51
|
Chen H, Zou Y, Shi H, Ma H, Huang W, Wang S, Lu J. COVID-19 affects psychological symptoms of pregnant women indirectly by increasing their maternal concerns. J Affect Disord 2022; 317:79-83. [PMID: 36030996 PMCID: PMC9420000 DOI: 10.1016/j.jad.2022.08.069] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/11/2022] [Accepted: 08/21/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pregnant women themselves are at higher risk for psychological symptoms. The impact of ongoing COVID-19 may increase the risk. However, it is uncertain whether COVID-19 affects pregnant women's psychological symptoms directly or indirectly being mediated. METHODS This survey was conducted in four obstetrics and gynecology hospitals in Beijing from February 28, 2020, to April 26, 2020. Pregnant women who visited the antenatal-care clinic were mobilized to finish the online questionnaires, including the Generalized Anxiety Disorder 7-Item Scale, Patient Health Questionnaire-9, Connor-Davidson resilience scale, and Insomnia Severity Index. RESULTS A total of 828 pregnant women were included in the analysis. The estimated self-reported rates of anxiety, depression, insomnia, and any of the three were 12.2 %, 24.3 %, 13.3 %, and 33.1 %, respectively. Mediating effect analysis showed that pregnant women's response to COVID-19 was not directly associated with psychological symptoms but indirectly through the mediating effect of maternal concerns, which accounted for 32.35 % of the total effect. Stratified analysis by psychological resilience showed that women's attitude toward COVID-19 (OR, 2.68, 95 % CI: 1.16-6.18) was associated with a higher risk of psychological symptoms in those with poor psychological resilience. LIMITATIONS The study was a non-probability sampling survey, and the causal relationship between maternal concerns and psychological symptoms could not be determined due to the study's design. CONCLUSIONS Under public health emergencies such as COVID-19, routine antenatal care should still be prioritized, and concerns related to childbirth-related caused by such emergencies should also be addressed, especially for those with weak psychological resilience.
Collapse
Affiliation(s)
- Hongguang Chen
- Peking University Sixth Hospital (Institute of Mental Health), Key Laboratory of Mental Health, Ministry of Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing 100083, China
| | - Yusong Zou
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hui Shi
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Hongyan Ma
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Wenyang Huang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Shuzhen Wang
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
| | - Junli Lu
- Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China.
| |
Collapse
|
52
|
Chorwe-Sungani G, Wella K, Mapulanga P, Nyirongo D, Pindani M. Systematic review on the prevalence of perinatal depression in Malawi. S Afr J Psychiatr 2022; 28:1859. [PMCID: PMC9634823 DOI: 10.4102/sajpsychiatry.v28i0.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Accepted: 06/24/2022] [Indexed: 11/06/2022] Open
Affiliation(s)
- Genesis Chorwe-Sungani
- Department of Mental Health, School of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Kondwani Wella
- Kamuzu University of Health Sciences Library, Lilongwe, Malawi
| | | | - Ditress Nyirongo
- Department of Mental Health, School of Nursing, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mercy Pindani
- Department of Mental Health, School of Nursing, Kamuzu University of Health Sciences, Lilongwe, Malawi
| |
Collapse
|
53
|
Groenewold NA, Wedderburn CJ, Pellowski JA, Fouché JP, Michalak L, Roos A, Woods RP, Narr KL, Zar HJ, Donald KA, Stein DJ. Subcortical brain volumes in young infants exposed to antenatal maternal depression: Findings from a South African birth cohort. Neuroimage Clin 2022; 36:103206. [PMID: 36162238 PMCID: PMC9668606 DOI: 10.1016/j.nicl.2022.103206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/16/2022] [Accepted: 09/17/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Several studies have reported enlarged amygdala and smaller hippocampus volumes in children and adolescents exposed to maternal depression. It is unclear whether similar volumetric differences are detectable in the infants' first weeks of life, following exposure in utero. We investigated subcortical volumes in 2-to-6 week old infants exposed to antenatal maternal depression (AMD) from a South African birth cohort. METHODS AMD was measured with the Beck Depression Inventory 2nd edition (BDI-II) at 28-32 weeks gestation. T2-weighted structural images were acquired during natural sleep on a 3T Siemens Allegra scanner. Subcortical regions were segmented based on the University of North Carolina neonatal brain atlas. Volumetric estimates were compared between AMD-exposed (BDI-II ⩾ 20) and unexposed (BDI-II < 14) infants, adjusted for age, sex and total intracranial volume using analysis of covariance. RESULTS Larger volumes were observed in AMD-exposed (N = 49) compared to unexposed infants (N = 75) for the right amygdala (1.93% difference, p = 0.039) and bilateral caudate nucleus (left: 5.79% difference, p = 0.001; right: 6.09% difference, p < 0.001). A significant AMD-by-sex interaction was found for the hippocampus (left: F(1,118) = 4.80, p = 0.030; right: F(1,118) = 5.16, p = 0.025), reflecting greater volume in AMD-exposed females (left: 5.09% difference, p = 0.001, right: 3.54% difference, p = 0.010), but not males. CONCLUSIONS Volumetric differences in subcortical regions can be detected in AMD-exposed infants soon after birth, suggesting structural changes may occur in utero. Female infants might exhibit volumetric changes that are not observed in male infants. The potential mechanisms underlying these early volumetric differences, and their significance for long-term child mental health, require further investigation.
Collapse
Affiliation(s)
- Nynke A. Groenewold
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa,South African Medical Research Council (SA-MRC) Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa,Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa,The Neuroscience Institute, University of Cape Town, Cape Town, South Africa,Corresponding author at: UCT Neuroscience Centre, E-Floor, Room 34, Groote Schuur Hospital, Anzio Road, Observatory, 7925, Cape Town, South Africa.
