Association between caregiver depression symptoms and child executive functioning. Results from an observational study carried out in four sub-Saharan countries

AIDS Care. 2020 Apr;32(4):486-494. doi: 10.1080/09540121.2019.1659917. Epub 2019 Aug 28.


Depressive symptoms among HIV-positive (HIV+) women may negatively impact their health and possibly that of their young children through risk of compromised caregiving. We evaluated how depression symptoms in predominantly (97%) female caregivers relate to neurodevelopmental outcomes in their HIV affected children. Data come from the IMPAACT P1104s Study, an observational cohort across six sites in four countries: Zimbabwe, South Africa, Uganda and Malawi. Participants (n = 611) were 5-11-year-old children with HIV (HIV), HIV exposed uninfected (HEU), or HIV unexposed uninfected (HUU). Primary caregivers were assessed for depression with the Hopkins Symptom Checklist (HSCL) and children with Behavior Rating Inventory for Executive Function (BRIEF) parent-report, Kauffman Assessment Battery for Children II (KABC), Bruininks-Oseretsky Test of Motor Proficiency 2nd Ed. (BOT-2), Test of Variables of Attention (TOVA), Multiple Indicators Cluster Survey, Child Disability and Development scales (MICS-4). Caregivers with higher depression scores (>1.75 mean HSCL score) reported more executive function problems in their children, regardless of HIV status. All executive function scores were significantly (p < 0.001) associated with depressive symptomatology at baseline and across time. Caregiver depressive symptomatology was not associated with other assessed neurocognitive outcomes. These results highlight the potential impact of caregiver depression on child behavioral outcomes.

Keywords: Executive functioning; HIV/AIDS; child neuropsychology; sub-Saharan Africa.

Publication types

  • Observational Study
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • Caregivers / psychology*
  • Child
  • Child, Preschool
  • Cost of Illness
  • Depression / diagnosis*
  • Depression / epidemiology
  • Executive Function / physiology*
  • Female
  • HIV Infections / complications*
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • Humans
  • Malawi / epidemiology
  • Male
  • Middle Aged
  • Neurocognitive Disorders / epidemiology*
  • South Africa / epidemiology
  • Uganda / epidemiology
  • Zimbabwe / epidemiology


  • Anti-Retroviral Agents