HIV CENTER for Clinical and Behavioral Studiesat 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. Mellins1

1 HIV Center for Clinical and Behavioral StudiesNew York State Psychiatric Institute and Columbia University

New York, NY, USA2 The CUNY School of Public Health at Lehman College

Bronx, NY, USA3 New York University Steinhardt School of Education, Applied Psychology,

New York, NY, USA

XIX International AIDS ConferenceWashington D.C., USA

HIV CENTER for Clinical and Behavioral Studiesat 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 Studiesat 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 Studiesat NY State Psychiatric Institute and Columbia University

METHODS

Risk & Resilience (NIMH R01MH63636; PI: Mellins): HIV- youth aged 10-14 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 Studiesat 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 Studiesat 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 Studiesat NY State Psychiatric Institute and Columbia University

CAREGIVER CHARACTERISTICS

HIV CENTER for Clinical and Behavioral Studiesat NY State Psychiatric Institute and Columbia University

DEPRESSION & ANXIETY SYMPTOMS

HIV CENTER for Clinical and Behavioral Studiesat NY State Psychiatric Institute and Columbia University

SUBSTANCE USE DISORDER

HIV CENTER for Clinical and Behavioral Studiesat 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 Studiesat 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 Studiesat 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 Studiesat 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 Studiesat 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.