HIV-infected Mothers and Mother-infant Interactions
HIV-infected Mothers and Mother-infant Interactions
Numerous studies have found that HIV-infected mothers are at risk for depression (Ethier et al., 2002; Knowlton et al., 2008; Murphy et al., 2002) and high levels of stress (Ethier et al., 2002), both of which may interfere with parenting (Knowlton et al., 2008) and ultimately child development. In a study byDutra et al. (2000), a positive mother-child relationship served as a protective factor for children of HIV-infected mothers. Consistent with the literature, this study's results indicate a relationship between certain maternal and child characteristics or outcomes. The transactional model serves as the basis for an explanation of these relationships. Although it is unclear where the cyclical pattern begins, this correlation study provides evidence that maternal characteristics or behaviors including maternal confidence, depression, distress, parental stress, and feelings about physical contact influence are influenced by infant characteristics or behaviors such as weight, temperament, number of children, and mother-child interactions.
In this study, maternal confidence showed a significant correlation with infant birth weight and dysfunctional parent-child interaction. The heavier the infants were, the more confident the mother was in her ability to parent. Although the general trend of this finding was not surprising based on premature infant literature that indicates lower maternal confidence/self-efficacy with a premature (small) infant compared with a larger infant (Zelkowitz et al., 2008), the fact that this trend holds true for full-term infants is somewhat novel and may be helpful in deciding which mothers should be targeted for an intervention aimed at increasing maternal confidence.
An inverse relationship was found for maternal confidence and dysfunctional parent-child interaction. Mothers reported lower levels of maternal confidence when there were elevated levels of dysfunctional parent-child interaction. Although no cause-and-effect relationship can be established with the current correlation study,Morawska and Sanders (2007), as well asBor and Sanders (2004), report that maternal confidence is a significant predictor of dysfunctional parenting. In addition to the role that parent-child interactions play in relation to maternal confidence, previous research also has identified the impact of the parent-child relationship on child developmental outcomes (Crockenberg & Leerkes, 2000). This finding is of particular concern because of the elevated incidences of mental health and social and cognitive disturbances among children of HIV-infected mothers (Forehand et al., 1998). Within the HIV literature, researchers suggest that quality of parent-child relationships and severity of maternal mental health issues are two key variables that influence psychosocial outcomes of the children of HIV-infected mothers (Forehand et al., 2002; Hough, Brumitt, Templin, Saltz, & Mood, 2003; McKee et al., 2007). These findings can be explained using the transactional model, which might suggest that infant weight may increase the chances of low maternal confidence and less than optimal parenting, which in turn may negatively influence parent-child interactions, which may affect child developmental outcomes in the end.
A third variable that consistently has been found in the literature to be influential on the psychosocial outcomes of children of HIV-infected mothers is maternal distress (Hough et al., 2003). A closer look at correlates of maternal depression and dysfunctional parent-child interactions among HIV-infected mothers highlights a significant relationship with maternal distress for both constructs. More frequent dysfunctional parent-child interactions as well as elevated maternal depression correspond with higher maternal distress. This close relationship among three risk factors for poor child outcomes among children with HIV-infected mothers causes significant concern. In developing an intervention for this group, it will be important to focus on characteristics that are changeable. However, unchangeable variables may be important in determining a particular subgroup with higher risks than the HIV-infected moms in general. One familial characteristic that is correlated with maternal depression is number of children. Incidents of maternal depression tend to increase with more children.
Another child characteristic that is difficult to influence is child temperament.Kivijarvi, Raiha, Kaljonen, Tamminen, and Piha (2005) found that infant temperament, maternal sensitivity, and negative mother-infant interactions that accompany difficult temperament and low maternal sensitivity remain stable over time. Because child temperament is difficult to change, an intervention for HIV-infected mothers and their children may instead focus on variables related to child temperament that might be more easily influenced. In this study, difficult child temperament was correlated with parental stress, dysfunctional parent-child interaction, and ongoing attitudes toward physical contact. A more difficult child temperament was associated with higher parental stress, more dysfunctional parent-child interactions, and less comfort with and feelings of importance of physical contact in general. Although a significant relationship between infant temperament and maternal depression was not apparent in this study's results,Hanington, Ramchandani, and Stein (2010) report significant effects of maternal depression on infant temperament from their longitudinal study. Once again, Sameroff's transactional model provides rationalization for these results because of the cyclical relationship of maternal and child characteristics. Understanding of the transactional model as it applies to the mother-infant relationship also will be essential when designing an intervention for this population because some key variables may be easier or more difficult to change.
Consistent with the HIV literature, this study shows that parent-child interactions are closely related to other important variables. In addition to variables mentioned previously, a relationship between dysfunctional parent-child interactions and parental stress as well as ongoing comfort with and feelings of importance of physical contact was revealed. In other words, as dysfunctional parent-child interactions increase, parental stress increases and comfort with and feelings of importance of physical contact in general decrease. The relationship between dysfunctional parent-child interactions and physical contact is particularly alarming. This finding suggests that in the event of a negative (dysfunctional) parent-child interaction, mothers appear to withdraw from physical contact in general and fail to see the value in it. For a group of mothers that is already at risk for depression and stress, retraction from and devaluing of physical contact appears to put them at even higher risk for these problems.
