HIV-infected mothers’ perceptions of uncertainty, stress, depression and social support during HIV viral testing of their infants

Original Contribution
First Online:
Received:
Accepted:

Abstract

To explore relationships between mothers’ uncertainty about infant HIV serostatus with stress, distress, depressive symptoms, and social support during infant HIV testing. This prospective longitudinal study of 20 HIV-infected mothers involved a prenatal visit and five postpartum visits clustered around infant HIV viral testing. Maternal uncertainty about infant HIV serostatus significantly decreased over time (p < 0.001). Before testing, uncertainty was inversely related to social support (r = −0.67), and positively related to perceived stress (r = 0.54), interpersonal social conflict (r = 0.57), symptom distress (r = 0.62), and depressive symptoms (r = 0.50); these relationships persisted throughout the infant testing period. Mothers with depressive symptoms during pregnancy demonstrated significantly more uncertainty within a few weeks after birth than mothers without depressive symptoms (p < 0.05). Several weeks after learning their infants were HIV negative, mothers’ uncertainty was only associated with social conflict (r = 0.49). Maternal uncertainty about infant HIV status declined significantly over time. There were no changes in perceptions of stress, distress or social support. Mothers with depressive symptoms experienced greater uncertainty about infants’ HIV status. Strategies to enhance support and treat depressive symptoms may reduce the uncertainty, stress, and distress HIV-infected mothers experience during viral testing of their infants.

Keywords

HIV-infected Postpartum Stress Depression Uncertainty 
This is a preview of subscription content, log in to check access.

Notes

Acknowledgements

The authors wish to thank Dr. Sheila Santacroce for permission to use the “Parental Perceptions of Uncertainty—Diagnosis” Scale and Dr. Virginia Tilden for permission to use the “Interpersonal Relationship Inventory” Scale for this study.

This research was funded in part by a National Research Service Award from the National Institute of Nursing Research (F31-NR008181), California University-wide AIDS Research Program dissertation award (D05-SF-403), and 2005 Woodrow Wilson and Johnson & Johnson Foundation Dissertation Award in Women’s Health.

