# Association of adult caregiver depression with developmental disorder likelihood in Ugandan children perinatally exposed and unexposed to HIV

## TL;DR

Higher depression in caregivers is linked to a greater likelihood of developmental disorders in Ugandan children, both HIV-exposed and unexposed.

## Contribution

This study is the first to examine the association between caregiver depression and developmental disorder risk in Ugandan children with and without HIV exposure.

## Key findings

- Higher caregiver depression was associated with increased perceived risk of autism spectrum disorder and functional impairment in children.
- Children of highly depressed caregivers had consistently higher risk scores for developmental disorders compared to those with low depression.
- The association between caregiver depression and child developmental risk was most consistent for autism spectrum disorder and functional impairment.

## Abstract

We assessed whether higher caregiver depression is associated with increased likelihood of caregivers rating their children as screening positive for developmental disorders—autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder, emotional behavioral disorder, and functional impairment (FI)—among Ugandan children perinatally exposed and unexposed to HIV. Children and their primary caregivers were followed for 12 months. Caregiver depression was measured using the Hopkins Symptom Checklist-25 and categorized as low, moderate, or high based on terciles. Child developmental indices were derived from the Behavioral Assessment System for Children (third edition) at 0, 6, and 12 months. Multivariable linear regression estimated mean differences (MDs) in disorder indices with 95% confidence intervals (CIs) by caregiver depression level. Compared with highly depressed caregivers, those with low depression reported consistently lower ASD risk scores (MD: −0.35 to −0.32; 95% CI: −0.60 to −0.08). Similar trends were observed for FI (MD: −0.56 to −0.31; 95% CI: −0.81 to −0.06). Moderate depression was associated with modestly lower FI risk at baseline and 6 months but not at 12 months. Overall, higher caregiver depressive symptoms were linked to greater perceived child disorder risk. Evaluating caregiver depression alongside child screening may improve interpretation of developmental risk assessments.