| | - Catherine J. Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa,The Neuroscience Institute, University of Cape Town, Cape Town, South Africa,Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Jennifer A. Pellowski
- Department of Behavioral and Social Sciences and International Health Institute, Brown University School of Public Health, Providence, RI, USA,Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jean-Paul Fouché
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa,The Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Liza Michalak
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa
| | - Annerine Roos
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa,The Neuroscience Institute, University of Cape Town, Cape Town, South Africa,SA-MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Roger P. Woods
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Katherine L. Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, USA
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa,South African Medical Research Council (SA-MRC) Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Kirsten A. Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, University of Cape Town, Cape Town, South Africa,The Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry & Mental Health, University of Cape Town, Cape Town, South Africa,The Neuroscience Institute, University of Cape Town, Cape Town, South Africa,SA-MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
54
|
Larsen AM, Osborn L, Ronen K, Richardson BA, Jiang W, Chohan B, Matemo D, Unger JA, Drake AL, Kinuthia J, John-Stewart G. Trajectories of Depression Symptoms From Pregnancy Through 24 months Postpartum Among Kenyan Women Living With HIV. J Acquir Immune Defic Syndr 2022; 90:473-481. [PMID: 35394987 PMCID: PMC9283247 DOI: 10.1097/qai.0000000000002998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 03/31/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND We examined longitudinal patterns and cofactors of depressive symptoms among pregnant and postpartum women living with HIV (WLWH). METHODS This study used data from a randomized trial of a text messaging intervention. WLWH were serially assessed for depressive symptoms from pregnancy through 24 months postpartum at 6 time points (pregnancy, 6 weeks, and 6, 12, 18, and 24 months postpartum). Depressive symptoms were assessed using Patient Health Questionnaire-9 and longitudinal patterns using group-based trajectory modeling. Moderate-to-severe depressive symptoms (MSD) correlates were assessed using generalized estimating equations. RESULTS Among 824 enrolled women, 14.6% ever had MSD during pregnancy or postpartum; 8.6% of WLWH had MSD in pregnancy and 9.0% any postpartum MSD. MSD was associated with abuse [RR: 3.8, 95% confidence interval (CI): 2.6 to 5.4], stigma (RR: 4.4, 95% CI: 3.1 to 6.3), and food insecurity (RR: 2.7, 95% CI: 1.9 to 3.8). Unintended pregnancy (RR: 1.6, 95% CI: 1.1 to 2.3) and recent HIV diagnosis (RR: 1.8, 95% CI: 1.2 to 2.6) were associated with higher MSD risk, whereas HIV status disclosure to partner (RR: 0.3, 95% CI: 0.2 to 0.6) and social support (RR: 0.97, 95% CI: 0.96 to 0.98) were associated with lower risk. Trajectory modeling identified 4 phenotypes of peripartum depressive symptoms: persistent no/low symptoms (38.5%), mild symptoms resolving postpartum (12.6%), low symptoms increasing slightly in postpartum (47.9%), and persistent moderate-severe symptoms throughout (1.1%). CONCLUSIONS WLWH attending PMTCT services had varied patterns of depressive symptoms, which were associated with stressors (recent diagnosis and food insecurity) and factors reflecting low social power (abuse, stigma, and unintended pregnancy). Women experiencing concurrent abuse, stigma, and food insecurity should be prioritized for interventions to prevent persistent depression.
Collapse
Affiliation(s)
| | - Lusi Osborn
- Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and
| | | | | | | | - Bhavna Chohan
- University of Washington, Seattle, WA
- Kenya Medical Research Institute, Nairobi, Kenya
| | - Daniel Matemo
- Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and
| | | | | | - John Kinuthia
- Kenyatta National Hospital Research and Programs, Nairobi, Kenya; and
| | | |
Collapse
|
55
|
Gemmill AW, Oliva JL, Ericksen J, Holt C, Holt CJ, Milgrom J. Web-based treatment for depression in pregnancy: a feasibility study of Mum2BMoodBooster. BMC Psychiatry 2022; 22:476. [PMID: 35842616 PMCID: PMC9287696 DOI: 10.1186/s12888-022-04111-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Depression in pregnancy is prevalent, under-treated, and has serious impacts on the wellbeing of women and on child development. Internet programs can reach women who may not access traditional treatments due to distance, stigma or concern about taking medication. We adapted our online postnatal depression program, MumMoodBooster, for antenatal use. We aimed to trial feasibility, acceptability, and potential efficacy of the new Mum2BMoodBooster intervention with depressed pregnant women. METHODS Twenty-seven pregnant women with Edinburgh Postnatal Depression Scale score > 11 used the program in a feasibility trial. Twenty-one had current diagnoses of major or minor depression on the Structured Clinical Interview for the DSM-IV. Assessment of symptoms occurred at screening/baseline, post-test (8 weeks post-enrollment), and at follow-up (3 months postpartum) using the Patient Health Questionnaire (PHQ-9) and the Depression Anxiety Stress Scales (DASS-21). RESULTS In this feasibility trial, depression scores on both the PHQ-9 and the DASS-21, showed significant reductions representing large effects, with average symptom scores reduced by > 50%, and maintained in the 'minimal or no depression' range at 3 month follow-up. Anxiety scores also decreased significantly. Program usage was high with 74% of women visiting all six sessions. Program acceptability ratings were moderate to high. CONCLUSIONS Findings paralleled the magnitude of symptom reductions seen in randomised trials of the postnatal MumMoodBooster program, suggesting that Mum2BMoodBooster is an effective treatment for depressed pregnant women. Effective internet therapies are likely to become increasingly important as the COVID-19 pandemic continues to make face-to-face access to health care problematic during 'lockdowns'.
Collapse
Affiliation(s)
- Alan W. Gemmill
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | - Jessica Lee Oliva
- grid.1011.10000 0004 0474 1797Department of Psychology, College of Health Care Science, James Cook University, Townsville, QLD Australia
| | - Jennifer Ericksen
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | - Charlene Holt
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia
| | | | - Jeannette Milgrom
- grid.413976.e0000 0004 0645 3457Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, VIC 3081 Australia ,grid.1008.90000 0001 2179 088XMelbourne School of Psychological Sciences, University of Melbourne, VIC, 3010 Australia
| |
Collapse
|
56
|
Thompson AL, Jahnke JR, Teran E, Bentley ME. Pathways linking maternal mental health and child health in a dual burden context: Evidence from Galapagos, Ecuador. Soc Sci Med 2022; 305:115043. [PMID: 35660699 DOI: 10.1016/j.socscimed.2022.115043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 11/28/2022]
Abstract
Research in low-and-middle income countries links maternal depression to child undernutrition; conversely, maternal depression is a risk factor for child overweight in higher income settings. Less is known about impacts of maternal mental health in dual burden contexts or the environmental and behavioral pathways linking maternal mental health to child health outcomes. Consequently, we examine the association between maternal mental health and the dual burden of undernutrition/infectious disease and overweight/obesity in children and test whether pathogenic, dietary and caregiving exposures mediate this association. Data come from 113 mothers and their 204 children, aged 2 weeks to 15 years, participating in the Healthy Families Study in Galapagos, Ecuador from July 2018 to May 2019, with mental health, anthropometry, diet and household environmental measures. Path analyses were used to test for direct and indirect effects of maternal distress on the likelihood of children experiencing the dual burden. We found that maternal distress is directly associated with a greater risk of having a child in the household with the dual burden with significant indirect paths through the emotional climate of the household and child diet quality. Maternal distress also moderated the impact of exposure to pathogens and diet quality. Our results highlight the need to understand how maternal distress may shape care practices in environments that present challenges for mothers in acquiring adequate resources and support needed to promote healthy child growth.
