Children of mothers with HIV/AIDS: Unmet needs for mental health services

OBJECTIVE. The objective of this study was to use multiple measures and sources to assess mental health over time in uninfected 8- to 12-year-old children of HIV-positive mothers. METHODS. We recruited from the New York City Division of AIDS Services and Income Support a consecutive sample of 157 single mothers who were living with an HIV-negative child aged 8 to 12. Families were randomly assigned to receive a custody planning intervention, Project Care, or standard care. Data were collected at baseline and 4 subsequent times 6 months apart. Children completed the Children's Depression Inventory; 8- to 10-year-olds completed the Terry, and 11-to 12-year-olds completed the Youth Self-Report. Mothers completed the Child Behavior Checklist. Each measure has a validated cutoff score to signify clinically significant symptoms. RESULTS. All 5 data points were available on 129 (82%) children. During 2 years, every child had a score in the clinical range (12% once, 25% twice, 26% 3 times, 27% 4 times, and 9% all 5 times). Clinically significant symptoms were most likely at baseline when mothers were sickest. Few had clinically significant symptoms based on maternal report only (5%) or child report only (8%). Chronicity of clinically significant symptoms was not related to child age or gender, maternal health or depression, parent-child relationship, or being assigned to Project Care. Although two thirds of the children received mental health services during the study, <25% did at any 1 time, and 28% of children with chronic clinically significant symptoms never received care. CONCLUSIONS. Children who are affected by AIDS should be routinely screened for psychiatric problems by using multiple measures and sources to avoid underidentification and be carefully monitored long-term.