Teens' Stress Begins Before a Parent With HIV Dies

A six-year study of New York City families with an HIV-positive parent found that teenage children were at greater risk of emotional distress and crime-related problems before their parent's death -- not after, according to researchers at the University of California-Los Angeles. The study's results show "the importance of helping families after HIV diagnosis, not just after a parent's death," said lead author Dr. Mary Jane Rotheram-Borus.

Rotheram-Borus and colleagues studied 272 HIV-positive parents and their teenage children, around half of whom had enrolled in a support program designed to help manage stress for families living with HIV. Previous research by the authors found that the program helped allay both the teens' and parents' emotional distress and that the teens were less likely than their peers to use drugs, drop out of school or have behavioral problems.

Among the more than 400 teens in the current study, half lost a parent -- most often their mother; 38 was the average age at death. At least one year before their parent's death, these teens were more likely than their peers to report feelings of depression, isolation, fear, and anger. But standard screening tests showed these problems unexpectedly waned in the year after a parent's death, so that the teens' distress was no greater than that of their peers whose parents were still alive. The researchers noted a similar pattern in respect to rates of arrests and convictions for crime, which were higher among the HIV-affected teens before their parents died but not after.

Teenagers who lost a parent had persistently higher rates of depression, but these too faded within a year, said Rotheram-Borus. For children who survive their parents, regardless of the illness, the toughest times often come during life milestones, such as graduations or weddings, she added.

The study's findings show that families need support services long before a parent dies, but there remains a considerable lack of HIV support programs for whole families. If such programs were to become more widespread, "drop-in" services where family members could seek support at times when they feel they need it would be ideal, the researchers concluded.

The full study, "Adolescent Adjustment Before and After HIV-Related Parental Death," was published in the Journal of Consulting and Clinical Psychology (2005;73(2):221-228).

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