Collapse
Affiliation(s)
- Amanda L Thompson
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Johanna R Jahnke
- Department of Anthropology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Enrique Teran
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador; Galapagos Science Center, San Cristobal, Ecuador
| | - Margaret E Bentley
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
57
|
Gaviria-Arbeláez SL, Uribe-Holguín A, Gil-Castaño LS, Uribe-Bravo SE, Serna-Galeano LE, Álvarez-Mesa C, Palacio-Moná R, Vélez-Cuervo SM. Prevalencia del riesgo de depresión y preocupaciones en mujeres gestantes en el contexto de la pandemia por COVID-19 en Antioquia, Colombia, 2020-2021. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGÍA 2022; 73:194-202. [PMID: 35939413 PMCID: PMC9395201 DOI: 10.18597/rcog.3821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
Abstract
Objetivos: Describir la prevalencia de los síntomas de depresión y las preocupaciones que afectaron a las gestantes durante la pandemia por COVID-19. Materiales y métodos: Estudio transversal descriptivo, se incluyeron mujeres gestantes, con acceso a un medio tecnológico (celular, computador o tableta) y conectividad a internet, residentes en Antioquia, Colombia. Se excluyeron mujeres con analfabetismo literario y tecnológico. Se encuestaron, en línea, las condiciones sociodemográficas y clínicas basales y las principales preocupaciones generadas por la pandemia, además se aplicó la Escala de Depresión de Edimburgo (EPDS) para medir el riesgo de depresión. Se usó el software Jamovi para el procesamiento y análisis estadístico. Resultados: Se encuestaron 345 mujeres gestantes de 15 a 44 años, se identificó una prevalencia de riesgo de depresión en 30,4 % de las mujeres encuestadas. Se identificó violencia intrafamiliar en el 4,9 % y ausencia de red de apoyo en el 8,4 %. Se encontraron como mayores preocupaciones temor a ser separadas del bebé el día del parto, la posibilidad de no tener acompañante durante el parto, y temor al contagio por los efectos en el bebé in útero o en el recién nacido. Conclusiones: Los síntomas de depresión han sido frecuentes en las mujeres gestantes durante la pandemia del COVID-19. Es importante averiguar por factores de estrés y síntomas de depresión en el control prenatal, el parto y el postparto. Se requieren nuevos estudios locales que evalúen otros trastornos de salud mental que se hayan podido incrementar durante la pandemia por COVID-19.
Collapse
|
58
|
The Lancet Psychiatry Commission on intimate partner violence and mental health: advancing mental health services, research, and policy. Lancet Psychiatry 2022; 9:487-524. [PMID: 35569504 DOI: 10.1016/s2215-0366(22)00008-6] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 12/07/2021] [Accepted: 01/04/2022] [Indexed: 01/26/2023]
|
59
|
Jiang W, Ronen K, Osborn L, Drake AL, Unger JA, Matemo D, Enquobahrie DA, Kinuthia J, John-Stewart G. Predictors of adverse pregnancy outcomes among Kenyan women with HIV on antiretroviral treatment in pregnancy. AIDS 2022; 36:1007-1019. [PMID: 35652673 PMCID: PMC9178912 DOI: 10.1097/qad.0000000000003215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to understand predictors of adverse pregnancy outcomes (APOs) among women on antiretroviral treatment (ART). DESIGN A longitudinal cohort. METHODS Participants from the Mobile WAChX trial were evaluated for APOs, including stillbirth (fetal death at ≥20 weeks' gestation), preterm birth (PTB, livebirth at <37 weeks' gestation,) and neonatal death (NND, ≤28 days after live birth). Predictors were determined by univariable and multivariable Cox proportional hazards and log-binomial models. RESULTS Among 774 women included, median age was 27 years and 29.0% had unsuppressed HIV viral load (>1000 copies/ml) at enrollment. Half (55.1%) started ART prepregnancy, 89.1% on tenofovir-based regimens. Women with depression had a higher risk of stillbirth (adjusted hazard ratio [aHR] 2.93, 95% confidence interval (95% CI) 1.04-8.23), and women with lower social support score had higher risk of late stillbirth (aHR 11.74, 2.47-55.86). Among 740 livebirths, 201 (27.2%) were preterm and 22 (3.0%) experienced NND. PTB was associated with unsuppressed maternal viral load (adjusted prevalence ratio [aPR] 1.28, 95% CI 1.02-1.61), intimate partner violence (IPV) in pregnancy (aPR 1.94, 95% CI 1.28-2.94), and history of any sexually transmitted infection (STI) (aPR 1.63, 95% CI 1.06-2.51). NND was associated with PTB (aPR 2.53, 95% CI 1.10-5.78) and STI history (aPR 4.25, 95% CI 1.39-13.06). Most associations retained significance in the subgroup of women with viral suppression. CONCLUSION Maternal viremia during pregnancy predicted PTB as did IPV, lower education, and STI history, while psychosocial stressors predicted stillbirth. Implementing mental health services, ART adherence, partner support, and routine STI screening and treatment could reduce APOs among women with HIV in sub-Saharan Africa settings.
Collapse
Affiliation(s)
- Wenwen Jiang
- University of Washington, Seattle, Washington, USA
| | - Keshet Ronen
- University of Washington, Seattle, Washington, USA
| | | | | | | | | | | | | | | |
Collapse
|
60
|
Zhu Y, Wang F, Zhou J, Gu S, Gong L, Lin Y, Hu X, Wang W, Zhang A, Ma D, Hu C, Wu Y, Guo L, Chen L, Cen L, He Y, Cai Y, Wang E, Chen H, Jin J, Huang J, Jin M, Sun X, Ye X, Jiang L, Zhang Y, Zhang J, Lin J, Zhang C, Shen G, Jiang W, Zhong L, Zhou Y, Wu R, Lu S, Feng L, Guo H, Lin S, Chen Q, Kong J, Yang X, Tang M, Liu C, Wang F, Hu XYM, Lee HW, Xu X, Zhang R, Robinson N, Lee MS, Han J, Qu F. Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2213261. [PMID: 35604687 PMCID: PMC9127553 DOI: 10.1001/jamanetworkopen.2022.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. OBJECTIVE To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation. DESIGN, SETTING, AND PARTICIPANTS This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population. INTERVENTIONS Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery. MAIN OUTCOMES AND MEASURES The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight). RESULTS Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups. CONCLUSIONS AND RELEVANCE Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs. TRIAL REGISTRATION Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.