References

  1. Beeghly M, Olson KL, Weinberg MK, Pierre SC, Downey SC, Tronick EZ (2003) Prevalence, stability, and socio-demographic correlates of depressive symptoms in Black mothers during the first 18 months postpartum. Matern Child Health J 7:157–168PubMedCrossRefGoogle Scholar
  2. Bennetts A, Shaffer N, Manopaiboon C, Chaiyakul P, Siriwasin W, Mock P, Klumthanom K, Sorapipatana S, Yuvasevee C, Jalanchavanapate S, Clark L (1999) Determinants of depression and HIV-related worry among HIV-positive women who have recently given birth, Bangkok, Thailand. Soc Sci Med 49:737–749PubMedCrossRefGoogle Scholar
  3. Bowen A, Muhajarine N (2006) Antenatal depression. Can Nurse 102:26–30PubMedGoogle Scholar
  4. Burack JH, Barrett DC, Stall RD, Chesney MA, Ekstrand ML, Coates TJ (1993) Depressive symptoms and CD4 lymphocyte decline among HIV-infected men. JAMA 270:2568–2573PubMedCrossRefGoogle Scholar
  5. Centers for Disease Control and Prevention (2006) Achievements in public health. Reduction in perinatal transmission of HIV infection—United States, 1985–2005. MMWR 55:592–597Google Scholar
  6. Cohen S, Williamson GM (1988) Perceived stress in a probability sample of the United States. In: Spacapan S, Oskamp S (eds) The social psychology of health. Sage, Newbury Park, CA, p 31Google Scholar
  7. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24:385–396PubMedCrossRefGoogle Scholar
  8. Cook JA, Cohen MH, Burke J, Grey DD, Anastos K, Kirstein L, Palacio H, Richardson J, Wilson T, Young M (2002) Effects of depressive symptoms and mental health quality of life on use of highly active antiretroviral therapy among HIV-seropositive women. J Acquir Immune Defic Syndr 30:401–409PubMedGoogle Scholar
  9. Cook JA, Grey DD, Burke-Miller JK, Cohen MH, Vlahov D, Kapadia F, Wilson TE, Cook R, Schwartz RM, Golub ET, Anastos K, Ponath C, Goparaju L, Levine AM (2007) Illicit drug use, depression and their association with highly active antiretroviral therapy in HIV-positive women. Drug Alcohol Depend 89:74–81PubMedCrossRefGoogle Scholar
  10. Derogatis LR, Melisaratos N (1983) The brief symptom inventory: an introductory report. Psychol Med 13:595–605PubMedGoogle Scholar
  11. Essex MJ, Kraemer HC, Armstrong JM, Boyce WT, Goldsmith HH, Klein MH, Woodward H, Kupfer DJ (2006) Exploring risk factors for the emergence of children’s mental health problems. Arch Gen Psychiatry 63:1246–1256PubMedCrossRefGoogle Scholar
  12. Ethier KA, Ickovics JR, Fernandez MI, Wilson TE, Royce RA, Koenig LJ, Perinatal Guidelines Evaluation Project Group (2002) The perinatal guidelines evaluation project HIV and pregnancy study: overview and cohort description. Public Health Rep 117:137–147PubMedGoogle Scholar
  13. Ethier KA, Kershaw TS, Lewis JB, Milan S, Niccolai LM, Ickovics JR (2006) Self-esteem, emotional distress and sexual behavior among adolescent females: inter-relationships and temporal effects. J Adolesc Health 38:268–274PubMedCrossRefGoogle Scholar
  14. Faithfull J (1997) HIV-positive and AIDS-infected women: challenges and difficulties of mothering. Am J Orthopsychiatry 67:144–151PubMedCrossRefGoogle Scholar
  15. Hackl KL, Somlai AM, Kelly JA, Kalichman SC (1997) Women living with HIV/AIDS: the dual challenge of being a patient and caregiver. Health Soc Work 22:53–62PubMedGoogle Scholar
  16. Halligan SL, Murray L, Martins C, Cooper PJ (2007) Maternal depression and psychiatric outcomes in adolescent offspring: a 13-year longitudinal study. J Affect Disord 97:145–154PubMedCrossRefGoogle Scholar
  17. Harris K, Campbell E (1999) The plans in unplanned pregnancy: secondary gain and the partnership. Br J Med Psychol 72:105–120PubMedCrossRefGoogle Scholar
  18. Hudson AL, Lee KA, Miramontes H, Portillo CJ (2001) Social interactions, perceived support, and level of distress in HIV-positive women. J Assoc Nurses AIDS Care 12:68–76PubMedCrossRefGoogle Scholar
  19. Ickovics JR, Ethier KA, Koenig LJ, Wilson TE, Walter EB, Fernandez MI (2000) Infant birth weight among women with or at high risk for HIV infection: the impact of clinical, behavioral, psychosocial, and demographic factors. Health Psychol 19:515–523PubMedCrossRefGoogle Scholar
  20. Ickovics JR, Hamburger ME, Vlahov D, Schoenbaum EE, Schuman P, Boland RJ, Moore J, HIV Epidemiology Research Study Group (2001) Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women. JAMA 285:1466–1474PubMedCrossRefGoogle Scholar
  21. Ickovics JR, Milan S, Boland R, Schoenbaum E, Schuman P, Vlahov D, HIV Epidemiology Research Study (HERS) Group (2006) Psychological resources protect health: 5-year survival and immune function among HIV-infected women from four U.S. cities. AIDS 20:1851–1860PubMedCrossRefGoogle Scholar
  22. Johnson MO, Lobo ML (2001) Mother–child interaction in the presence of maternal HIV infection. J Assoc Nurses AIDS Care 12:40–51PubMedCrossRefGoogle Scholar
  23. Kalichman SC, Ramachandran B, Catz S (1999) Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med 14:267–273PubMedCrossRefGoogle Scholar
  24. Kane RT, Day C (1999) The psychometric characteristics of the IPR inventory: data from rural Western Australia. Nurs Res 48:324–328PubMedCrossRefGoogle Scholar
  25. Kline CR, Martin DP, Deyo RA (1998) Health consequences of pregnancy and childbirth as perceived by women and clinicians. Obstet Gynecol 92:842–848PubMedCrossRefGoogle Scholar
