Ms. Murray proposes to investigate caregiver mental health and child physical health among HIV-affected families in Uganda. The goal of this research is to prepare Ms. Murray for a career as an independent researcher of global mental health in low-resource settings. Ms. Murray will perform the proposed research while completing intensive predoctoral training that combines coursework, seminars, and mentorship geared towards the following objectives: (1) to develop a multifaceted knowledge-base on the interaction of HIV, mental health, and child development by drawing upon biological, developmental, and sociocultural perspectives;(2) to develop the competencies in longitudinal data analysis, mixed models, causal inference, and psychometrics necessary for addressing epidemiologic questions in a complex, HIV-endemic environment;and, (3) to disseminate key study findings in order to promote health in HIV-affected families and participate in professional development. Meeting these objectives will lead to the methodological skills and subject-matter expertise necessary to become an independent investigator in her proposed project and future career. Poorer physical health outcomes have been demonstrated among children of depressed mothers in low-resource settings, placing them at greater risk for low educational achievement and disease. Only five longitudinal studies have been conducted on this relationship to date. No study has assessed this relationship specifically in HIV-affected families, though HIV-infected caregivers are at higher risk of depression, and, HIV-infected and affected children are at higher risk of poor child growth and nutrition. With growing evidence that community health workers can effectively treat depression in low-resource settings, results of the proposed research could have major implications for the standard of care offered to HIV-affected families. The proposed research will address this gap in the literature through two aims: (1) to assess the degree to which caregiver mental health affects physical health outcomes of HIV-infected and affected young children (ages 2-5 years) over a two year follow-up;and, (2) to explore the potential reciprocal impact of improvements in child physical health on caregiver mental health over time. Further, mechanisms of this relationship will be explored in a secondary aim to examine potential mediators and moderators of the relationship between caregiver mental health and child physical health in HIV-infected and affected young children. For this research, the applicant will conduct a secondary analysis of data collected from caregiver-child dyads in the control arm of a randomized controlled trial of a parenting skills intervention for HIV-affecte families in rural Uganda. The proposed research fits well with the National Institute of Mental Health's emphasis on exploring the impact of co-morbidities linked to HIV on the healthy development of children, examining this question from a unique intergenerational perspective.
The proposed study has the potential to inform policy for essential services to families living with HIV/AIDS by demonstrating interactions in the health of family members and the links between mental and physical health. This study will also inform service provision aimed at fostering healthy child development, improving growth outcomes, and reducing morbidity among children affected by HIV/AIDS.