Relationship between Child Emotional and Behavior Difficulties and the Mental Health of Caregivers of Adolescents Living with HIV

Background and Purpose: Children and adolescents living with HIV are at a high risk of emotional and behavioral difficulties. In sub-Saharan Africa (SSA), a high prevalence of emotional and behavioral difficulties has been documented, with 24-27% of adolescents scoring positive for any psychiatric disorders and 30-50% exhibiting emotional, behavioral difficulties or significant psychological distress. Studies have documented environmental and family-level predictors of child difficulties. While the bidirectional relationship between child difficulties and caregivers’ mental health has been documented, the majority of studies have focused on caregivers of children with an autism spectrum disorder and those with developmental delays or disabilities. Few studies have focused on caregivers of children living with HIV, especially in SSA. Yet, distressed caregivers may be less responsive to and engaging with their children, more authoritarian and more neglectful in their parenting behaviors –which may increase the risk of non-adherence to medication, and overall poor health functioning of adolescents. This study examined the relationship between child emotional and behavioral difficulties and the mental health functioning of caregivers of adolescents living with HIV.

Methods: Data from a two-year pilot study (2020-2022) for adolescents living with HIV and their caregivers in southern Uganda were analyzed. A total of 89 child-caregiver dyads (N=178) were recruited into the study. Adolescents were eligible to participate if they: 1) were living with HIV and aware of their status; 2) between 10-14 years; 3) enrolled on ART in participating clinics; and 4) living within a family, including with extended family. Caregivers were eligible if, they identified as the primary caregiver of the adolescent and were willing to complete study activities. Ordinary Least Square (OLS) regression models were conducted to examine the association between caregivers’ reports of adolescent emotional and behavior difficulties (measured by Child Strengths and Difficulties Scale), parenting stress (measured by the Parenting Stress Index) and caregiver mental health (measured by the Brief Symptom Inventory).

Results: Adjusting for social demographic characteristics, child behavioral difficulties (b = 0.516; 95%CI: 0.182, 0.849), perceived impact of child difficulties (b = 0.891; 95%CI: 0.236, 1.545), being a child’s grandparent (b = -12.839; 95%CI: -23.278, -2.401) or other non-biological caregiver (b = -10.141; 95%CI: -18.131, -2.152), were all associated with parenting stress. On the other hand, perceived impact of child difficulties (b = 1.731; 95%CI: 1.094, 2.369), household asset index (b = -1.541; 95%CI: -2.716, -0.366), and other non-biological caregiver (b = -12.361; 95%CI: -19.485, -5.238) were associated with caregiver mental health.

Implication and Conclusion: Study findings contribute to the limited literature examining the relationship between child emotional and behavior difficulties and the mental health of caregivers of children living with HIV in SSA. Findings support the need for the development of strategies to address child behavioral health among children living with HIV and to mitigate the effects of these difficulties on their caregivers.