Family Stress and Support among Mothers Living with HIV and Their Children: A Mixed-Methods Longitudinal Investigation

 说明(由申请人提供)：本申请的总体目标是推进一系列研究方案，调查青年在家庭背景下的心理社会适应情况，特别是在面临母亲艾滋病毒等独特压力因素的家庭中。本研究的目的是探讨各种家庭压力源和过程与儿童结局的纵向关系，并探讨家庭支持对这些压力源的缓冲作用。这项拟议的项目旨在实现国家卫生研究院艾滋病研究部的目标，即对艾滋病毒的影响进行社会和行为研究，包括审查母亲艾滋病毒对儿童心理社会适应的影响、受艾滋病毒影响的家庭的家庭过程(例如育儿)以及艾滋病毒携带者母亲及其子女的社会支持网络。据估计，美国有120万成年人携带艾滋病毒，随着艾滋病毒携带者的预期寿命开始接近普通人群的预期寿命，MLH越来越有能力抚养他们的孩子。MLH面临着独特的挑战，既要管理疾病对身体和心理的影响，又要平衡养育子女的责任和减轻疾病对家庭的负面影响。因此，MLH往往会经历更高的育儿压力，降低的育儿质量，以及与是否向孩子披露他们的艾滋病毒血清状况有关的压力。此外，与非感染父母的儿童相比，患有MLH的儿童经历心理社会适应困难的风险更大。面对这些挑战，受母体艾滋病毒影响的家庭可能会向他们的社会网络寻求支持。然而，尽管初步证据表明，家庭社会支持可以保护MLH及其子女免受家庭压力的影响，但受艾滋病毒影响的家庭报告的社会支持水平低于未受影响的家庭。尽管MLH和他们的孩子经历了许多压力源和相对较低的社会支持，但随着时间的推移，人们对这些不同的家庭过程是如何相互联系的知之甚少。因此，运用尖端的统计技术和定性方法，本研究旨在(1)考察育儿实践、育儿压力、母亲艾滋病毒披露和儿童心理社会适应之间的纵向交易关系；(2)考察母亲和子女的社会支持在这些家庭过程中的缓冲作用；(3)定性地探讨这些家庭和社区过程与艾滋病毒披露和青少年适应的关系。该项目将从NIMH资助的一项父母研究中提取定量数据，该研究测试艾滋病毒披露干预措施，Track-II。第一阶段将涉及定量数据收集和分析，样本来自佐治亚州亚特兰大和加利福尼亚州洛杉矶的110名MLH儿童。第二阶段将涉及定性数据收集和分析，样本为16个二联体。第三阶段将涉及量化和定性调查结果的整合， 数据收尾和传播。结果将通过强调相关的治疗目标和变化的决定因素，为受产妇艾滋病毒影响的家庭的临床干预提供信息。

 DESCRIPTION (provided by applicant): The overarching goal of this application is to advance a programmatic line of research investigating youth psychosocial adjustment in the context of the family, particularly among families facing unique stressors such as maternal HIV. The objective of this study is to examine the longitudinal relations among various family stressors and processes with child outcomes and to explore the role of family support as a buffer against these stressors. The proposed project addresses the NIMH's Division of Aids Research (DAR) objective of conducting social and behavioral research on the impact of HIV, including an examination of the consequences of maternal HIV for children's psychosocial adjustment, family processes (e.g., parenting) among families affected by HIV, and the social support networks of mothers living with HIV (MLH) and their children. An estimated 1.2 million adults in the U.S. are living with HIV, and as the life expectancy for individuals who are HIV+ has begun to approach that of the general population, MLH are increasingly able to raise their children. MLH face the unique challenge of managing the physical and psychological effects of their illness while balancing childrearing responsibilities and mitigating the negative impact of their illness on thei families. As a result, MLH tend to experience elevated parenting stress, compromised parenting quality, and stress related to the decision of whether to disclose their HIV serostatus to their children. Also, children of MLH are at greater risk for experiencing psychosocial adjustment difficulties compared to children of non-infected parents. Faced with these challenges, families affected by maternal HIV may turn to their social networks for support. However, despite preliminary evidence that family social support may protect MLH and their children against family stress, families affected by HIV report lower levels of social support than non-affected families. Despite the many stressors and relatively low social support experienced by MLH and their children, little is known about how these various family processes are related to one another over time. Thus, applying cutting-edge statistical techniques as well as qualitative methods, the current study aims to (1) examine transactional longitudinal relations among parenting practices, parenting stress, maternal HIV disclosure, and child psychosocial adjustment; (2) examine the buffering role of mothers' and children's social support in these family processes; and (3) qualitatively explore these family and community processes as they relate to HIV disclosure and youth adjustment. This project will draw quantitative data from an NIMH-funded parent study testing an HIV disclosure intervention, TRACK-II. Phase I will involve quantitative data collection and analysis with a sample of 110 MLH-child dyads in Atlanta, GA, and Los Angeles, CA. Phase II will involve qualitative data collection and analysis with a subsample of 16 dyads. Phase III will involve integration of quantitative and qualitative findings, data closeout, and dissemination. Results will inform clinical interventions among families affected by maternal HIV by highlighting relevant targets for treatment and determinants of change.