title: Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa: the Amagugu intervention.
abstract: OBJECTIVE
  Increasingly, HIV-infected parents are surviving to nurture their children. Parental HIV disclosure is beneficial, but disclosure rates to younger children remain low. Previously, we demonstrated that the 'Amagugu' intervention increased disclosure to young children; however, effects on psychological outcomes have not been examined in detail. This study investigates the impact of the intervention on the maternal and child psychological outcomes.
  
  
  METHODS
  This pre-post evaluation design enrolled 281 HIV-infected women and their HIV-uninfected children (6-10 years) at the Africa Centre for Health and Population Studies, in rural South Africa. The intervention included six home-based counselling sessions delivered by lay-counsellors. Psychological outcomes included maternal psychological functioning (General Health Questionnaire, GHQ12 using 0,1,2,3 scoring); parenting stress (Parenting Stress Index, PSI36); and child emotional and behavioural functioning (Child Behaviour Checklist, CBCL).
  
  
  RESULTS
  The proportions of mothers with psychological distress reduced after intervention: GHQ threshold at least 12 (from 41.3 to 24.9%, P < 0.001) and GHQ threshold at least 20 (from 17.8 to 11.7%, P = 0.040). Parenting stress scores also reduced (Pre M = 79.8; Post M = 76.2, P < 0.001): two subscales, parental distress and parent-child relationship, showed significant improvement, while mothers' perception of 'child as difficult' was not significantly improved. Reductions in scores were not moderated by disclosure level (full/partial). There was a significant reduction in child emotional and behavioural problems (CBCL Pre M = 56.1; Post M = 48.9, P < 0.001).
  
  
  CONCLUSIONS
  Amagugu led to improvements in mothers' and children's mental health and parenting stress, irrespective of disclosure level, suggesting general nonspecific positive effects on family relationships. Findings require validation in a randomized control trial.
authors.affiliation: aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Durban bDepartment of Psychology, Stellenbosch University, Stellenbosch, South Africa cSection of Child and Adolescent Psychiatry, Department of Psychiatry, University of Oxford, Oxford, UK dDepartment of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil eSchool of Public Health, University of Witwatersrand, Johannesburg, South Africa fInstitute of Health and Wellbeing, and Royal Hospital for Sick Children, University of Glasgow, UK.
authors.forename: Tamsen J
authors.initials: TJ
authors.lastname: Rochat
authors.forename: Adriane X
authors.initials: AX
authors.lastname: Arteche
authors.forename: Alan
authors.initials: A
authors.lastname: Stein
authors.forename: Joanie
authors.initials: J
authors.lastname: Mitchell
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Bland
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009034:Mother-Child Relations / Q000523:psychology*; D012423:Rural Health; D013019:South Africa; D013315:Stress, Psychological; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D055815:Young Adult