Collapse
Affiliation(s)
- Yuhang Zhu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fangfang Wang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jue Zhou
- School of Food Science and Biotechnology, Zhejiang Gongshang University, Hangzhou, China
| | - Shuiqin Gu
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Lianqing Gong
- Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China
| | - Yaoyao Lin
- Department of Epidemiology and Biostatistics at School of Public Health and the Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoli Hu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Wang
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Aihua Zhang
- Department of Obstetrics, Xianju People’s Hospital, Xianju, China
| | - Dongmei Ma
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chunxiao Hu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yan Wu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lanzhong Guo
- Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China
| | - Limin Chen
- Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Leiyin Cen
- Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China
| | - Yan He
- Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China
| | - Yuqing Cai
- Department of Obstetrics, Ruian People’s Hospital, Ruian, China
| | - Enli Wang
- Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China
| | - Honglou Chen
- Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Jing Jin
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Jinhe Huang
- Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China
| | - Meiyuan Jin
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xiujuan Sun
- Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Xiaojiao Ye
- Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China
| | - Linping Jiang
- Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China
| | - Ying Zhang
- Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China
| | - Jian Zhang
- Department of Obstetrics, Ruian People’s Hospital, Ruian, China
| | - Junfei Lin
- Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China
| | - Chunping Zhang
- Department of Obstetrics, Xianju People’s Hospital, Xianju, China
| | - Guofang Shen
- Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Wei Jiang
- Department of Obstetrics, Jiaxing Maternity and Child Health Care Hospital, Jiaxing, China
| | - Liuyan Zhong
- Department of Obstetrics, Yiwu Maternity and Child Health Care Hospital, Yiwu, China
| | - Yuefang Zhou
- Department of Obstetrics, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Ruoya Wu
- Department of Obstetrics, Shaoxing Maternity and Child Health Care Hospital, Shaoxing, China
| | - Shiqing Lu
- Department of Obstetrics, The Women and Children Hospital of Dongyang, Dongyang, China
| | - Linlin Feng
- Department of Obstetrics, Cixi Maternity and Child Health Care Hospital, Cixi, China
| | - Hong Guo
- Department of Obstetrics, Zhoushan Women and Children Hospital, Zhoushan, China
| | - Shanhu Lin
- Department of Obstetrics, Ruian People’s Hospital, Ruian, China
| | - Qiaosu Chen
- Department of Obstetrics, Wenling Maternity and Child Health Care Hospital, Wenling, China
| | - Jinfang Kong
- Department of Obstetrics, Zhejiang Xiaoshan Hospital, Hangzhou, China
| | - Xuan Yang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Mengling Tang
- Department of Epidemiology and Biostatistics at School of Public Health and the Fourth Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chang Liu
- Department of Obstetrics, The Second Clinical Medical College of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fang Wang
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiao-Yang Mio Hu
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Hye Won Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Xinfen Xu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Rong Zhang
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Nicola Robinson
- School of Health and Social Care, London South Bank University, London, United Kingdom
| | - Myeong Soo Lee
- Clinical Research Division, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea
| | - Jisheng Han
- Neuroscience Research Institute, Peking University, Beijing, China
| | - Fan Qu
- Department of Chinese Integrative Medicine, Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| |
Collapse
|
61
|
Evans DK, Jakiela P, Knauer H, Mendez Acosta A. Tools to measure the impact of early childhood development interventions on maternal mental health in low- and middle-income countries. SSM - MENTAL HEALTH 2022. [DOI: 10.1016/j.ssmmh.2022.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
62
|
Postpartum PTSD and Birth experience in Russian-speaking women. Midwifery 2022; 112:103385. [DOI: 10.1016/j.midw.2022.103385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/21/2022]
|
63
|
Alonzo D, Popescu M, Zubaroglu Ioannides P. Mental health impact of the Covid-19 pandemic on parents in high-risk, low income communities. Int J Soc Psychiatry 2022; 68:575-581. [PMID: 33517821 PMCID: PMC7862916 DOI: 10.1177/0020764021991896] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND COVID-19 has spread across the globe, resulting in significant changes in virtually every aspect of life. Mitigation efforts, like shelter-in-place orders, have taken a particular toll on parents who have had to navigate disruptions in work and/or school schedules. Research from high-income countries demonstrates increased parental anxiety, stress, depression, and burnout resulting from the pandemic. It is unclear if these outcomes are the same for parents in high-risk communities in low-income countries where pre-pandemic conditions were deleterious. This study addresses this gap and examines the mental health impact of the pandemic on parents in high-risk communities in Guatemala. METHODS A total of 330 individuals from 11 districts in Guatemala participated in the study and were assessed for sociodemographic characteristics and mental health impairment. Chi-squares were conducted for bivariate analysis. Multivariate analysis was conducted using binary logistic regression. RESULTS Bivariate analysis revealed differences between groups on burnout, with parents more often reporting feelings of burnout than nonparents (p < .001). Binary regression demonstrated that non-parents were 70% less likely to endorse feelings of stress as compared to parents (OR = .285; p = .014). CONCLUSION Our findings underscore the importance of identifying the unique mental health impact of the COVID 19 pandemic on parents in high-risk communities. In high-risk communities, parental stress is a pressing problem that, if unaddressed, has the potential to result in even greater psychological distress and child maltreatment. Training community healthcare providers to assess and address parental stress can lead to increased community capacity and the development of a community-based network to serve as a first line of support for parents and their children.
Collapse
Affiliation(s)
- Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
| | - Marciana Popescu
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
| | | |
Collapse
|
64
|
Ahmad SI, Shih EW, LeWinn KZ, Rivera L, Graff JC, Mason WA, Karr CJ, Sathyanarayana S, Tylavsky FA, Bush NR. Intergenerational Transmission of Effects of Women's Stressors During Pregnancy: Child Psychopathology and the Protective Role of Parenting. Front Psychiatry 2022; 13:838535. [PMID: 35546925 PMCID: PMC9085155 DOI: 10.3389/fpsyt.2022.838535] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/23/2022] [Indexed: 12/22/2022] Open
Abstract
Objective Experiences of stress and adversity, such as intimate partner violence, confer risk for psychiatric problems across the life span. The effects of these risks are disproportionately borne by women and their offspring-particularly those from communities of color. The prenatal period is an especially vulnerable period of fetal development, during which time women's experiences of stress can have long-lasting implications for offspring mental health. Importantly, there is a lack of focus on women's capacity for resilience and potential postnatal protective factors that might mitigate these intergenerational risks and inform intervention efforts. The present study examined intergenerational associations between women's prenatal stressors and child executive functioning and externalizing problems, testing maternal parenting quality and child sex as moderators, using a large, prospective, sociodemographically diverse cohort. Methods We used data from 1,034 mother-child dyads (64% Black, 30% White) from the Conditions Affecting Neurocognitive Development and Learning in Early Childhood (CANDLE) pregnancy cohort within the ECHO PATHWAYS consortium. Women's prenatal stressors included stressful life events (pSLE) and intimate partner violence (pIPV). Measures of child psychopathology at age 4-6 included executive functioning and externalizing problems. Parenting behaviors were assessed by trained observers, averaged across two sessions of mother-child interactions. Linear regression models were used to estimate associations between women's prenatal stressors and child psychopathology, adjusting for confounders and assessing moderation effects by maternal parenting quality and child sex. Results Women's exposures to pSLE and pIPV were independently associated with child executive functioning problems and externalizing problems in fully-adjusted models. Maternal parenting quality moderated associations between pSLE and both outcomes, such that higher parenting quality was protective for the associations between women's pSLE and child executive functioning and externalizing problems. No moderation by child sex was found. Discussion Findings from this large, sociodemographically diverse cohort suggest women's exposures to interpersonal violence and major stressful events-common for women during pregnancy-may prenatally program her child's executive functioning and externalizing problems. Women's capacity to provide high quality parenting can buffer this intergenerational risk. Implications for universal and targeted prevention and early intervention efforts to support women's and children's wellbeing are discussed.
