Background
Mothers living with HIV are at increased risk of comorbidities, including mental health
conditions. Mental health condition rates may be high yet often undiagnosed and
untreated. This study aimed to assess the prevalence and factors associated with
mental health conditions in mothers living with HIV and their association with parenting
behaviour.
Methods
Firstly, the 8-item Shona Symptom Questionnaire (SSQ-8), which identifies the risk of
common mental disorders (CMD), was validated in a sample of 264 primary care clinic
attendees compared to a gold standard, using a receiver operating characteristic curve
to identify the optimal cut point of 6. The next phase used data from 485 mothers living
with HIV, participating in a cluster-randomised controlled trial evaluating parenting and
income interventions, to explore the prevalence of and risk factors for CMD, defined
as a 3-category ordinal variable (no CMD, CMD at one timepoint, CMD at both
timepoints). I also investigated the association of CMD with parenting stress, parenting
sense of competence and discipline. Lastly, a comprehensive parenting intervention
was evaluated using mixed methods and guided by the MRC guidance to evaluate
complex interventions.
Results
The SSQ-8 was found to have good validity when compared to the clinical
assessments conducted by psychologists using the gold standard, Structured Clinical
Interview for DSM-V (SCID). In the sample living with HIV, the optimal cut-off was ≥6
with an area under the curve of 89% (95% CI: 83%–93%). A quarter (N=127, 25.7%)
of the 495 mothers in our sample experienced repeat CMD symptoms and a further
33.5% experienced CMD symptoms at one timepoint, with no difference by trial arm.
Associated risk factors for CMD included food insecurity (aOR=2.23 (1.32, 3.78)
p=0.003); domestic violence (aOR=3.12 (95% CI: 1.71, 5.70) p