1. Anxiety/stress among Mothers Living with HIV: Effects on Parenting Skills & Child Outcomes

2. Debra A. Murphy, Ph.D. Director, Health Risk Reduction Projects Department of Psychiatry University of California at Los Angeles

3. Will briefly discuss two studies today PACT TRACK

4. P arents A nd children C oping T ogether (P ACT ) 1997 - 2002 P arents and A dolescents C oping T ogether (P ACT II ) 2002 - 2007 P arents and A dolescents C oping T ogether (P ACT III ) 2008 – 2013 First cohort of children affected by maternal HIV/AIDS followed from early school age to late adolescence/early adulthood

5. P ACT Sample 135 mother/child dyads (N = 270) Mothers HIV symptomatic or AIDS dx Well children, 5 - 11 years (1 child per household)

6. Mother M age = 34.7 (SD = 6.21) African American 30% Latina 55% White (Not Latina) 6% Native American/ Alaskan Native 3% Mixed/Other 6% Child M age = 8.47 (SD = 1.85); 47% Female

7. The majority of MLH were on antiretroviral therapy & had very poor adherence Factors Associated with Decreased Adherence –Stressp <.05 –Having a Partnerp <.001 –Age of youngest child (trend)p <.10 Adherence & Stress

8. Disclosure to children is one of the main concerns of mothers Nondisclosure can impact the mom’s physical and psychological functioning –skip medications –more likely to miss medical appointments –greater levels of depression Disclosure & Stress

9. Family Routines & Stress Parenting skills may play an especially important role in families with a chronically ill parent. Longitudinal study (average child age at start was 8 years of age; at end was 13.8)

10. Maternal health associated with family routines across time –huge impact of family routines on child outcomes Issue of stability of parental skill

11. Projected Trajectories for Low & High Stability of Family Routines x Age The trajectory for those where family routines are highly unstable exhibit Increasing conduct disorder behavior over time.

12. QUESTIONS

13. All of the factors discussed so far that cause stress to the mothers have an impact on child outcomes (such as mothers not being able to implement consistent family routines). Mothers are aware of the fact that children are being impacted—this is clear from the following quotes:

14. Quotes from Mothers “You feel useless. You cannot cook for your kids, take care of them, take them out... It was very frustrating. I felt bad.” “Many times he wanted me to take him to the park and I was... suffering from the side effects of the medicine. He got frustrated, angry... he really wanted more attention.”

15. “When they hospitalized me for three months straight, I wasn’t there for him and I couldn’t—3 months seemed like not a long time, but it is for his age... He wanted momma and I couldn’t be there.”

16. “When I knew there was something going on, I didn’t take the medicine... holidays, school events... things like that. I don’t take the medicine because if I take [it], I’m going to be sleepy, I’m going to have diarrhea, I’m going to be nauseated, dizzy, can’t drive, pain in my legs, all that.”

17. “One day he came home from school and told me, ‘Mommy, I am going to tell you something... Sometimes I am at school and I am thinking about the hospital and what is happening to you... That is happening to me a lot’.”

18. QUESTIONS

19. Teaching, Raising, And Communicating with Kids (TRACK) Study to investigate maternal stress among mothers living with HIV

20. Background Parenting stress has been defined as the difficulty that arises from the demands of being a parent. High levels of anxiety & stress have been associated with negative parenting practices.

21. Mother M age = 37.5 (SD = 7.3) African American 15.9% Latina 81.2% White 1.4% Other 1.4% Sample Characteristics: 69 MLH

22. HIV Health-Related Anxiety Anxiety Parenting Stress Parental Anxiety/ Stress Aggression Delinquency Anxiety Child Problem Behaviors Parenting Skills Family Routines Parent/Child Communication Parent Discipline -0.96**-0.73**

23. Maternal anxiety/stress had a direct association with parenting skills. Those who were more stressed: Had less consistent discipline Had poorer parent-child communication Engaged in less frequent family routines Parenting skills had a direct negative association with child outcomes.

24. Parenting interventions need to provide mother with information: How their distress can affect the child Strategies & support for dealing with distress Strategies to implement parenting skills

25. QUESTIONS