 166, 1440-8. e1.
8. Pearson, RM, Bornstein, MH, Cordero, M, et al Maternal perinatal mental health and offspring academic achievement at age 16: the mediating role of childhood executive function. J Child Psychol Psychiatry. 2016; 57, 491501.
9. Ding, X-X, Wu, Y-L, Xu, S-J, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014; 159, 103110.
10. Grigoriadis, S, VonderPorten, EH, Mamisashvili, L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013; 74, 321341.
11. Grote, NK, Bridge, JA, Gavin, AR, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010; 67, 10121024.
12. Hancock, KJ, Mitrou, F, Shipley, M, Lawrence, D, Zubrick, SR. A three generation study of the mental health relationships between grandparents, parents and children. BMC Psychiatry. 2013; 13, 299.
13. Rochat, T, Netsi, E, Redinger, S, Stein, A. Parenting and HIV. Curr Opin Psychol. 2017; 15, 155161.
14. Abidin, R. Parenting Stress Index Professional Manual, 3rd edn, 1995. Psychological Assessment Resources Incorporated: Lutz, FL.
15. Pereira, J, Vickers, K, Atkinson, L, et al. Parenting stress mediates between maternal maltreatment history and maternal sensitivity in a community sample. Child Abuse Negl. 2012; 36, 433437.
16. Åsander, A-S, Björkman, A, Belfrage, E, Faxelid, E. HIV-infected African parents living in Stockholm, Sweden: disclosure and planning for their children’s future. Health Soc Work. 2009; 34, 107115.
17. Allen, AB, Finestone, M, Eloff, I, et al. The role of parenting in affecting the behavior and adaptive functioning of young children of HIV-infected mothers in South Africa. AIDS Behav. 2014; 18, 605616.
18. Richter, LM, Rochat, TJ, Hsiao, C, Zuma, TH. Evaluation of a brief intervention to improve the nursing care of young children in a high HIV and AIDS setting. Nurs Res Pract. 2012; 2012, 21372145.
19. Rochat, TJ, Arteche, AX, Stein, A, Mitchell, J, Bland, RM. Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa: the Amagugu intervention. AIDS. 2015; 29, S67S79.
20. Sowa, NA, Cholera, R, Pence, BW, Gaynes, BN. Perinatal depression in HIV-infected African women: a systematic review. J Clin Psychiatry. 2015; 76, 13851396.
21. Kapetanovic, S, Dass-Brailsford, P, Nora, D, Talisman, N. Mental health of HIV-seropositive women during pregnancy and postpartum period: a comprehensive literature review. AIDS Behav. 2014; 18, 11521173.
22. Rochat, TJ, Tomlinson, M, Bärnighausen, T, Newell, ML, Stein, A. The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord. 2011; 135, 362373.
23. Rochat, TJ, Richter, LM, Doll, HA, Buthelezi, NP, Tomkins, A, Stein, A. Depression among pregnant rural South African women undergoing HIV testing. Jama. 2006; 295, 13761378.
24. Nachega, JB, Uthman, OA, Anderson, J, Peltzer, K, et al. Adherence to antiretroviral therapy during and after pregnancy in low-income, middle-income, and high-income countries: a systematic review and meta-analysis. AIDS. 2012; 26, 20392052.
25. Sin, NL, DiMatteo, MR. Depression treatment enhances adherence to antiretroviral therapy: a meta-analysis. Ann Behav Med. 2014; 47, 259269.
26. Stein, A, Desmond, C, Garbarino, J, et al. Predicting long-term outcomes for children affected by HIV and AIDS: perspectives from the scientific study of children’s development. AIDS. 2014; 28(Suppl. 3), S261S268.
27. Collins, PY, Holman, AR, Freeman, MC, Patel, V. What is the relevance of mental health to HIV/AIDS care and treatment programs in developing countries? A systematic review. AIDS. 2006; 20, 15711582.
28. Patel, V, Chowdhary, N, Rahman, A, Verdeli, H. Improving access to psychological treatments: lessons from developing countries. Behav Res Ther. 2011; 49, 523528.
29. Tanser, F, Hosegood, V, Bärnighausen, T, et al. Cohort profile: Africa Centre Demographic Information System (ACDIS) and population-based HIV survey. Int J Epidemiol. 2007; 37, 956962.
30. Tanser, F, Bärnighausen, T, Grapsa, E, Zaidi, J, Newell, M-L. High coverage of ART associated with decline in risk of HIV acquisition in rural KwaZulu-Natal, South Africa. Science.. 2013; 339, 966971.
31. Le Doaré, K, Bland, R, Newell, M-L. Neurodevelopment in children born to HIV-infected mothers by infection and treatment status. Pediatrics.. 2012; 130, 19.
32. Houlihan, CF, Bland, RM, Mutevedzi, PC, et al. Cohort profile: Hlabisa HIV treatment and care programme. Int J Epidemiol. 2011; 40(2), 318326.
33. Rochat, T, Houle, B, Stein, A, Pearson, RM, Newell, ML, Bland, R. Cohort Profile: The Siyakhula Cohort, rural South Africa. Online first. International Journal of Epidemiology. 2017; doi: https://doi.org/10.1093/ije/dyx148
34. Coovadia, HM, Rollins, NC, Bland, RM, et al. Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study. Lancet.. 2007; 369, 11071116.
35. Bland, R, Coovadia, H, Coutsoudis, A, Rollins, N, Newell, M. Cohort profile: mamanengane or the Africa centre vertical transmission study. Int J Epidemiol. 2010; 39, 351360.
36. Rochat, TJ, Houle, B, Stein, A, et al. Exclusive breastfeeding and cognition, executive function, and behavioural disorders in primary school-aged children in rural South Africa: a cohort analysis. PLoS medicine. 2016; 13(6), e1002044.
