Teens feel most stress before HIV-infected parent dies

A UCLA AIDS Institute study has discovered that teens of HIV-infected parents are at the highest risk for depression and self-destructive behavior before their parent's death, not after. Published in the April issue of the Journal of Consulting and Clinical Psychology, the findings emphasize the importance of providing support services to HIV-affected families promptly after a parent's diagnosis and through the subsequent illness — not only after the parent's death.

"We always knew that children suffered long-term consequences when their parents died," said Mary Jane Rotheram-Borus, professor of psychiatry and biobehavioral sciences at UCLA's David Geffen School of Medicine, and a member of the UCLA AIDS Institute and Neuropsychiatric Institute. "But we did not know that the clock for negative outcomes for the child literally starts ticking as soon as their parent falls ill."

UCLA researchers collaborated with New York City's Division of AIDS Services to recruit and study 307 HIV-infected parents with 414 adolescent children for a six-year study.

Half of the teens participated in a comprehensive intervention program designed to help them develop practical skills to cope with their parent's illness, manage negative emotions, plan for the future and reduce risky behavior related to sexual activity and drug use. The study compared the emotional state and behavior of children in the research and control groups at two time periods before their parent's death, and two time periods after.

As expected, teenagers who were worried about the impending death of a gravely ill parent experienced significantly more emotional distress, negative life events and contact with the criminal justice system than adolescents whose parents were living with chronic HIV.

But the researchers were surprised to see that these problems tapered off relatively quickly after the parent died. Only a year after their parent's death, the teenagers were less depressed than youngsters whose parents had chronic HIV disease.

The UCLA study found that after a parent died of AIDS, the teenager did not abuse drugs, experience more problems at school or encounter trouble with peers any more than youth with chronically ill parents.

"In many families, the adolescents became the parents for their parents. Many also became caretakers for their sisters and brothers," Rotheram-Borus said.

The study results, she pointed out, demonstrate how early intervention for at-risk youth can provide measurable economic benefits to society at large.

"By teaching emotional tools to teens during their parent's illness, we give them the coping skills they need to function better as young adults — even after they lose their parents," Rotheram-Borus said. "Addressing these families' psychosocial issues results in long-term benefits to society as well as to the young adults involved."

She noted that the adolescents in the study were less likely to drop out of school, have babies as teens, or require welfare or unemployment payments. However, these teens were more likely to have high-risk sex after their parent died.

"We did see an increase in risky sex by adolescents after they lost their parent," Rotheram-Borus said. "This may reflect the young person's attempts to reach for intimacy or replace their lost family.

"We believe that this finding underscores the importance of maintaining support services to teens in the first year after their parent's death," she added. "This is when bereaved young people are most likely to begin exploring sex or drugs."

Most of the families in the UCLA study were headed by African American and Latino single mothers. Previous research examining the effect of one parent's death had primarily studied white, two-parent families.

In the United States, some 350,000 children live with an HIV-positive parent. Despite drug therapies that extend infected people's life spans, nearly 70,000 adolescents have survived a parent who died from AIDS.

The National Institute of Mental Health funded the study. Rotheram-Borus' UCLA co‑authors included Dr. Patricia Lester, research specialist at the UCLA Neuropsychiatric Institute; Robert Weiss, professor of public health; and student Susan Alber.