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

 描述（由申请人提供）：本申请的总体目标是推进一项研究计划，调查家庭背景下的青年心理社会调整，特别是在面临独特压力的家庭中，如孕产妇艾滋病毒。本研究的目的是探讨各种家庭压力源和过程与儿童结果之间的纵向关系，并探讨家庭支持作为缓冲这些压力源的作用。拟议的项目涉及NIMH艾滋病研究部（DAR）的目标，即对艾滋病毒的影响进行社会和行为研究，包括检查孕产妇艾滋病毒对儿童心理社会调整、家庭过程（例如，艾滋病毒感染者家庭的社会支持网络（父母养育子女）以及艾滋病毒感染者母亲及其子女的社会支持网络。据估计，美国有120万成年人感染了艾滋病毒，随着艾滋病毒阳性者的预期寿命开始接近普通人群，MLH越来越有能力抚养他们的孩子。MLH面临着独特的挑战，即管理他们的疾病对身体和心理的影响，同时平衡育儿责任和减轻他们的疾病对家庭的负面影响。因此，MLH往往经历升高的养育压力，降低养育质量，并与决定是否透露他们的艾滋病毒血清状态给他们的孩子的压力。此外，与非感染父母的儿童相比，MLH儿童经历心理社会适应困难的风险更大。面对这些挑战，受孕产妇艾滋病毒影响的家庭可能会向其社交网络寻求支持。然而，尽管有初步证据表明，家庭社会支持可以保护MLH及其子女免受家庭压力，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。尽管许多压力和相对较低的社会支持所经历的MLH和他们的孩子，很少有人知道这些不同的家庭过程是如何随着时间的推移相互关联。因此，本研究运用先进的统计技术和定性方法，旨在（1）探讨父母教养方式、父母教养压力、母亲艾滋病暴露和儿童心理社会适应之间的纵向关系;（2）探讨母亲和儿童的社会支持在这些家庭过程中的缓冲作用;定性探讨这些家庭和社区过程，因为它们涉及到艾滋病毒的披露和青年的调整。该项目将从NIMH资助的父母研究中提取定量数据，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的样本110 MLH儿童二对在亚特兰大，佐治亚州和洛杉矶，加利福尼亚州。第二阶段将涉及定性数据收集和分析，子样本为16对。第三阶段将把定量和定性结果结合起来， 数据收尾和传播。研究结果将通过强调相关的治疗目标和变化的决定因素，为受孕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.