Collapse
Affiliation(s)
- Shaikh I. Ahmad
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Emily W. Shih
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Kaja Z. LeWinn
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
| | - Luisa Rivera
- Department of Anthropology, Emory University, Atlanta, GA, United States
| | - J. Carolyn Graff
- College of Nursing, The University of Tennessee Health Science Center, Memphis, TN, United States
- Center on Developmental Disabilities, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - W. Alex Mason
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Catherine J. Karr
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, WA, United States
| | - Sheela Sathyanarayana
- Department of Pediatrics, University of Washington, Seattle, WA, United States
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Frances A. Tylavsky
- Department of Preventative Medicine, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Nicole R. Bush
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, United States
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States
| |
Collapse
|
65
|
Shuffrey LC, Sania A, Brito NH, Potter M, Springer P, Lucchini M, Rayport YK, Du Plessis C, Odendaal HJ, Fifer WP. Association of maternal depression and anxiety with toddler social-emotional and cognitive development in South Africa: a prospective cohort study. BMJ Open 2022; 12:e058135. [PMID: 35418432 PMCID: PMC9014070 DOI: 10.1136/bmjopen-2021-058135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A robust literature has identified associations between prenatal maternal depression and adverse child social-emotional and cognitive outcomes. The majority of prior research is from high-income countries despite increased reporting of perinatal depression in low/middle-income countries (LMICs). Additionally, despite the comorbidity between depression and anxiety, few prior studies have examined their joint impact on child neurodevelopment. The objective of the current analysis was to examine associations between prenatal maternal depression and anxiety with child social-emotional and cognitive development in a cohort from the Western Cape Province of South Africa. DESIGN Prenatal maternal depression and anxiety were measured using the Edinburgh Postnatal Depression Scale and the State-Trait Anxiety Inventory Scale at 20-24 weeks' gestation. Child neurobehaviour was assessed at age 3 using the Brief Infant-Toddler Social Emotional Assessment and the Bayley Scales of Infant Development III Screening Test (BSID-III ST). We used linear regression models to examine the independent and joint association between prenatal maternal depression, anxiety and child developmental outcomes. RESULTS Participants consisted of 600 maternal-infant dyads (274 females; gestational age at birth: 38.89 weeks±2.03). Children born to mothers with both prenatal depression and trait anxiety had higher social-emotional problems (mean difference: 4.66; 95% CI 3.43 to 5.90) compared with children born to mothers with no prenatal depression or trait anxiety, each condition alone, or compared with mothers with depression and state anxiety. Additionally, children born to mothers with prenatal maternal depression and trait anxiety had the greatest reduction in mean cognitive scores on the BSID-III ST (mean difference: -1.04; 95% CI -1.99 to -0.08). CONCLUSIONS The observed association between comorbid prenatal maternal depression and chronic anxiety with subsequent child social-emotional and cognitive development underscores the need for targeting mental health support among perinatal women in LMICs to improve long-term child neurobehavioural outcomes.
Collapse
Affiliation(s)
- Lauren C Shuffrey
- Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York City, New York, USA
| | - Ayesha Sania
- Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York City, New York, USA
| | - Natalie H Brito
- Department of Applied Psychology, New York University, New York City, New York, USA
| | - Mandy Potter
- Obstetrics and Gynaecology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Priscilla Springer
- Paediatrics and Child Health, Stellenbosch University, Stellenbosch, South Africa
| | - Maristella Lucchini
- Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
- Neuroscience, New York State Psychiatric Institute, New York City, New York, USA
| | - Yael K Rayport
- Neuroscience, New York State Psychiatric Institute, New York City, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
| | - Carlie Du Plessis
- Department of Obstetrics and Gynaecology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - Hein J Odendaal
- Obstetrics & Gynaecology, Stellenbosch University Faculty of Medicine and Health Sciences, Cape Town, South Africa
| | - William P Fifer
- Psychiatry, Columbia University Irving Medical Center, New York City, New York, USA
- Neuroscience, New York State Psychiatric Institute, New York City, New York, USA
| |
Collapse
|
66
|
Maulina R, Qomaruddin MB, Sumarmi S, Fahrul A, Haryuni S. Antenatal Depression as a Stunting Risk Factor: A Systematic Review. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Depression during pregnancy is often found and ignored even though depression has a negative impact not only on the mother but also on the fetus to adulthood. Stunting is a problem of lack of nutritional status that begins during pregnancy.
AIM: The purpose of this article is to systematically identify the description and relationship between depression during pregnancy and stunting in children.
METHOD: The approach used is the systematic review method to search articles. Articles were identified from 2010-2020 by conducting a literature search with the keywords "antenatal depression" OR "prenatal depression" OR "depression during pregnancy" and "stunting" in the electronic databases dataset by Sciencedirect, Pubmed Research Gate, and Google Scholar.
RESULTS: The search results found 1875 articles selected into 20 journal articles that match the inclusion criteria. CONCLUSION: The results found that depression during pregnancy correlated with risk factors for stunting. As a preventive measure, health workers, especially midwives, can provide psychological care in antenatal care by considering these factors.
Collapse
|
67
|
DNA methylation mediates a randomized controlled trial home-visiting intervention during pregnancy and the Bayley infant's cognitive scores at 12 months of age. J Dev Orig Health Dis 2022; 13:556-565. [PMID: 35256034 DOI: 10.1017/s2040174421000738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The crosstalk between maternal stress exposure and fetal development may be mediated by epigenetic mechanisms, including DNA methylation (DNAm). To address this matter, we collect 32 cord blood samples from low-income Brazilian pregnant adolescents participants of a pilot randomized clinical intervention study (ClinicalTrials.gov, Identifier: NCT02807818). We hypothesized that the association between the intervention and infant neurodevelopmental outcomes at 12 months of age would be mediated by DNAm. First, we searched genome methylation differences between cases and controls using different approaches, as well as differences in age acceleration (AA), represented by the difference of methylation age and birth age. According to an adjusted p-value ≤ 0.05 we identified 3090 differentially methylated positions- CpG sites (DMPs), 21 differentially methylated regions (DMRs) and one comethylated module weakly preserved between groups. The intervention group presented a smaller AA compared to the control group (p = 0.025). A logistic regression controlled by sex and with gestational age indicated a coefficient of -0.35 towards intervention group (p = 0.016) considering AA. A higher cognitive domain score from Bayley III scale was observed in the intervention group at 12 months of age. Then, we performed a potential causal mediation analysis selecting only DMPs highly associated with the cognitive domain (adj. R2 > 0.4), DMRs and CpGs of hub genes from the weakly preserved comethylated module and epigenetic clock as raw values. DMPs in STXBP6, and PF4 DMR, mediated the association between the maternal intervention and the cognitive domain at 12 months of age. In conclusion, DNAm in different sites and regions mediated the association between intervention and cognitive outcome.
