HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University Mental Health and Substance Use Problems among.

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Presentation transcript:

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University Mental Health and Substance Use Problems among a Sample of African-American and Latina Caregivers of Children Infected, Affected, and Unaffected by HIV E. Karina Santamaria, 1,2 Katherine S. Elkington, 1 Stacey Alicea, 3 Curtis Dolezal, 1 Cheng-Shiun Leu, 1 Claude A. Mellins 1 1 HIV Center for Clinical and Behavioral Studies New York State Psychiatric Institute and Columbia University New York, NY, USA 2 The CUNY School of Public Health at Lehman College Bronx, NY, USA 3 New York University Steinhardt School of Education, Applied Psychology, New York, NY, USA XIX International AIDS Conference Washington D.C., USA

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University BACKGROUND HIV+ Birth mothers vulnerable:  Must cope with the stress of their own HIV.  Studies have found high rates of mental health problems (Brackis-Cott et al., 2007). Children perinatally HIV infected or exposed often do not reside with their birth mothers (Bachanas et al., 2001; Naar-King et al., 2006). Few studies have examined the psychological functioning of these other caregivers who include grandmothers, aunts, and non-kin adoptive parents. Similar to HIV+ mothers, these other caregivers are also typically from vulnerable backgrounds:  Reside in impoverished communities, affected by poverty, discrimination, racism.  Caring for youth who may have significant health and mental health problems of their own (Havens & Mellins, 2008).

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University STUDY AIM This study compares mental health problems and substance use disorder in 3 groups of caregivers of adolescents in US:  HIV+ birth mothers of HIV+/HIV- youth.  HIV- caregivers (relatives, non-kin adoptive parents) with HIV+/HIV-affected (HIV- born to HIV+ mother) youth. And a comparison group of  HIV- birth mothers with HIV- youth (Family Unaffected by HIV)

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University METHODS Risk & Resilience (NIMH R01MH63636; PI: Mellins):  HIV- youth aged years.  HIV+ and HIV- birth mothers. CASAH (NIMH R01-MH069133; PI Mellins):  Youth aged 9-16 years perinatally exposed to HIV (both HIV+ and HIV- included).  HIV+ birth mothers and other type of HIV- caregivers (e.g., relatives, adoptive parents). Families were recruited from clinics based in NYC:  General pediatric clinics.  HIV primary care clinics.  Network of HIV care providers.

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University METHODS (cont’d) The combined sample resulted in:  HIV+ Birth mothers = 46%  HIV- Non Birth caregivers = 27%  HIV- Birth mothers = 27% The samples from both studies were recruited from similar areas in New York City Data were collected via in-depth interviews.

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University MEASURES Demographic information:  Caregiver age, race/ethnicity, household composition, HIV status, relationship to child. Depression and anxiety symptoms:  Beck Depression Inventory (Beck, 1987).  State-Trait Anxiety Inventory (Spielberger, 1973). Substance use disorder:  Clinical Diagnostic Questionnaire (Aidala & Havens, 2000).

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University CAREGIVER CHARACTERISTICS

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University DEPRESSION & ANXIETY SYMPTOMS

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University SUBSTANCE USE DISORDER

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University MULTIPLE REGRESSION ANALYSES After adjusting for age, race/ethnicity, number of children under 18-years, income and having a partner in home:  HIV+ Birth mothers were more depressed and anxious than HIV- Non Birth caregivers (p≤.01).  Both Birth mother groups (HIV+ and HIV-) had more substance use problems than Non Birth caregivers (p≤.05).

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University LIMITATIONS Convenience sample. Cross-sectional analyses. Exclusion of men and foster care parents:  Too few men to include and NY state law makes it difficult to include foster care families in behavioral research. Possible under reporting by caregivers due to concerns of disclosure to child welfare agencies.

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University CONCLUSIONS HIV+ Birth mothers have worse mental health and more substance use problems than Non Birth caregivers. HIV- Non Birth caregivers were on average older with a higher annual income:  Income and related resources may buffer against mental health stressors. Differences in outcomes do not appear to be solely related to caregiver HIV status:  HIV- Birth mothers also had worse mental health and substance use outcomes than HIV- Non Birth caregivers.  Highlighting the vulnerability of inner-city HIV- Birth mothers and Latina mothers/caregivers.

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University RECOMMENDATIONS Data support the need for:  Efficacy-based interventions to promote the mental health and well being of HIV+ mothers.  Mental health and substance use interventions for inner-city, impoverished mothers who may not access health care and child support systems.  Further research to understand the resilience of Non Birth mothers is warranted.

HIV CENTER for Clinical and Behavioral Studies at NY State Psychiatric Institute and Columbia University ACKNOWLEDGEMENTS The Research Team:  Claude A. Mellins, PhD (PI)  Katherine S. Elkington, PhD  Stacey Alicea, MPH  Curtis Dolezal, PhD  Cheng-Shiun Leu, PhD The women who participated in the Risk and Resilience Study and CASAH.