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Association between caregiver depression symptoms and child executive functioning. Results from an observational study carried out in four sub-Saharan countries.

  • Familiar, Itziar1
  • Chernoff, Miriam2
  • Ruisenor-Escudero, Horacio1
  • Laughton, Barbara3
  • Joyce, Celeste4
  • Fairlie, Lee5
  • Vhembo, Tichaona6
  • Kamthunzi, Portia7
  • Barlow-Barlow, Linda8
  • Zimmer, Bonnie9
  • McCarthy, Katie10
  • Boivin, Michael J11
  • 1 Department of Psychiatry, Michigan State University , East Lansing , MI , USA.
  • 2 Center for Biostatistics in AIDS Research, Harvard University , Boston , MA , USA.
  • 3 Department of Pediatrics and Child Health, Stellenboch University , Tygerberg , RSA.
  • 4 Perinatal HIV Research Unit (PHRU), Chris Hani Baragwanath Hospital , Johannesburg , RSA.
  • 5 Wits Reproductive Health and HIV Institute, Shandukani Clinic , Johannesburg , RSA.
  • 6 Harare Family Care CRS, University of Zimbabwe , Harare , Zimbabwe. , (Zimbabwe)
  • 7 University of North Carolina-Lilongwe Clinical Research Institute , Lilongwe , Malawi. , (Malawi)
  • 8 Makerere University-Johns Hopkins University Research Collaboration , Kampala , Uganda. , (Uganda)
  • 9 Frontier Science Foundation , Amherst , MA , USA.
  • 10 FHI 360 , Durham , NC , USA.
  • 11 Departments of Psychiatry and Neurology, Michigan State University , East Lansing , MI , USA.
Published Article
AIDS care
Publication Date
Aug 28, 2019
DOI: 10.1080/09540121.2019.1659917
PMID: 31462095


Depressive symptoms among HIV-positive (HIV+) women may negatively impact their health and possibly that of their young children through risk of compromised caregiving. We evaluated how depression symptoms in predominantly (97%) female caregivers relate to neurodevelopmental outcomes in their HIV affected children. Data come from the IMPAACT P1104s Study, an observational cohort across six sites in four countries: Zimbabwe, South Africa, Uganda and Malawi. Participants (n = 611) were 5-11-year-old children with HIV (HIV), HIV exposed uninfected (HEU), or HIV unexposed uninfected (HUU). Primary caregivers were assessed for depression with the Hopkins Symptom Checklist (HSCL) and children with Behavior Rating Inventory for Executive Function (BRIEF) parent-report, Kauffman Assessment Battery for Children II (KABC), Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2), Test of Variables of Attention (TOVA), Multiple Indicators Cluster Survey, Child Disability and Development scales (MICS-4). Caregivers with higher depression scores (>1.75 mean HSCL score) reported more executive function problems in their children, regardless of HIV status. All executive function scores were significantly (p < 0.001) associated with depressive symptomatology at baseline and across time. Caregiver depressive symptomatology was not associated with other assessed neurocognitive outcomes. These results highlight the potential impact of caregiver depression on child behavioral outcomes.

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