The Impact of Child Emotional and Behavioral Difficulties on Caregiver's Mental Health: Insights from Families Impacted By HIV in Southern Uganda

Background and Purpose: In Uganda, children orphaned by HIV are at a high risk of emotional and behavioral difficulties (EBDs). This elevated risk of EBDs threatens caregivers’ mental health given that caregiving is an involving responsibility that can affect mental, physical health and overall well-being. While the existence of child EBDs and its impact on caregivers’ mental health is well documented in high income countries, studies examining child difficulties and caregiver mental health specifically, among those impacted by HIV in Sub-Saharan Africa is limited. To better understand child difficulties and caregiver mental health, this study addressed the following research objective: what is the association between child difficulties and caregiver mental among families impacted by HIV? The study further examined this relationship after controlling for gender, family cohesion and alcohol use.

Methods: This study utilized a baseline data from the Suubi-Maka study (2008-2012) that was implemented in10 primary schools in Southern Uganda. A total of 346 adolescent- caregiver dyads participated in the study. The Suubi-Maaka study was a cluster randomized controlled trial at the school level. Child EBDs were measured using the Child Strength and Difficulties scale (SDQ) as reported by caregivers. Caregiver mental health was measured by the Brief Symptom Inventory. Descriptive statistics were used to summarize the demographics of participants (with a mean age of 45.78 years, SD = 14.56; range: 18–87). Mixed effect linear regression model was used to examine the relationship between child difficulties and caregiver mental health.

Results: Results showed a significant positive association between child EBDs and caregiver mental health. High levels of child difficulties were associated with higher levels of caregiver mental health problems (𝛽=0.85, 95% CI: 0.64, 1.06 p<0.001). Male caregivers showed poorer mental health outcomes as compared to female caregivers (𝛽=10.18, 95% CI: 5.65, 14.72, p<0.001) and caregiver alcohol use (𝛽=5.22., 95% CI: 2.03, 8.41, p=0.001) was associated with poorer caregiver mental health. Notably, there was also a significant negative association between family cohesion and caregivers’ mental health (𝛽=-0.57., 95% CI: -1.05, 0.09, p=0.019)

Conclusion and Implications: The results emphasize the complex interplay of child difficulties, family cohesion, gender and its influence on caregivers’ mental health posing a significant implication for global health. The findings also challenge the idea that caregiving is primarily a female role, indicating a need to direct policy efforts and mental health services that addresses the unique needs of male caregivers. Future research is needed to explore the longitudinal pathways of this relationship: whether improving child EBDs can improve care giver mental health or vice versa.