Psychological morbidity and parenting stress in mothers of primary school children by timing of acquisition of HIV infection: a longitudinal cohort study in rural South Africa.
Psychological morbidity and parenting stress in mothers of primary school children by timing of acquisition of HIV infection: a longitudinal cohort study in rural South Africa.
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DOI：
10.1017/s204017441700068x
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发表时间：
2017-09
影响因子：
1.7
通讯作者：
T. Rochat;B. Houle;Alan Stein;Rebecca M. Pearson;Marie-Louise Newell;Ruth M. Bland;Ruth M. Bland
中科院分区：
文献类型：
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作者：
T. Rochat;B. Houle;Alan Stein;Rebecca M. Pearson;Marie-Louise Newell;Ruth M. Bland;Ruth M. Bland
需要艾滋病毒高流行地区的纵向孕产妇心理健康数据。 Siyakhula 队列 (SC) 是一个基于人群的队列，由来自南非农村地区的 HIV 阳性和阴性母亲 (n=1506) 以及 HIV 阴性儿童 (n=1536) 组成。 SC 包括 767 名 HIV 阴性母亲； 465 怀孕期间艾滋病毒呈阳性； 272 名自怀孕以来艾滋病毒呈阳性（n=2 缺少艾滋病毒状况）。一个亚组（n=890）参与了非随机母乳喂养干预[垂直传播研究（VTS）]；其余 (n=616) 居住在同一地区，并在 VTS 时接受产前护理，但不属于 VTS，而是接受预防母婴传播 (PMTCT) 计划的标准护理。在二次分析中，我们调查了在随访（出生后 7-11 年）中仍然是孩子主要照顾者的母亲（1506 名中的 1265 名）中心理发病率及其相关因素。我们使用标准化的界限和算法测量了母亲的抑郁症（患者健康问卷-9）、焦虑症（一般性焦虑症量表-7）和养育压力（养育压力指数-36）。总共有 75 名（5.9%）母亲符合抑郁标准，37 名（2.9%）母亲符合焦虑标准，134 名（10.6%）母亲有养育压力。使用完整病例逻辑回归（1265 名母亲中的 n=1206 名）与 HIV 阴性相比，怀孕期间检测 HIV 阳性使抑郁症的几率增加一倍[调整后的奇数比 (aOR)=1.96 [1.0-3.7] P=0.039]。育儿压力与怀孕后感染艾滋病毒 (aOR=3.11 [1.9-5.2] P<0.001) 和接触家庭犯罪 (aOR=2.02 [1.3-3.2] P=0.003) 呈正相关；与较高的母亲教育（aOR=0.29 [0.1-0.8] P=0.014）、母亲就业（aOR=0.55 [0.3-0.9] P=0.024）呈负相关。与标准护理 PMTCT 相比，VTS 母亲承受养育压力的几率降低 (aOR=0.61 [0.4-0.9] P=0.016)。将父母的支持纳入怀孕期间和怀孕后的生物医学治疗计划非常重要。
Longitudinal maternal mental health data are needed from high HIV prevalence settings. The Siyakhula Cohort (SC) is a population-based cohort of HIV-positive and negative mothers (n=1506) with HIV-negative children (n=1536) from rural South Africa. SC includes 767 HIV-negative mothers; 465 HIV-positive in pregnancy; 272 HIV-positive since pregnancy (n=2 missing HIV status). A subgroup (n=890) participated in a non-randomized breastfeeding intervention [Vertical Transmission Study (VTS)]; the remaining (n=616) were resident in the same area and received antenatal care at the time of the VTS, but were not part of the VTS, instead receiving the standard of care Prevention of Mother-to-Child Transmission (PMTCT) Programme. In secondary analysis we investigated the prevalence of, and factors associated with, psychological morbidity amongst mothers who were still the primary caregiver of the child (1265 out of 1506) at follow-up (7-11 years post-birth). We measured maternal depression (Patient Health Questionnaire-9), anxiety (General Anxiety Disorder Scale-7) and parenting stress (Parenting Stress Index-36), using standardized cut-offs and algorithms. In total, 75 (5.9%) mothers met criteria for depression, 37 (2.9%) anxiety and 134 (10.6%) parenting stress. Using complete case logistic regression (n=1206 out of 1265 mothers) as compared to being HIV-negative, testing HIV-positive in pregnancy doubled odds of depression [adjusted odd ratios (aOR)=1.96 [1.0-3.7] P=0.039]. Parenting stress was positively associated with acquisition of HIV after pregnancy (aOR=3.11 [1.9-5.2] P<0.001) and exposure to household crime (aOR=2.02 [1.3-3.2] P=0.003); negatively associated with higher maternal education (aOR=0.29 [0.1-0.8] P=0.014), maternal employment (aOR=0.55 [0.3-0.9] P=0.024). Compared with the standard of care PMTCT, VTS mothers had reduced odds of parenting stress (aOR=0.61 [0.4-0.9] P=0.016). Integrating parental support into mostly bio-medical treatment programmes, during and beyond pregnancy, is important.