The burden of poor mental health on parenting in mothers living with HIV in Zimbabwe
Bibliographic record
Abstract
Background \nMothers living with HIV are at increased risk of comorbidities, including mental health \nconditions. Mental health condition rates may be high yet often undiagnosed and \nuntreated. This study aimed to assess the prevalence and factors associated with \nmental health conditions in mothers living with HIV and their association with parenting \nbehaviour. \nMethods \nFirstly, the 8-item Shona Symptom Questionnaire (SSQ-8), which identifies the risk of \ncommon mental disorders (CMD), was validated in a sample of 264 primary care clinic \nattendees compared to a gold standard, using a receiver operating characteristic curve \nto identify the optimal cut point of 6. The next phase used data from 485 mothers living \nwith HIV, participating in a cluster-randomised controlled trial evaluating parenting and \nincome interventions, to explore the prevalence of and risk factors for CMD, defined \nas a 3-category ordinal variable (no CMD, CMD at one timepoint, CMD at both \ntimepoints). I also investigated the association of CMD with parenting stress, parenting \nsense of competence and discipline. Lastly, a comprehensive parenting intervention \nwas evaluated using mixed methods and guided by the MRC guidance to evaluate \ncomplex interventions. \nResults \nThe SSQ-8 was found to have good validity when compared to the clinical \nassessments conducted by psychologists using the gold standard, Structured Clinical \nInterview for DSM-V (SCID). In the sample living with HIV, the optimal cut-off was ≥6 \nwith an area under the curve of 89% (95% CI: 83%–93%). A quarter (N=127, 25.7%) \nof the 495 mothers in our sample experienced repeat CMD symptoms and a further \n33.5% experienced CMD symptoms at one timepoint, with no difference by trial arm. \nAssociated risk factors for CMD included food insecurity (aOR=2.23 (1.32, 3.78) \np=0.003); domestic violence (aOR=3.12 (95% CI: 1.71, 5.70) p<0.001); mobility problems (aOR=2.71 (1.55, 4.72) p<0.001); increased pain and discomfort (aOR=1.61 \n(0.19, 2.43) p=0.015), low resilience (aOR=0.61 (0.42, 0.89) p=<0.010) and low \npostpartum bonding (aOR=3.13 (1.78, 5.52) p<0.001). CMD was associated with \nincreased parenting stress. Mean parenting stress (total score) standard deviation \nscores (SD) were higher among mothers with repeat CMD symptoms (97.1, SD 15.0) \ncompared to those with CMD symptoms at one timepoint (84.8, SD 14.8) and those \nwithout CMD symptoms (78.0, SD 12.8). Children of parents with repeat CMD were \nalmost three times as likely to have been spanked >20 times as opposed to children \nwith no CMD symptoms (14.2% vs 5.0%). A multivariate model found no association \nbetween repeat CMD symptoms and harsh discipline after adjusting for parenting \nstress. The process evaluation provided evidence that complex parenting \ninterventions are feasible, but there is a need to foresee and address potential \ncontextual and individual barriers to uptake. A major learning point was that future \ninterventions targeting mothers living with HIV should consider lessons learnt from the \nCHIDO intervention and seek to comprehensively address risk factors not only \naffecting their parenting outcomes but their mental health. \nConclusion \nThe SSQ-8 has been shown to be valid for the use of screening common mental \ndisorders in a population with high HIV prevalence. There is a high burden of mental \nhealth conditions in mothers living with HIV. These mothers have been shown to be at \nrisk of experiencing depressive symptoms at different trajectories of their parenting \njourney, with several risk factors identified. Therefore, there is a need for interventions \naimed at improving parenting and child outcomes and also to target addressing the \nrisk factors associated with poor maternal mental health.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".