Adolescent mothers and their children affected by HIV-An exploration of maternal mental health, and child cognitive development.

Publisher: Public Library of Science Country of Publication: United States NLM ID: 101285081 Publication Model: eCollection Cited Medium: Internet ISSN: 1932-6203 (Electronic) Linking ISSN: 19326203 NLM ISO Abbreviation: PLoS One Subsets: MEDLINE

Original Publication: San Francisco, CA : Public Library of Science

Child Development* ; HIV Infections*/epidemiology; Humans ; Child ; Adolescent ; Female ; Mental Health ; Cross-Sectional Studies ; Adolescent Mothers ; Mothers/psychology ; Cognition

Background: Some children born to adolescent mothers may have developmental challenges, while others do not. Research focusing on which children of adolescent mothers are at the highest risk for cognitive delay is still required. Both maternal HIV status and maternal mental health may affect child development. An examination of maternal mental health, especially in the presence of maternal HIV infection may be timely. This study explores the relationship between the mental health of adolescent mothers (comparing those living with and not living with HIV) and the cognitive development performance scores of their children. Additional possible risk and protective factors for poor child development are explored to identify those children born to adolescent mothers who may be at the greatest risk of poor cognitive development.
Methods: Cross-sectional data utilised within the analyses was drawn from a large cohort of adolescent mothers and their children residing in South Africa. Detailed study questionnaires were completed by adolescent mothers relating to their self and their child and, standardised cognitive assessments were completed by trained researchers for all children using in the Mullen Scales of Early Learning. Chi-square, t-tests (Kruskal Wallis tests, where appropriate), and ANOVA were used to explore sample characteristics and child cognitive development scores by maternal mental health status (operationalised as likely common mental disorder) and combined maternal mental health and HIV status. Multivariable linear regression models were used to explore the relationship between possible risk factors (including poor maternal mental health and HIV) and, child cognitive development scores.
Results: The study included 954 adolescent mothers; 24.1% (230/954) were living with HIV, 12.6% (120/954) were classified as experiencing likely common mental disorder. After adjusting for covariates, maternal HIV was found to be associated with reduced child gross motor scores (B = -2.90 [95%CI: -5.35, -0.44], p = 0.02), however, no other associations were identified between maternal likely common mental disorder, or maternal HIV status (including interaction terms), and child cognitive development scores. Sensitivity analyses exploring individual maternal mental health scales identified higher posttraumatic stress symptomology scores as being associated with lower child cognitive development scores. Sensitivity analyses exploring potential risk and protective factors for child cognitive development also identified increased maternal educational attainment as being protective of child development scores, and increased child age as a risk factor for lower development scores.
Conclusions: This study addresses a critical evidence gap relating to the understanding of possible risk factors for the cognitive development of children born to adolescent mothers affected by HIV. This group of mothers experience a complex combination of risk factors, including HIV, likely common mental disorder, and structural challenges such as educational interruption. Targeting interventions to support the cognitive development of children of adolescent mothers most at risk may be of benefit. Clearly a basket of interventions needs to be considered, such as the integration of mental health provision within existing services, identifying multiple syndemics of risk, and addressing educational and structural challenges, all of which may boost positive outcomes for both the mother and the child.
Competing Interests: The authors have declared that no competing interests exist.