Collapse
|
68
|
Wang K, Qiu J, Meng L, Lai X, Yao Z, Peng S. Postpartum hemorrhage and postpartum depressive symptoms: A retrospective cohort study. Depress Anxiety 2022; 39:246-253. [PMID: 35167153 DOI: 10.1002/da.23245] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/14/2021] [Accepted: 02/03/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Many psychological and obstetrical factors contribute to the development of postpartum depression. However, little is known about how postpartum hemorrhage (PPH) influences postpartum depressive symptoms. This study explored the relationship between PPH and postpartum depressive symptoms in the Chinese population. METHODS A retrospective cohort study was conducted at the Baoan Maternal and Child Health Hospital in Shenzhen, China, from January 2016 to June 2020. The Edinburgh Postnatal Depression Scale was used to assess postpartum depressive symptoms. A multivariate logistic regression model was used to estimate the odds ratios (ORs) with 95% confidence intervals (95% CIs) between PPH and risk of postpartum depressive symptoms. RESULTS Of the 7734 respondents, 293 (3.8%) and 7441 were in the PPH and control groups, respectively. Puerperal women with PPH were more likely to screen positive for postpartum depressive symptoms than those without PPH (16.4% vs. 11.7%, p = .016). Adjusting for other covariates, women with PPH still had higher risk of postpartum depressive symptoms (OR = 1.68, 95% CI: 1.16-2.42). Stratification analyses revealed no interaction between PPH and maternal age, prepregnancy body mass index, mode of delivery, and fetal sex in developing depressive symptoms (p for interaction > .05). CONCLUSIONS PPH may increase the risk of postpartum depressive symptoms. Therefore, women with PPH should be actively screened for depressive symptoms in the immediate postpartum period.
Collapse
Affiliation(s)
- Kewei Wang
- Department of Children's Intensive Research Center, Hunan Children's Hospital, Changsha, China
| | - Jun Qiu
- Department of Children's Intensive Research Center, Hunan Children's Hospital, Changsha, China
| | - Liping Meng
- Department of Public Health, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, China
| | - Xin Lai
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Zhenzhen Yao
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| | - Songxu Peng
- Department of Maternal and Child Health, Xiangya School of Public Health, Central South University, Changsha, China
| |
Collapse
|
69
|
Asare H, Rosi A, Scazzina F, Faber M, Smuts CM, Ricci C. Maternal postpartum depression in relation to child undernutrition in low- and middle-income countries: a systematic review and meta-analysis. Eur J Pediatr 2022; 181:979-989. [PMID: 34652508 DOI: 10.1007/s00431-021-04289-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/02/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Perinatal (antenatal and postpartum) depression is increasingly becoming a global public health problem. Studies have shown that the presence of depression during the perinatal period impact on a mother's ability to adequately provide nutritional care for herself and her infants and young children. This may thus negatively influence the nutritional status of these vulnerable children resulting in poor growth, such as stunting which is currently a public health problem in low- and middle-income countries (LMICs). The aim of this systematic review and meta-analysis was to determine the association between maternal postpartum depression and child growth in LMICs. Electronic databases were systematically reviewed by screening abstracts, titles, full text and additional data sources of eligible papers. Articles were eligible for inclusion if based on children aged 0 to 59 months, if reporting maternal postpartum depression as an exposure, if based on observational studies evaluating the relation between maternal postpartum depression and child growth, if reporting at least one physical growth indicator such as stunting as an outcome, and if published after 2000. Article selection was based on the PRISMA guidelines for reporting systematic reviews. Twelve articles were included in the quantitative synthesis (12 for stunting, 8 for underweight and 2 for wasting). Maternal postpartum depression was observed to be associated with an increased risk of child stunting (1.87 (95% CI: 1.52, 2.30; I2 = 41.6%, p = 0.064)) and underweight (1.81 (95% Cl: 1.25, 2.62; I2 = 70.7%, p = 0.001)). These results were confirmed after influence analyses, with publication bias being negligible. Conclusion: Maternal depression is a risk factor for poor child growth in LMICs. This study contributes to the knowledge on this topic and calls on policymakers to improve on its understanding, screening and treatment to alleviate the potential negative impact on child growth. What is Known: • Maternal postpartum depression is currently a public health relevance in low- and middle-income countries (LMICs). • Maternal postpartum depression is a risk factor for poor nutritional status in children from LMICs. What is New: • Maternal postpartum depression is associated with an 80 to 90% increased risk of childhood stunting and underweight in LMICs. • The association between risk of childhood stunting and underweight with maternal postpartum depression is slightly influenced by geographical area, rural or urban location, by factors such as study design, study quality and sample size.
Collapse
Affiliation(s)
- Hannah Asare
- Centre of Excellence for Nutrition, North-West University, 11 Hoffman Street, Potchefstroom, South Africa.
| | - Alice Rosi
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - Francesca Scazzina
- Human Nutrition Unit, Department of Food and Drug, University of Parma, Parma, Italy
| | - Mieke Faber
- Centre of Excellence for Nutrition, North-West University, 11 Hoffman Street, Potchefstroom, South Africa.,Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Cornelius M Smuts
- Centre of Excellence for Nutrition, North-West University, 11 Hoffman Street, Potchefstroom, South Africa
| | - Cristian Ricci
- Africa Unit for Transdisciplinary Health Research (AUTHeR), North-West University, Potchefstroom, South Africa
| |
Collapse
|
70
|
Rokicki S, McGovern M, Von Jaglinsky A, Reichman NE. Depression in the Postpartum Year and Life Course Economic Trajectories. Am J Prev Med 2022; 62:165-173. [PMID: 34696940 PMCID: PMC8748295 DOI: 10.1016/j.amepre.2021.08.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Perinatal depression affects 13% of childbearing individuals in the U.S. and has been linked to an increased risk of household economic insecurity in the short term. This study aims to assess the relationship between perinatal depression and long-term economic outcomes. METHODS This was a longitudinal analysis of a cohort of mothers from the Fragile Families and Child Wellbeing Study starting at delivery in 1998-2000 and followed until 2014-2017. Analysis was conducted in 2021. Maternal depression was assessed using the Composite International Diagnostic Interview-Short Form 1 year after childbirth, and the outcomes included measures of material hardship, household poverty, and employment. Associations between maternal depression and outcomes were analyzed using logistic regression and group-based trajectory modeling. RESULTS In total, 12.2% of the sample met the criteria for a major depressive episode 1 year after delivery. Maternal depression had a strong and sustained positive association with material hardship and not working for pay in Years 3, 5, 9, and 15 after delivery. Maternal depression also had a significant positive association with household poverty across Years 3-9 and with unemployment in Year 3. Trajectory modeling established that maternal depression was associated with an increased probability of being in a persistently high-risk trajectory for material hardship, a high-risk trajectory for household poverty, and a high-declining risk trajectory for unemployment. CONCLUSIONS Supporting perinatal mental health is crucial for strengthening the economic well-being of childbearing individuals and reducing the impact of maternal depression on intergenerational transmission of adversity.