37. Kroenke, K, Spitzer, RL, Williams, JBW, Löwe, B. The Patient Health Questionnaire Somatic, Anxiety, and Depressive Symptom Scales: a systematic review. Gen Hosp Psychiatry. 2010; 32, 345359.
38. Raven, J, Raven, JC, Court, JH. Raven’s Standard Progressive Matrices (SPM) Manual, 2000 edn, 2004. Pearsons: Bloomington, IN.
39. Haskett, ME, Ahern, LS, Ward, CS, Allaire, JC. Factor structure and validity of the parenting stress index-short form. J Clin Child Adolesc Psychol. 2006; 35, 302312.
40. Mkwanazi, NB, Rochat, TJ, Bland, RM. Living with HIV, disclosure patterns and partnerships a decade after the introduction of HIV programmes in rural South Africa. AIDS care. 2015; 27(sup1), 6572.
41. Rochat, TJ, Bland, RM, Tomlinson, M, Stein, A. Suicide ideation, depression and HIV among pregnant women in rural South Africa. 2013; 5(3A), 650–661.
42. Mitchell, J, Wight, M, Van Heerden, A, Rochat, TJ. Intimate partner violence, HIV, and mental health: a triple epidemic of global proportions. International Review of Psychiatry. 2016; 28(5), 452463.
43. Hammerton, G, Mahedy, L, Mars, B, et al. Association between maternal depression symptoms across the first eleven years of their child’s life and subsequent offspring suicidal ideation. PloS ONE.. 2015; 10, e0131885.
44. Rochat, TJ, Tomlinson, M, Newell, M-L, Stein, A. Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal Depression Scale (EPDS). Arch Womens Ment Health. 2013; 16, 401410.
45. Woolhouse, H, Gartland, D, Mensah, F, Giallo, R, Brown, S. Maternal depression from pregnancy to 4 years postpartum and emotional/behavioural difficulties in children: results from a prospective pregnancy cohort study. Arch Womens Ment Health. 2016; 19, 141151.
46. Rochat, TJ, Bland, R, Coovadia, H, Stein, A, Newell, M-L. Towards a family-centered approach to HIV treatment and care for HIV-exposed children, their mothers and their families in poorly resourced settings. Future Virol. 2011; 6, 687696.
47. Ickovics, JR, Hamburger, ME, Vlahov, D, et al. Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. JAMA.. 2001; 285, 14661474.
48. Fotso, JC, Higgins-Steele, A, Mohanty, S. Male engagement as a strategy to improve utilization and community-based delivery of maternal, newborn and child health services: evidence from an intervention in Odisha, India. BMC Health Serv Res. 2015; 15, S5.
49. Yargawa, J, Leonardi-Bee, J. Male involvement and maternal health outcomes: systematic review and meta-analysis. J Epidemiol Commun Health. 2015; 69, 604612.
50. Black, MM, Walker, SP, Fernald, LC, et al. Early childhood development coming of age: science through the life course. Lancet.. 2017; 389, 7790.
51. Stein, A, Krebs, G, Richter, L, et al. Babies of a pandemic. Arch Dis Child. 2005; 90, 116118.
52. Rotheram-Borus, M-J, Richter, L, Van Rooyen, H, et al. Project Masihambisane: a cluster randomised controlled trial with peer mentors to improve outcomes for pregnant mothers living with HIV. Trials. 2011; 12, 2.
53. Tomlinson, M, Rotheram-Borus, MJ, le Roux, IM, et al. Thirty-six-month outcomes of a generalist paraprofessional perinatal home visiting intervention in South Africa on maternal health and child health and development. Prev Sci. 2016; 17, 937948.
54. Richter, L, Rotheram-Borus, MJ, Van Heerden, A, et al. Pregnant women living with HIV (WLH) supported at clinics by peer WLH: a cluster randomized controlled trial. AIDS Behav. 2014; 18, 706715.
55. Rollins, NC, Bhandari, N, Hajeebhoy, N, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016; 387, 491504.
56. Richter, LM, Daelmans, B, Lombardi, J, et al. Investing in the foundation of sustainable development: pathways to scale up for early childhood development. Lancet. 2017; 389, 103118.
57. Rochat, TJ, Mitchell, J, Stein, A, Mkwanazi, NB, Bland, RM. The Amagugu intervention: a conceptual framework for increasing HIV disclosure and parent-led communication about health among HIV-infected parents with HIV-uninfected primary school-aged children. Front Public Health. 2016; 4, 183.
58. Rochat, TJ, Stein, A, Cortina-Borja, M, Tanser, F, Bland, RM. The Amagugu intervention for disclosure of maternal HIV to uninfected primary school-aged children in South Africa: a randomised controlled trial. The Lancet HIV. 2017; Online First doi: 10.1016/S2352-3018(17)30133-9.
59. Yousafzai, AK, Obradović, J, Rasheed, MA, et al. Effects of responsive stimulation and nutrition interventions on children’s development and growth at age 4 years in a disadvantaged population in Pakistan: a longitudinal follow-up of a cluster-randomised factorial effectiveness trial. Lancet Glob Health. 2016; 4, e548e558.
60. Biaggi, A, Conroy, S, Pawlby, S, Pariante, CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. Journal of affective disorders. 2016; 191, 6277.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Journal of Developmental Origins of Health and Disease
  • ISSN: 2040-1744
  • EISSN: 2040-1752
  • URL: /core/journals/journal-of-developmental-origins-of-health-and-disease
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 11
Total number of PDF views: 78 *
Loading metrics...

Abstract views

Total abstract views: 503 *
Loading metrics...

* Views captured on Cambridge Core between 13th September 2017 - 23rd September 2018. This data will be updated every 24 hours.