Discussion
Numerous studies have found that HIV-infected mothers are at risk for depression (Ethier et al., 2002; Knowlton et al., 2008; Murphy et al., 2002) and high levels of stress (Ethier et al., 2002), both of which may interfere with parenting (Knowlton et al., 2008) and ultimately child development. In a study byDutra et al. (2000), a positive mother-child relationship served as a protective factor for children of HIV-infected mothers. Consistent with the literature, this study's results indicate a relationship between certain maternal and child characteristics or outcomes. The transactional model serves as the basis for an explanation of these relationships. Although it is unclear where the cyclical pattern begins, this correlation study provides evidence that maternal characteristics or behaviors including maternal confidence, depression, distress, parental stress, and feelings about physical contact influence are influenced by infant characteristics or behaviors such as weight, temperament, number of children, and mother-child interactions.
In this study, maternal confidence showed a significant correlation with infant birth weight and dysfunctional parent-child interaction. The heavier the infants were, the more confident the mother was in her ability to parent. Although the general trend of this finding was not surprising based on premature infant literature that indicates lower maternal confidence/self-efficacy with a premature (small) infant compared with a larger infant (Zelkowitz et al., 2008), the fact that this trend holds true for full-term infants is somewhat novel and may be helpful in deciding which mothers should be targeted for an intervention aimed at increasing maternal confidence.
An inverse relationship was found for maternal confidence and dysfunctional parent-child interaction. Mothers reported lower levels of maternal confidence when there were elevated levels of dysfunctional parent-child interaction. Although no cause-and-effect relationship can be established with the current correlation study,Morawska and Sanders (2007), as well asBor and Sanders (2004), report that maternal confidence is a significant predictor of dysfunctional parenting. In addition to the role that parent-child interactions play in relation to maternal confidence, previous research also has identified the impact of the parent-child relationship on child developmental outcomes (Crockenberg & Leerkes, 2000). This finding is of particular concern because of the elevated incidences of mental health and social and cognitive disturbances among children of HIV-infected mothers (Forehand et al., 1998). Within the HIV literature, researchers suggest that quality of parent-child relationships and severity of maternal mental health issues are two key variables that influence psychosocial outcomes of the children of HIV-infected mothers (Forehand et al., 2002; Hough, Brumitt, Templin, Saltz, & Mood, 2003; McKee et al., 2007). These findings can be explained using the transactional model, which might suggest that infant weight may increase the chances of low maternal confidence and less than optimal parenting, which in turn may negatively influence parent-child interactions, which may affect child developmental outcomes in the end.
A third variable that consistently has been found in the literature to be influential on the psychosocial outcomes of children of HIV-infected mothers is maternal distress (Hough et al., 2003). A closer look at correlates of maternal depression and dysfunctional parent-child interactions among HIV-infected mothers highlights a significant relationship with maternal distress for both constructs. More frequent dysfunctional parent-child interactions as well as elevated maternal depression correspond with higher maternal distress. This close relationship among three risk factors for poor child outcomes among children with HIV-infected mothers causes significant concern. In developing an intervention for this group, it will be important to focus on characteristics that are changeable. However, unchangeable variables may be important in determining a particular subgroup with higher risks than the HIV-infected moms in general. One familial characteristic that is correlated with maternal depression is number of children. Incidents of maternal depression tend to increase with more children.
Another child characteristic that is difficult to influence is child temperament.Kivijarvi, Raiha, Kaljonen, Tamminen, and Piha (2005) found that infant temperament, maternal sensitivity, and negative mother-infant interactions that accompany difficult temperament and low maternal sensitivity remain stable over time. Because child temperament is difficult to change, an intervention for HIV-infected mothers and their children may instead focus on variables related to child temperament that might be more easily influenced. In this study, difficult child temperament was correlated with parental stress, dysfunctional parent-child interaction, and ongoing attitudes toward physical contact. A more difficult child temperament was associated with higher parental stress, more dysfunctional parent-child interactions, and less comfort with and feelings of importance of physical contact in general. Although a significant relationship between infant temperament and maternal depression was not apparent in this study's results,Hanington, Ramchandani, and Stein (2010) report significant effects of maternal depression on infant temperament from their longitudinal study. Once again, Sameroff's transactional model provides rationalization for these results because of the cyclical relationship of maternal and child characteristics. Understanding of the transactional model as it applies to the mother-infant relationship also will be essential when designing an intervention for this population because some key variables may be easier or more difficult to change.
Consistent with the HIV literature, this study shows that parent-child interactions are closely related to other important variables. In addition to variables mentioned previously, a relationship between dysfunctional parent-child interactions and parental stress as well as ongoing comfort with and feelings of importance of physical contact was revealed. In other words, as dysfunctional parent-child interactions increase, parental stress increases and comfort with and feelings of importance of physical contact in general decrease. The relationship between dysfunctional parent-child interactions and physical contact is particularly alarming. This finding suggests that in the event of a negative (dysfunctional) parent-child interaction, mothers appear to withdraw from physical contact in general and fail to see the value in it. For a group of mothers that is already at risk for depression and stress, retraction from and devaluing of physical contact appears to put them at even higher risk for these problems.
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