Maternal depression and infant social withdrawal as predictors of behaviour and development in vertically HIV-infected children at 3.5 years

ABSTRACT

Background

In low- and middle-income countries, there is a high prevalence of post-partum depression and it is often associated with HIV status. Maternal depression negatively affects mothering and can lead to social withdrawal in infants. Maternal depression and infant social withdrawal can have deleterious long-term effects on children’s behaviour and neurodevelopmental trajectories.

Aim

To investigate whether maternal depression and infant social withdrawal at 10–12 months post-partum were significant predictors of child behaviour and development at 42 months.

Method

Seventy-four mother–infant dyads living with HIV were followed in a prospective, longitudinal design. Mothers were assessed for depression using the Center for Epidemiologic Studies Depression scale (CES-D). Infant social withdrawal was assessed by the modified Alarm Distress Baby Scale (m-ADBB), and development and behaviour were evaluated by the Griffiths Mental Development Scales (GMDS) and the Child Behavior Checklist (CBCL), respectively.

Results

   Maternal depression  explained 4.8% of the variance in child behaviour (β = 0.98, t = 2.05, p < 0.05) and 10.3% of the variance in development   (β = −0.30, t = −2.66, p < 0.05). Infant social withdrawal   was not a significant predictor of behaviour   (β = 3.27, t = 1.36, p = 0.18), but it did uniquely explain 7% of the variance in development (β = −1.32, t = −2.48, p < 0.05).

Conclusion

In the context of HIV, screening for maternal depression and the quality of mother–infant interactions are important (especially in the 1st year post-partum), given the significant long-term impact they have on behaviour and neurodevelopment.

Abbreviations

ANOVA: analysis of variance; ART: antiretroviral therapy; CBCL: Child Behavioral Checklist; CES-D: Center for Epidemiologic Studies Depression Scale; CHEI: children HIV-exposed and infected; CHER: Children with HIV Early Antiretroviral Treatment Trial; CHEU: children HIV-exposed and uninfected; CHUU: children HIV-unexposed and -uninfected; GMDS: Griffiths Mental Development Scales; HIV: human immunodeficiency virus; LMIC: low- and middle-income countries; m-ADBB: modified Alarm Distress Baby Scale; NRF: National Research Foundation; SAMRC: South African Medical Research Council; WHO: World Health Organization

KEYWORDS:

• Maternal depression
• infant social withdrawal
• child development
• child behaviour
• HIV

Author contributions

Jani Nöthling: Methodology, formal analysis, data curation, writing the original draft.

Barbara Laughton: conceptualisation, methodology, formal analysis, investigation, resources, data curation, review and editing, supervision, project administration, funding acquisition.

Soraya Seedat: Conceptualisation, methodology, formal analysis, resources, data curation, review and editing, supervision, project administration, funding acquisition.

Data availability

The data that support the findings of this study are available from the principal investigator and co-author of the study, Soraya Seedat, upon reasonable request.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

Support for the CHER trial which provided the infrastructure for the neurodevelopmental and behavioural assessments was provided by the United States National Institute of Allergy and Infectious Diseases through the Comprehensive International Program for Research in AIDS in South Africa network [Grant U19 AI53217]; the Departments of Health of the Western Cape and Gauteng, South Africa; and GlaxoSmithKline/Viiv Healthcare. Additional support was provided by federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States Department of Health and Human Services [Contract No. HHSN272200800014C]. Neurodevelopmental assessments were funded by the Harry Crossley Foundation, the South African Medical Research Council (SAMRC), the National Research Foundation (NRF) of South Africa and the Comprehensive International Programme for Research in AIDS in South Africa. Collection of maternal data was funded by the South African Research Chair in Posttraumatic Stress Disorder (PTSD) hosted by Stellenbosch University, funded by the Department of Science and Technology in South Africa and administered by the National Research Foundation (NRF). The first author is funded by the South African Medical Research Council (SAMRC) through its Division of Research Capacity Development under the National Health Scholarship Programme from funding received from the Public Health Enhancement Fund/South African National Department of Health and under the Intra-Mural Postdoctoral Fellowship Programme from funding received from the South African National Treasury. The last author is the director of the Extramural Unit on the Genomics of Brain Disorders that is funded by the South African Medical Research Council (SAMRC). The content herein is the sole responsibility of the authors and does not necessarily represent the official views of the South African Medical Research Council (SAMRC).

Notes on contributors

Jani Nöthling

Jani Nöthling is a post-doctoral fellow with an interest in psychological/psychiatric research related to post-traumatic stress disorder and depression.

Barbara Laughton

Barbara Laughton is a developmental paediatrician and researcher with an interest in infectious diseases and neurodevelopmental outcome in children living with HIV.

Soraya Seedat

Soraya Seedat is a psychiatrist and a professor of psychiatry at Stellenbosch University. She has a special interest in clinical and translational work in childhood and adult post-traumatic stress disorder.