Collapse
Affiliation(s)
- Slawa Rokicki
- From the Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Mark McGovern
- From the Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey.
| | - Annette Von Jaglinsky
- From the Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Nancy E Reichman
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; Child Health Institute of New Jersey, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey; and the Department of Economics, Princeton University, Princeton, New Jersey
| |
Collapse
|
71
|
Asmussen J, Skovgaard AM, Bilenberg N. Trajectories of dysregulation in preschool age. Eur Child Adolesc Psychiatry 2022; 31:313-324. [PMID: 33386524 DOI: 10.1007/s00787-020-01689-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/18/2020] [Indexed: 02/06/2023]
Abstract
Dysregulation of emotions, behaviour and attention is involved in several areas of childhood psychopathology, but knowledge about early developmental trajectories remains scarce. This study aims to explore continuity and associations of dysregulation in preschool age. Dysregulation was measured at age 2½ years and again at 5 years in a community-based birth cohort of 1099 children using the Child Behavior Checklist, preschool version (CBCL1½-5), answered by mothers. Based on the Dysregulation Profile (CBCL-DP) score, we defined four trajectory groups, using the 75th percentile from the Danish norm material as a cut-off. Associations between the four CBCL-DP trajectory groups and potential covariates, including child, parental and family factors, were analysed using univariate and multiple multinomial logistic regression. Nearly half (54%) of the children showed persistent low scores of CBCL-DP, 17% displayed continuing dysregulation problems, 13% had problems that increased from 2½ years to 5 years, whereas 16% of the children showed reduced problems across preschool age. Persistent dysregulation was associated with maternal postpartum depressive symptoms RRR = 2.20 (95% CI 1.29-3.75), low maternal educational level RRR = 1.69 (95% CI 1.08-2.66), and mothers' smoking during pregnancy RRR = 2.87 (95% CI 1.09-7.55). Persistent problems of emotional, behavioural and attention regulation in children aged 2½ years to 5 years is influenced by maternal educational level and post-partum depression symptoms. The study draws clinical attention to early symptoms of dysregulation and to the importance of addressing the specific needs of mentally vulnerable parents in intervention planning.
Collapse
Affiliation(s)
- Jette Asmussen
- Research Unit of Child and Adolescent Mental Health, Department of Clinical Research, University of Southern Denmark, J.B Winsløws Vej 16, indgang 228, 5000, Odense C, Denmark.
| | - Anne Mette Skovgaard
- Faculty of Health Sciences, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Niels Bilenberg
- Research Unit of Child and Adolescent Psychiatry Odense, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
72
|
Leonard R, Linden M, Grant A. Personal and professional influences on health visitors' family focused practice for maternal mental illness: a cross sectional study. BMC Health Serv Res 2022; 22:113. [PMID: 35081961 PMCID: PMC8790840 DOI: 10.1186/s12913-022-07499-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Accepted: 01/14/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Family focused practice (FFP) is an approach that recognises the inter-related needs of family members and recommends a continuum of activities to support families. While it is recognised that health visitors play a key role in supporting families when mothers have mental illness, there is limited understanding of health visitor's family focused practice (FFP) in this context and its relationships with factors, such as, workload, training, skill and knowledge, and personal and professional experience. This paper examined the effect of health visitors' interaction with the family, and personal and professional experience on their family focused practice. METHODS A cross sectional questionnaire (Family Focused Mental Health Practice Questionnaire) was distributed to 488 health visitors within community practice in Northern Ireland, with 230 choosing to take part. Independent t-tests and one-way analysis of variance were used to compare family focused practice scores. RESULTS Results found that health visitors who had face to face contact with partners and children (t(221) = 2.61, p = .01), and those that directly supported the partner (t(221) = 2.61, p = 0.01) had a significantly higher mean score of FFP, than those that did not. However, frequency of visits (daily, weekly, monthly or yearly) had no effect on family focused practice scores. Training also had a significant effect on family focused practice scores (F(2,221) = 4.841, p = 0.029). Analysis of variance revealed that personal experience of mental illness had a significant effect on scores (M = 97.58, p = 0.009), however variables such as, age, parental status, time since registration, and being in a specialist position had no effect. CONCLUSIONS In order for family focused practice to be effective, the quality, and content of visits and contact with family should be addressed, as opposed to a focus on the quantity of visits. However, in order for this to occur health visitors need to have appropriate support in their own right, with manageable caseloads and resources.
Collapse
Affiliation(s)
- Rachel Leonard
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Mark Linden
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| | - Anne Grant
- Research Fellow, School of Nursing and Midwifery, Queen’s University, Medical Biology Centre, 97 Lisburn Road, Belfast, Northern Ireland BT9 7BL UK
| |
Collapse
|
73
|
Alexandra Dunn J, Medhin G, Dewey M, Alem A, Worku B, Paksarian D, Newton CR, Tomlinson M, Prince M, Hanlon C. Common perinatal mental disorders and post‐infancy child development in rural Ethiopia: a population‐based cohort study. Trop Med Int Health 2022; 27:251-261. [PMID: 35080279 PMCID: PMC9305759 DOI: 10.1111/tmi.13725] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective To investigate whether maternal common mental disorders (CMD) in the postnatal period are prospectively associated with child development at 2.5 and 3.5 years in a rural low‐income African setting. Methods This study was nested within the C‐MaMiE (Child outcomes in relation to Maternal Mental health in Ethiopia) population‐based cohort in Butajira, Ethiopia, and conducted from 2005 to 2006. The sample comprised of 496 women who had recently given birth to living, singleton babies with recorded birth weight measurements, who were 15 to 44 years of age, and residing in six rural sub‐districts. Postnatal CMD measurements were ascertained 2 months after delivery. Language, cognitive, and motor development were obtained from the child 2.5 and 3.5 years after birth using a locally adapted version of the Bayley Scales of Infant Development (3rd Ed). Maternal CMD symptoms were measured using a locally validated WHO Self‐Reporting Questionnaire. A linear mixed‐effects regression model was used to analyze the relationship between postnatal CMD and child development. Results After adjusting for confounders, there was no evidence for an association between postnatal CMD and overall child development or the cognitive sub‐domain in the preschool period. There was no evidence of effect modification by levels of social support, socioeconomic status, stunting, or sex of the child. Conclusions Previous studies from predominantly urban and peri‐urban settings in middle‐income countries have established a relationship between maternal CMD and child development, which contrasts with the findings from this study. The risk and protective factors for child development may differ in areas characterized by high social adversity and food insecurity. More studies are needed to investigate maternal CMD’s impact on child development in low‐resource and rural areas.
