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BACKGROUND

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

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BACKGROUND

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  1. 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 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

  2. 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).

  3. 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)

  4. 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.

  5. 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.

  6. 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).

  7. CAREGIVER CHARACTERISTICS

  8. DEPRESSION & ANXIETY SYMPTOMS

  9. SUBSTANCE USE DISORDER

  10. 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).

  11. 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.

  12. 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.

  13. 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.

  14. 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.

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