van den Heuvel Leigh L, Levin Jonathan, Mpango Richard S, Gadow Kenneth D, Patel Vikram, Nachega Jean B, Seedat Soraya, Kinyanda Eugene
Department of Psychiatry, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town, South Africa.
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Front Psychiatry. 2019 Jul 11;10:460. doi: 10.3389/fpsyt.2019.00460. eCollection 2019.
HIV-infected children and adolescents (CA-HIV) face significant mental health challenges related to a broad range of biological and psychosocial factors. Data are scarce on the agreement and discrepancy between caregivers and CA-HIV regarding emotional and behavioral problems (EBPs) in CA-HIV. We determined agreement between self- versus caregiver- reported EBPs and describe factors associated with informant discrepancy among caregiver-youth dyads who participated in the "Mental health among HIV-infected CHildren and Adolescents in KAmpala and Masaka, Uganda" (CHAKA) study. In a cross-sectional sample, caregiver-reported EBPs were assessed with the Child and Adolescent Symptom Inventory-5 (CASI-5), and self-reported problems were evaluated with the Youth Inventory-4 (YI-4) in 469 adolescents aged 12-17 years and the Child Inventory-4 (CI-4) in 493 children aged 8-11 years. Adolescents were questioned about experiences of HIV stigma. Caregiver psychological distress was assessed with the Self-Reporting Questionnaire (SRQ-20). Linear regression models were applied to identify variables associated with discrepancy scores. Self-reported emotional problems (EPs) were present in 28.8% of adolescents and 36.9% of children, and 14.5% of adolescents self-reported behavioral problems (BPs). There was only a modest correlation ( ≤ 0.29) between caregiver- and CA-HIV-reported EBPs, with caregivers reporting more EPs whereas adolescents reported more BPs. Informant discrepancy between adolescents and caregivers for BPs was associated with adolescent age and caregiver's employment and HIV status. Among adolescents, EP discrepancy scores were associated with adolescent's WHO HIV clinical stage, caregiver level of education, and caregivers caring for other children. Among children, EP discrepancy scores were associated with child and caregiver age, caregiver level of education, and caregiver self-rated health status. HIV stigma and caregiver psychological distress were also associated with discrepancy, such that adolescents who experienced HIV stigma rated their EPs as more severe than their caregivers did and caregivers with increased psychological distress rated EBPs as more severe than CA-HIV self-rated. EBPs are frequently endorsed by CA-HIV, and agreement between informants is modest. Informant discrepancy is related to unique psychosocial and HIV-related factors. Multi-informant reports enhance the evaluation of CA-HIV and informant discrepancies can provide additional insights into the mental health of CA-HIV.
感染艾滋病毒的儿童和青少年（CA-HIV）面临着与广泛的生物和心理社会因素相关的重大心理健康挑战。关于CA-HIV的照顾者与CA-HIV之间在情绪和行为问题（EBP）方面的一致性和差异的数据很少。我们确定了自我报告与照顾者报告的EBP之间的一致性，并描述了参与“乌干达坎帕拉和马萨卡感染艾滋病毒儿童和青少年的心理健康”（CHAKA）研究的照顾者-青少年二元组中信息提供者差异的相关因素。在一个横断面样本中，使用儿童和青少年症状量表-5（CASI-5）评估照顾者报告的EBP，使用青少年量表-4（YI-4）评估469名12至17岁青少年的自我报告问题，使用儿童量表-4（CI-4）评估493名8至11岁儿童的自我报告问题。询问青少年关于艾滋病毒污名化的经历。使用自我报告问卷（SRQ-20）评估照顾者的心理困扰。应用线性回归模型来识别与差异分数相关的变量。28.8%的青少年和36.9%的儿童存在自我报告的情绪问题（EP），14.5%的青少年自我报告存在行为问题（BP）。照顾者报告的EBP与CA-HIV报告的EBP之间只有适度的相关性（≤0.29），照顾者报告的EP更多，而青少年报告的BP更多。青少年与照顾者之间在BP方面的信息提供者差异与青少年年龄、照顾者的就业情况和艾滋病毒感染状况有关。在青少年中，EP差异分数与青少年的世界卫生组织艾滋病毒临床分期、照顾者的教育水平以及照顾其他儿童的照顾者有关。在儿童中，EP差异分数与儿童和照顾者的年龄、照顾者的教育水平以及照顾者的自我评定健康状况有关。艾滋病毒污名化和照顾者的心理困扰也与差异有关，即经历艾滋病毒污名化的青少年对其EP的评定比照顾者更严重，而心理困扰增加的照顾者对EBP的评定比CA-HIV自我评定更严重。CA-HIV经常认可EBP，信息提供者之间的一致性适度。信息提供者差异与独特的心理社会和艾滋病毒相关因素有关。多信息提供者报告可加强对CA-HIV的评估，信息提供者差异可为CA-HIV的心理健康提供更多见解。
