Caregiver Mental Health and Child Physical Health in HIV-Affected Families

描述（由申请人提供）：Murray女士提议调查乌干达受艾滋病毒影响家庭的照顾者心理健康和儿童身体健康状况。这项研究的目标是为Murray女士在低资源环境中作为全球心理健康独立研究员的职业生涯做好准备。Murray女士将在完成密集的博士前培训的同时进行拟议的研究，该培训结合了课程，研讨会和面向以下目标的导师制：（1）通过借鉴生物，发展和社会文化观点，建立关于艾滋病毒，心理健康和儿童发展相互作用的多方面知识基础;（2）发展在复杂的艾滋病流行环境中解决流行病学问题所需的纵向数据分析、混合模型、因果推理和心理测量学方面的能力;（3）传播主要研究结果，以促进受艾滋病毒影响家庭的健康和参与专业发展。满足这些目标将导致必要的方法技能和主题知识，成为一个独立的调查员在她拟议的项目和未来的职业生涯。 在低资源环境中，抑郁母亲的子女的身体健康结果很好，使他们面临更大的教育成就低和疾病的风险。迄今为止，只有五项纵向研究对这种关系进行了研究。没有研究评估这种关系，特别是在受艾滋病毒影响的家庭，虽然艾滋病毒感染的照顾者是在抑郁症的风险较高，和艾滋病毒感染和受影响的儿童是在儿童生长不良和营养不良的风险较高。随着越来越多的证据表明，社区卫生工作者可以有效地治疗抑郁症在低资源环境中，拟议的研究结果可能会对提供给艾滋病毒感染家庭的护理标准产生重大影响。 拟议的研究将通过两个目标来解决文献中的这一差距：（1）评估照顾者心理健康在两年随访期间对艾滋病毒感染和受影响幼儿（2-5岁）的身体健康结果的影响程度;（2）探索随着时间的推移，儿童身体健康改善对照顾者心理健康的潜在相互影响。此外，这种关系的机制将探讨在一个次要的目的，以检查潜在的调解人和调解人之间的关系，照顾者的心理健康和儿童的身体健康，艾滋病毒感染和影响的幼儿。在这项研究中，申请人将对从乌干达农村艾滋病毒影响家庭的父母技能干预随机对照试验的对照组中收集的数据进行二次分析。拟议的研究非常符合国家精神卫生研究所的重点，即探索与艾滋病毒有关的合并症对儿童健康发展的影响，从独特的代际角度研究这个问题。 公共卫生相关性：拟议的研究有可能通过展示家庭成员健康的相互作用以及身心健康之间的联系，为向艾滋病毒/艾滋病患者家庭提供基本服务的政策提供信息。这项研究还将为提供服务提供信息，以促进儿童健康发展，改善成长成果，降低受艾滋病毒/艾滋病影响的儿童的发病率。

DESCRIPTION (provided by applicant): Ms. Murray proposes to investigate caregiver mental health and child physical health among HIV-affected families in Uganda. The goal of this research is to prepare Ms. Murray for a career as an independent researcher of global mental health in low-resource settings. Ms. Murray will perform the proposed research while completing intensive predoctoral training that combines coursework, seminars, and mentorship geared towards the following objectives: (1) to develop a multifaceted knowledge-base on the interaction of HIV, mental health, and child development by drawing upon biological, developmental, and sociocultural perspectives; (2) to develop the competencies in longitudinal data analysis, mixed models, causal inference, and psychometrics necessary for addressing epidemiologic questions in a complex, HIV-endemic environment; and, (3) to disseminate key study findings in order to promote health in HIV-affected families and participate in professional development. Meeting these objectives will lead to the methodological skills and subject-matter expertise necessary to become an independent investigator in her proposed project and future career. Poorer physical health outcomes have been demonstrated among children of depressed mothers in low-resource settings, placing them at greater risk for low educational achievement and disease. Only five longitudinal studies have been conducted on this relationship to date. No study has assessed this relationship specifically in HIV-affected families, though HIV-infected caregivers are at higher risk of depression, and, HIV-infected and affected children are at higher risk of poor child growth and nutrition. With growing evidence that community health workers can effectively treat depression in low-resource settings, results of the proposed research could have major implications for the standard of care offered to HIV-affected families. The proposed research will address this gap in the literature through two aims: (1) to assess the degree to which caregiver mental health affects physical health outcomes of HIV-infected and affected young children (ages 2-5 years) over a two year follow-up; and, (2) to explore the potential reciprocal impact of improvements in child physical health on caregiver mental health over time. Further, mechanisms of this relationship will be explored in a secondary aim to examine potential mediators and moderators of the relationship between caregiver mental health and child physical health in HIV-infected and affected young children. For this research, the applicant will conduct a secondary analysis of data collected from caregiver-child dyads in the control arm of a randomized controlled trial of a parenting skills intervention for HIV-affecte families in rural Uganda. The proposed research fits well with the National Institute of Mental Health's emphasis on exploring the impact of co-morbidities linked to HIV on the healthy development of children, examining this question from a unique intergenerational perspective. PUBLIC HEALTH RELEVANCE: The proposed study has the potential to inform policy for essential services to families living with HIV/AIDS by demonstrating interactions in the health of family members and the links between mental and physical health. This study will also inform service provision aimed at fostering healthy child development, improving growth outcomes, and reducing morbidity among children affected by HIV/AIDS.