title: Psychological distress, substance use, and adjustment among parents living with HIV.
abstract: BACKGROUND
  Being a parent, especially a custodial parent, living with HIV was anticipated to increase psychological distress and challenges to self-care.
  
  
  METHODS
  Mental health symptoms, substance use, and health care utilization were assessed among 3818 HIV-infected adults, including custodial parents, noncustodial parents, and nonparents, in 4 AIDS epicenters.
  
  
  RESULTS
  Custodial parents demonstrated significantly poorer medication adherence and attendance at medical appointments but were similar to nonparents and noncustodial parents in mental health symptoms and treatment utilization for mental health and substance use problems. Noncustodial parents demonstrated the highest levels of recent substance use and substance abuse treatment. Other markers of risk, such as African American ethnicity, lack of current employment income, and injection drug use moderated many of the apparent psychosocial disadvantages exhibited by parents.
  
  
  CONCLUSIONS
  Interventions specific to the psychosocial stressors facing families living with HIV are needed.
authors.affiliation: Center for Community Health, UCLA Neuropsychiatric Institute, USA. goldster@mail.nih.gov
authors.forename: Risë B
authors.initials: RB
authors.lastname: Goldstein
authors.forename: Mallory O
authors.initials: MO
authors.lastname: Johnson
authors.forename: Mary Jane
authors.initials: MJ
authors.lastname: Rotheram-Borus
authors.forename: Sheri B
authors.initials: SB
authors.lastname: Kirshenbaum
authors.forename: Rogério M
authors.initials: RM
authors.lastname: Pinto
authors.forename: Lauren
authors.initials: L
authors.lastname: Kittel
authors.forename: Willo
authors.initials: W
authors.lastname: Pequegnat
authors.forename: Joanne D
authors.initials: JD
authors.lastname: Mickalian
authors.forename: Lance S
authors.initials: LS
authors.lastname: Weinhardt
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kelly
authors.forename: Marguerita
authors.initials: M
authors.lastname: Lightfoot
mesh_terms: D000223:Adaptation, Psychological; D015897:Comorbidity; D015658:HIV Infections / Q000453:epidemiology* / Q000523:psychology; D006801:Humans; D015999:Multivariate Analysis; D010290:Parents / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology