Department of Psychiatry, College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA.
Department of Epidemiology, College of Public Health, University of Georgia, Athens, GA, USA.
Trop Med Int Health. 2019 May;24(5):608-619. doi: 10.1111/tmi.13221. Epub 2019 Mar 13.
Caregiver socio-emotional attributes are major determinants of child well-being. This investigation in vulnerable school-aged Ugandan children estimates relationships between children's well-being and their caregiver's anxiety, depression and social support.
Perinatally HIV-infected, HIV-exposed uninfected and HIV-unexposed Ugandan children and their caregivers were enrolled. Perinatal HIV status was determined by 18 months of age using DNA-polymerase chain-reaction test; status was confirmed via HIV rapid diagnostic test when children were 6-18 years old. Five indicators of child well-being (distress, hopelessness, positive future orientation, esteem and quality of life (QOL)) and caregivers' socioemotional status (depressive symptoms, anxiety and social support) were measured using validated, culturally adapted and translated instruments. Categories based on tertiles of each caregiver psychosocial indicator were defined. Linear regression analyses estimated percent differences (β) and corresponding 95% confidence intervals (CI) for child well-being in relation to caregiver's psychosocial status.
As per tertile increment, caregiver anxiety was associated with 2.7% higher distress (95%CI:0.2%, 5.3%) and lower self-esteem/QOL (β = -1.3%/-2.6%; 95%CI: -5.0%,-0.2%) in their children. Child distress/hopelessness increased (β = 3.3%/7.6%; 95%CI:0.4%, 14.7%) and self-esteem/QOL decreased 2.3% (β = -2.3%/-4.4%; 95%CI: -7.2%, -1.3%) as per tertile increment in caregiver depression. Higher caregiver social support was associated with lower distress and higher positive outlook (β = 3%; 95%CI:1.4%, 4.5%) in their children. HIV-infected/exposed children had most caregiver depression-related QOL deficit (β = -5.2%/-6.8%; 95%CI: -12.4%, -0.2%) and HIV-unexposed children had most caregiver social support-related enhancements in positive outlook (β=4.5%; 95%CI:1.9%, 7.1%).
Caregiver anxiety, depressive symptoms and low social support were associated with worse well-being in school-aged and adolescent children. Improvement of caregiver mental health and strengthening caregiver social support systems may be a viable strategy for improving well-being of vulnerable children and adolescents in this setting.
照顾者的社会情感属性是儿童福祉的主要决定因素。本研究在脆弱的学龄期乌干达儿童中，评估了儿童福祉与照顾者焦虑、抑郁和社会支持之间的关系。
本研究纳入了围产期感染艾滋病毒、感染艾滋病毒但未感染以及未感染艾滋病毒的乌干达儿童及其照顾者。通过聚合酶链反应试验，在儿童 18 个月时确定围产期艾滋病毒状况；在儿童 6-18 岁时，使用 HIV 快速诊断试验确认状况。使用经过验证、具有文化适应性和翻译的工具，测量了 5 项儿童福祉指标（痛苦、绝望、积极的未来取向、自尊和生活质量 (QOL)）和照顾者的社会情感状况（抑郁症状、焦虑和社会支持）。根据每个照顾者心理社会指标的三分位类别定义了类别。线性回归分析估计了与照顾者心理社会状况相关的儿童福祉的百分比差异 (β) 和相应的 95%置信区间 (CI)。
随着三分位增量，照顾者焦虑与儿童痛苦增加 2.7%（95%CI：0.2%，5.3%）和自尊/生活质量降低 1.3%（95%CI：-5.0%，-0.2%）有关。儿童的痛苦/绝望感增加（β=3.3%/7.6%；95%CI：0.4%，14.7%），自尊/生活质量降低 2.3%（β=-2.3%/-4.4%；95%CI：-7.2%，-1.3%），随着照顾者抑郁的三分位增量。更高的照顾者社会支持与儿童的痛苦减少和积极展望增加有关（β=3%；95%CI：1.4%，4.5%）。感染艾滋病毒/暴露的儿童的照顾者与生活质量相关的抑郁症状最严重（β=-5.2%/-6.8%；95%CI：-12.4%，-0.2%），而未感染艾滋病毒的儿童的照顾者与生活质量相关的社会支持最显著（β=4.5%；95%CI：1.9%，7.1%）。
照顾者的焦虑、抑郁症状和低社会支持与学龄期和青少年儿童的幸福感较差有关。改善照顾者的心理健康和加强照顾者的社会支持系统可能是改善这一环境中弱势儿童和青少年幸福感的可行策略。