PLoS Med. 2021 May 10;18(5):e1003602. (PMID: 33970913)
AIDS Behav. 2022 Apr;26(4):1197-1210. (PMID: 34570313)
Glob Public Health. 2020 Nov;15(11):1655-1673. (PMID: 32507031)
S Afr J Commun Disord. 2018 Mar 08;65(1):e1-e9. (PMID: 29781700)
J Child Psychol Psychiatry. 2015 Aug;56(8):865-73. (PMID: 25399699)
BMC Public Health. 2010 Nov 12;10:693. (PMID: 21073710)
BMC Public Health. 2016 Nov 25;16(1):1191. (PMID: 27884181)
J Epidemiol Community Health. 2016 Feb;70(2):168-73. (PMID: 26359503)
J Clin Psychiatry. 2010 Mar;71(3):313-26. (PMID: 20331933)
Arch Dis Child. 2003 Jan;88(1):34-7. (PMID: 12495957)
J Abnorm Child Psychol. 1978 Jun;6(2):271-80. (PMID: 670592)
J Child Psychol Psychiatry. 2000 Sep;41(6):747-57. (PMID: 11039687)
J Affect Disord. 2019 Feb 15;245:82-90. (PMID: 30368074)
J Pediatr Adolesc Gynecol. 2014 Jun;27(3):138-50. (PMID: 24559618)
Br J Psychiatry. 2004 Feb;184:169-75. (PMID: 14754831)
Am J Epidemiol. 1993 Dec 1;138(11):923-36. (PMID: 8256780)
JAMA Pediatr. 2017 Jun 1;171(6):573-592. (PMID: 28384795)
Lancet. 2007 Jan 6;369(9555):60-70. (PMID: 17208643)
Soc Sci Med. 2010 Aug;71(3):517-528. (PMID: 20621748)
PLoS One. 2012;7(10):e46905. (PMID: 23056523)
Nervenarzt. 2019 Mar;90(3):243-250. (PMID: 30643954)
S Afr Med J. 2020 Aug 31;110(9):850-854. (PMID: 32880266)
Stud Fam Plann. 2008 Dec;39(4):351-68. (PMID: 19248720)
J Int AIDS Soc. 2013 Jun 18;16:18593. (PMID: 23782478)
Pediatrics. 2013 Feb;131(2):e463-9. (PMID: 23296445)
Health Promot Perspect. 2020 Nov 07;10(4):325-337. (PMID: 33312928)
J Int AIDS Soc. 2017 May 16;20(Suppl 3):21497. (PMID: 28530045)
Pan Afr Med J. 2013 Aug 06;15:120. (PMID: 24255726)
AIDS Care. 2016 Mar;28 Suppl 2:130-41. (PMID: 27392008)
Soc Sci Med. 1991;32(6):705-14. (PMID: 2035047)
J Affect Disord. 2008 Apr;107(1-3):241-5. (PMID: 17854906)
J Child Psychol Psychiatry. 2007 Aug;48(8):764-72. (PMID: 17683448)
JAMA Pediatr. 2013 Dec;167(12):1135-42. (PMID: 24165922)
J Psychosom Res. 2012 Nov;73(5):369-74. (PMID: 23062811)
AIDS Care. 2019 Jan;31(1):117-124. (PMID: 30304947)
Lancet. 2017 Jan 7;389(10064):103-118. (PMID: 27717610)
Glob Public Health. 2022 Aug-Sep;17(9):2111-2124. (PMID: 34432605)
Am J Epidemiol. 1989 Jan;129(1):125-37. (PMID: 2910056)
AIDS Behav. 2021 Jul;25(7):2094-2107. (PMID: 33452658)
Lancet Glob Health. 2019 Nov;7(11):e1521-e1540. (PMID: 31607465)
Matern Child Health J. 2014 Sep;18(7):1728-41. (PMID: 24352625)
Int J Environ Res Public Health. 2018 Jul 06;15(7):. (PMID: 29986446)
J Child Adolesc Psychiatr Nurs. 2009 Nov;22(4):194-202. (PMID: 19930300)
Issues Ment Health Nurs. 2010 Nov;31(11):700-7. (PMID: 20936891)
BMJ. 2004 May 15;328(7449):1152. (PMID: 15142897)
Stud Fam Plann. 2008 Dec;39(4):369-82. (PMID: 19248721)
AIDS Care. 2018 Jun;30(sup2):74-82. (PMID: 29848008)
Curr Psychiatry Rep. 2016 Mar;18(3):24. (PMID: 26830882)
Lancet Glob Health. 2016 Dec;4(12):e916-e922. (PMID: 27717632)
J Int AIDS Soc. 2014 Mar 19;17:18585. (PMID: 24650763)
PLoS One. 2015 May 21;10(5):e0126929. (PMID: 25996151)
Lancet. 2017 Jan 7;389(10064):9-11. (PMID: 27717607)
J Int AIDS Soc. 2020 Dec;23(12):e25654. (PMID: 33340267)
PLoS Negl Trop Dis. 2009 Aug 25;3(8):e412. (PMID: 19707588)
Appl Nurs Res. 2014 Nov;27(4):242-8. (PMID: 24726421)

K43 TW011434 United States TW FIC NIH HHS; MR/R022372/1 United Kingdom MRC_ Medical Research Council; United Kingdom DH_ Department of Health

Date Created: 20221020 Date Completed: 20221024 Latest Revision: 20240410

20240410

PMC9584392

10.1371/journal.pone.0275805

36264898