Mother-child relationships, self-silencing, caregiving burden, and health outcomes among HIV+ and HIV− women
Firpo-Perretti, Yudelki M.
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Since the advent of antiretroviral therapy (ART), few studies have examined how mother-child relationships relate to physical and mental health in HIV+ and demographically-similar uninfected mothers. The present three studies investigated the relationships of mother-child relationship quality (MCRQ: measured qualitatively with autobiographical narratives) with HIV status, domestic violence, substance use, childcare burden, self-silencing, and mental and physical health outcomes. Health outcomes were measured at two time points, concurrent with the autobiographical narratives (T1) and 11 months later (T2). Participants were recruited from the Chicago Women’s Interagency HIV Study and included 87 HIV+ mothers and 38 demographically matched HIV‒ mothers (M age=43.8, SD=9.4) who were primarily African American (89.6%) and low income. Study 1 used analyses of covariance to examine relationships between MCRQ and concurrent HIV status, self-reported self-silencing, substance use, domestic violence, caregiving (i.e., number of children and time spent caregiving) and childcare burden (i.e., mother’s opinion of parenting, perceived difficulty of parenting, help received from children). Relative to HIV‒ mothers, HIV+ mothers spent fewer hours caregiving and cared for fewer children. Negative mother-child relationships related to higher substance use and self-silencing, and positive mother-child relationships related to more time caregiving and more children cared for. In Study 2, multiple and logistic regressions were used to examine MCRQ as predicting T1 and T2 self-reported depression symptoms and health-related quality of life among HIV+ and HIV‒ mothers, and self-reported ART adherence and viral load and CD4+ counts assessed through blood specimens in HIV+ mothers. Negative MCRQ predicted higher depression symptoms at T1, as well as lower health-related quality of life at T1 and T2. Positive MCRQ predicted lower viral load at T1. Study 3 examined the potential moderation of MCRQ on the relationship between time spent caregiving and health indicators in HIV+ and HIV‒ mothers. At higher levels of positive and negative MCRQ, more hours caring for children related to better odds of being 95% adherent to ART medications at T1. Together these studies suggest that mother-child relationships are integrally related to the health of HIV+ and HIV− mothers and may be important areas to consider in treating this population.