  26. Lau Y, Keung DW (2007) Correlates of depressive symptomatology during the second trimester of pregnancy among Hong Kong Chinese. Soc Sci Med 64:1802–1811PubMedCrossRefGoogle Scholar
  27. Lazarus RS, Folkman S (1984) Stress, appraisal, and coping. Springer, New YorkGoogle Scholar
  28. Lee KA, Portillo CJ, Miramontes H (2001) The influence of sleep and activity patterns on fatigue in women with HIV/AIDS. J Assoc Nurses AIDS Care 12:19–27PubMedGoogle Scholar
  29. Lester P, Partridge JC, Chesney MA, Cooke M (1995) The consequences of a positive prenatal HIV antibody test for women. J Acquir Immune Defic Syndr and Hum Retrovirol 10:341–349Google Scholar
  30. Linn JG, Anema MG, Estrada JJ, Cain VA, Sharpe CP (1996) Self-appraised health, HIV infection, and depression in female clients of AIDS counseling centers. AIDS Patient Care STDS 10:250–257PubMedCrossRefGoogle Scholar
  31. McDowell I, Newell C (1996) Measuring health. A guide to rating scales and questionnaires, 2nd edn. Oxford University Press, New YorkGoogle Scholar
  32. McEwen BS (1998) Protective and damaging effects of stress mediators. N Engl J Med 338:171–179PubMedCrossRefGoogle Scholar
  33. Miles MS, Gillespie JV, Holditch-Davis D (2001) Physical and mental health in African American mothers with HIV. J Assoc Nurses AIDS Care 12:42–50PubMedCrossRefGoogle Scholar
  34. Miles MS, Holditch-Davis D, Eron J, Black BP, Pedersen C, Harris DA (2003) An HIV self-care symptom management intervention for African American Mothers. Nurs Res 52:350–360PubMedCrossRefGoogle Scholar
  35. Mishel M (1981) The measurement of uncertainty in illness. Nurs Res 30:258–263PubMedCrossRefGoogle Scholar
  36. Mishel M (1983) Parents’ perceptions of uncertainty concerning their hospitalized child. Nurs Res 32:324–334PubMedCrossRefGoogle Scholar
  37. Moehler E, Brunner R, Wiebel A, Reck C, Resch F (2006) Maternal depressive symptoms in the postnatal period are associated with long-term impairment of mother–child bonding. Arch Womens Ment Health 9:273–278PubMedCrossRefGoogle Scholar
  38. Moskowitz JT (2003) Positive affect predicts lower risk of AIDS mortality. Psychosom Med 65:620–626PubMedCrossRefGoogle Scholar
  39. Murphy LM, Koranyi K, Crim L, Whited S (1999) Disclosure, stress and psychological adjustment among mothers affected by HIV. AIDS Patient Care STDS 13:111–118PubMedGoogle Scholar
  40. Nelms TP (2005) Burden: the phenomenon of mothering with HIV. J Assoc Nurses AIDS Care 16:3–13PubMedCrossRefGoogle Scholar
  41. Otchet F, Carey MS, Adam L (1999) General health and psychological symptom status in pregnancy and the puerperium: what is normal? Obstet Gynecol 94:935–941PubMedCrossRefGoogle Scholar
  42. Perinatal HIV Guidelines Working Group of the United States (U.S.) Public Health Service Task Force (2006) Public Health Service Task Force recommendations for use of antiretroviral drugs in HIV-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States. October 12, 2006. Retrieved on March 31, 2007 from http://www.aidsinfor.nih.gov/guidelines/perinatal
  43. Philipps LH, O’Hara MW (1991) Prospective study of postpartum depression: 4 1/2-year follow-up of women and children. J Abnorm Psychol 100:151–155PubMedCrossRefGoogle Scholar
  44. Radloff LS (1977) The CES-D Scale: a self-report depression scale for research in the general population. Appl Psychol Meas 1:385–401CrossRefGoogle Scholar
  45. Ruiz JD, Molitor F, McFarland W, Klausner J, Lemp G, Page-Shafer K, Parikh-Patel A, Morrow S, Sun RK (2000) A population-based survey of young women residing in low-income neighborhoods of Northern California: methods, HIV and STD prevalence, and related risk behavior. West J Med 172:368–373PubMedCrossRefGoogle Scholar
  46. San Francisco HIV Epidemiology Report. Annual AIDS Surveillance Report (1998) www.dph.sf.ca.us/PHP/RptsHIVAIDS/survrpt.pdf Accessed March 29, 2008
  47. Santacroce SJ (2000) Support from health care providers and parental uncertainty during the diagnosis phase of perinatally acquired HIV infection. J Assoc Nurses AIDS Care 11:63–75PubMedCrossRefGoogle Scholar
  48. Santacroce SJ (2001) Measuring parental uncertainty during the diagnosis phase of serious illness in a child. J Pediatr Nurs 16:3–12PubMedCrossRefGoogle Scholar
  49. Sharts-Hopko NC, Regan-Kubinski JJ, Lincoln PS, Heverly MA (1996) Problem-focused coping in HIV-infected mothers in relation to self-efficacy, uncertainty, social support, and psychological distress. Image J Nurs Sch 28:107–111PubMedCrossRefGoogle Scholar
  50. Tilden VP, Nelson CA, May BA (1990) The IPR inventory: development and psychometric characteristics. Nurs Res 39:337–343PubMedGoogle Scholar
  51. Working Group on Antiretroviral Therapy and Medical Management of HIV-Infected Children (2006) Guidelines for the use of antiretroviral agents in pediatric HIV infection. October 26, 2006. Retrieved on March 31, 2007 from http://www.aidsinfor.nih.gov/guidelines/pediatric/PED

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  1. 1.School of Nursing and Dental HygieneUniversity of Hawaii at ManoaHonoluluUSA
  2. 2.Department of Family Health Care NursingUniversity of California, San FranciscoSan FranciscoUSA

Personalised recommendations