Adolescent mothers and their children affected by HIV-An exploration of maternal mental health, and child cognitive development.
Adolescent mothers and their children affected by HIV-An exploration of maternal mental health, and child cognitive development.
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DOI：
10.1371/journal.pone.0275805
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Sherr, Lorraine
中科院分区：
文献类型：
--
作者：
Roberts, Kathryn J. Steventon;Smith, Colette;Cluver, Lucie;Toska, Elona;Jochim, Janina;Wittesaele, Camille;Marlow, Marguerite;Sherr, Lorraine
青春期母亲所生的一些孩子可能会面临发育问题，而另一些孩子则不会。仍然需要开展研究，重点关注哪些青春期母亲的孩子认知迟缓的风险最高。母亲的艾滋病毒状况和母亲的心理健康都可能影响儿童的发育。对孕产妇心理健康状况进行检查，尤其是在孕产妇感染艾滋病毒的情况下，可能是及时的。本研究探讨了青少年母亲的心理健康（比较感染艾滋病毒和未感染艾滋病毒的母亲）与其孩子的认知发展表现得分之间的关系。探讨了儿童发育不良的其他可能风险和保护因素，以确定青春期母亲所生的儿童可能面临认知发育不良的最大风险。分析中使用的横截面数据来自居住在南非的一大群青少年母亲及其孩子。青少年母亲完成了与自己和孩子有关的详细研究问卷，并由经过培训的研究人员使用马伦早期学习量表对所有儿童完成了标准化认知评估。使用卡方、t 检验（Kruskal Wallis 检验，如适用）和方差分析，根据孕产妇心理健康状况（可操作为可能的常见精神障碍）以及结合孕产妇心理健康和艾滋病毒状况来探索样本特征和儿童认知发展评分。使用多变量线性回归模型探讨可能的危险因素（包括孕产妇心理健康状况不佳和艾滋病毒）与儿童认知发展得分之间的关系。该研究纳入了 954 名青春期母亲； 24.1% (230/954) 感染艾滋病毒，12.6% (120/954) 被归类为可能患有常见精神障碍。调整协变量后，发现母亲艾滋病毒与儿童粗大运动评分降低相关（B = -2.90 [95%CI：-5.35，-0.44]，p = 0.02），但是，在母亲可能的常见精神障碍或母亲艾滋病毒状况（包括相互作用项）与儿童认知发展评分之间没有发现其他关联。探索个体母亲心理健康量表的敏感性分析发现，较高的创伤后应激症状评分与较低的儿童认知发展评分相关。探索儿童认知发展的潜在风险和保护因素的敏感性分析还发现，母亲受教育程度的提高可以保护儿童的发展分数，而儿童年龄的增加则可以作为较低发展分数的风险因素。这项研究解决了一个关键的证据差距，涉及了解受艾滋病毒影响的青少年母亲所生的孩子认知发展的可能风险因素。这群母亲经历着复杂的风险因素组合，包括艾滋病毒、可能常见的精神障碍，以及教育中断等结构性挑战。有针对性地采取干预措施来支持高危青少年母亲的孩子的认知发展可能是有益的。显然，需要考虑一揽子干预措施，例如将心理健康服务纳入现有服务、识别多种流行病风险以及解决教育和结构性挑战，所有这些都可能为母亲和儿童带来积极的结果。
Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development. Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores. The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores. This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.
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