Association between caregiver depression symptoms and child executive functioning. Results from an observational study carried out in four sub-Saharan countries

ABSTRACT

Depressive symptoms among HIV-positive (HIV+) women may negatively impact their health and possibly that of their young children through risk of compromised caregiving. We evaluated how depression symptoms in predominantly (97%) female caregivers relate to neurodevelopmental outcomes in their HIV affected children. Data come from the IMPAACT P1104s Study, an observational cohort across six sites in four countries: Zimbabwe, South Africa, Uganda and Malawi. Participants (n = 611) were 5–11-year-old children with HIV (HIV), HIV exposed uninfected (HEU), or HIV unexposed uninfected (HUU). Primary caregivers were assessed for depression with the Hopkins Symptom Checklist (HSCL) and children with Behavior Rating Inventory for Executive Function (BRIEF) parent-report, Kauffman Assessment Battery for Children II (KABC), Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2), Test of Variables of Attention (TOVA), Multiple Indicators Cluster Survey, Child Disability and Development scales (MICS-4). Caregivers with higher depression scores (>1.75 mean HSCL score) reported more executive function problems in their children, regardless of HIV status. All executive function scores were significantly (p < 0.001) associated with depressive symptomatology at baseline and across time. Caregiver depressive symptomatology was not associated with other assessed neurocognitive outcomes. These results highlight the potential impact of caregiver depression on child behavioral outcomes.

KEYWORDS:

• Executive functioning
• child neuropsychology
• HIV/AIDS
• sub-Saharan Africa

Acknowledgements

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Drs E. Pim Brouwers (NIH/NIMH) and Sonia Lee (NIH/NICHD) served as protocol advisors to the research leadership team for P1104s for their respective NIH institutes. We gratefully acknowledge their expertise and counsel during the study. We would like to acknowledge Jane Lindsey for key contributions to study design, implementation and analysis, to Meredith Warsaw for critical review of study design, and to both Meredith Warshaw and Heather Ribaudo for advice on study analysis. We extend our gratitude to members of the research staff at each site: Mary Nyakato and Agatha Kuteesa (Uganda), Janet Grab and Mmule Ratswana (Zimbabwe), Patricia Thinda, Noel Mumba (Malawi), Haseena Cassim and Given Leshabane (Soweto, RSA), Joan Coetzee and Thandiwe Hamana (Stellenboch, RSA), Sukunema J Maturure and Mary N Tichareva (Zimbabwe).

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Overall support for the International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) was provided by the National Institute of Allergy and Infectious Diseases (NIAID) with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) and the National Institute of Mental Health (NIMH), all components of the National Institutes of Health (NIH), under Award Numbers UM1AI068632 (IMPAACT LOC), UM1AI068616 (IMPAACT SDMC) and UM1AI106716 (IMPAACT LC), and by NICHD contract number HHSN275201800001I.