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中照料者的心理健康和儿童的身体健康。这项研究的目的是为Murray女士在低资源环境中成为一名独立的全球心理健康研究人员做好准备。Murray女士将进行拟议的研究，同时完成结合课程、研讨会和指导的密集博士前培训，以实现以下目标：(1)通过借鉴生物学、发育学和社会文化观点，建立一个关于艾滋病毒、心理健康和儿童发展相互作用的多方面知识库；(2)培养纵向数据分析、混合模型、因果推理和心理测量学方面的能力，以解决复杂的艾滋病毒流行环境中的流行病学问题；(3)传播主要研究成果，以促进艾滋病毒感染家庭的健康和参与专业发展。达到这些目标将导致方法学技能和主题方面的专业知识，这是她在拟议项目和未来职业生涯中成为独立调查员所必需的。

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.