Collapse
Affiliation(s)
- Julia Alexandra Dunn
- King’s College London Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience London UK
- National Institute of Mental Health Genetic Epidemiology Research Branch Intramural Research Program Bethesda USA
| | - Girmay Medhin
- Aklilu‐Lemma Institute of Pathobiology Addis Ababa University Addis Ababa Ethiopia
| | - Michael Dewey
- King’s College London Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience London UK
| | - Atalay Alem
- Addis Ababa University Department of Psychiatry WHO Collaborating Centre for Mental Health Research and Capacity‐Building School of Medicine College of Health Sciences Addis Ababa Ethiopia
| | - Bogale Worku
- Department of Paediatrics and Community Health Addis Ababa University Addis Ababa Ethiopia
| | - Diana Paksarian
- National Institute of Mental Health Genetic Epidemiology Research Branch Intramural Research Program Bethesda USA
| | | | - Mark Tomlinson
- Institute for Life Course Health Research Department of Global Health Stellenbosch University Cape Town South Africa
- School of Nursing and Midwifery Queens University Belfast UK
| | - Martin Prince
- King’s College London King’s Global Health Institute London UK
| | - Charlotte Hanlon
- King’s College London Centre for Global Mental Health Health Service and Population Research Department Institute of Psychiatry, Psychology and Neuroscience London UK
- Addis Ababa University Department of Psychiatry WHO Collaborating Centre for Mental Health Research and Capacity‐Building School of Medicine College of Health Sciences Addis Ababa Ethiopia
- Addis Ababa University Centre for Innovative Drug Development and Therapeutic Trials for Africa (CDT‐Africa) College of Health Sciences Addis Ababa Ethiopia
| |
Collapse
|
74
|
Prenatal depression exposure alters white matter integrity and neurodevelopment in early childhood. Brain Imaging Behav 2022; 16:1324-1336. [PMID: 35000066 PMCID: PMC9107412 DOI: 10.1007/s11682-021-00616-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2021] [Indexed: 11/02/2022]
Abstract
Prenatal exposure to maternal depression increases the risk for onset of emotional and behavioral disorders in children. We investigated the effects of exposure to prenatal depression on white matter microstructural integrity at birth and at 2-3 years, and associated neurodevelopment. Diffusion-weighted images were acquired for children of the Drakenstein Child Health Study at 2-4 weeks postpartum (n=70, 47% boys) and at 2-3 years of age (n=60, 58% boys). Tract-Based Spatial Statistics was used to compare, using an ROI based approach, diffusion tensor metrics across groups defined by presence (>19 on Beck's Depression Inventory and/or >12 on the Edinburgh Postnatal Depression Scale) or absence (below depression thresholds) of depression, and associations with neurodevelopmental measures at age 2-3 years were determined. We did not detect group differences in white matter integrity at neonatal age, but at 2-3 years, children in the exposed group demonstrated higher fractional anisotropy, and lower mean and radial diffusivity in association tracts compared to controls. This was notable in the sagittal stratum (radial diffusivity: p<0.01). Altered white matter integrity metrics were also observed in projection tracts, including the corona radiata, which associated with cognitive and motor outcomes in exposed 2-3-year-olds (p<0.05). Our findings of widespread white matter alterations in 2-3-year-old children with prenatal exposure to depression are consistent with previous findings, as well as with neuroimaging findings in adults with major depression. Further, we identified novel associations of altered white matter integrity with cognitive development in depression-exposed children, suggesting that these neuroimaging findings may have early functional impact.
Collapse
|
75
|
Roubinov DS, Epel ES, Adler NE, Laraia BA, Bush NR. Transactions between Maternal and Child Depressive Symptoms Emerge Early in Life. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:61-72. [PMID: 31453717 PMCID: PMC7044043 DOI: 10.1080/15374416.2019.1644649] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Maternal depression is a robust risk factor for children's internalizing symptoms; however, the intergenerational transmission of mood disorders is likely more complex than unidirectional parent-directed effects. Theoretical models support transactional associations between maternal and child symptomatology over time but have not been well examined, especially in younger high-risk samples. The present investigation examined predictive transactional relations between maternal depression and children's internalizing in toddlerhood and early childhood using a cross-lagged panel model. Participants were 162 low-income, largely racial/ethnic minority mothers and their offspring (32% African American, 16% White, 52% Other/Multiethnic; 53% female) who were assessed when children were 18 months and 4 years old. There were significant cross-sectional relations between maternal depressive and child internalizing symptoms when children were 18 months but not 4 years of age. Cross-lagged associations were evident such that maternal depression symptoms at 18 months were positively associated with internalizing symptoms among children at 4 years, adjusting for prior maternal symptom levels and the cross-sectional correlations between maternal-child symptoms at 18 months. Within the same model, children's internalizing symptoms at 18 months were also positively associated with maternal depressive symptoms at 4 years, adjusting for prior child symptom levels and cross-sectional correlations. This study is among the first to demonstrate that transactional relations between maternal and child mood symptoms occur as early as toddlerhood/early childhood. Findings highlight the potential utility of inclusive, family-focused interventions that support both parents and children in the treatment of early emotional problems.
Collapse
Affiliation(s)
| | - Elissa S. Epel
- Department of Psychiatry, University of California, San Francisco
| | - Nancy E. Adler
- Department of Psychiatry, University of California, San Francisco
| | - Barbara A. Laraia
- Community Health Sciences, Berkeley School of Public Health, University of California, Berkeley
| | - Nicole R. Bush
- Department of Psychiatry, University of California, San Francisco,Department of Pediatrics, University of California, San Francisco
| |
Collapse
|
76
|
Rayport YK, Sania A, Lucchini M, Du Plessis C, Potter M, Springer PE, Gimenez LA, Odendaal HJ, Fifer WP, Shuffrey LC. Associations of adverse maternal experiences and diabetes on postnatal maternal depression and child social-emotional outcomes in a South African community cohort. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001124. [PMID: 36962592 PMCID: PMC10021654 DOI: 10.1371/journal.pgph.0001124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 09/07/2022] [Indexed: 11/07/2022]
Abstract
Previous literature has identified associations between diabetes during pregnancy and postnatal maternal depression. Both maternal conditions are associated with adverse consequences on childhood development. Despite an especially high prevalence of diabetes during pregnancy and maternal postnatal depression in low- and middle-income countries, related research predominates in high-income countries. In a South African cohort with or without diabetes, we investigated associations between adverse maternal experiences with postnatal maternal depression and child social-emotional outcomes. South African mother-child dyads were recruited from the Bishop Lavis community in Cape Town. Participants consisted of 82 mother-child dyads (53 women had GDM or type 2 diabetes). At 14-20 months postpartum, maternal self-report questionnaires were administered to assess household socioeconomic status, food insecurity, maternal depressive symptoms (Edinburgh Postnatal Depression Scale (EPDS)), maternal trauma (Life Events Checklist), and child social-emotional development (Brief Infant Toddler Social Emotional Assessment, Ages and Stages Questionnaires: Social-Emotional, Second Edition). Lower educational attainment, lower household income, food insecurity, living without a partner, and having experienced physical assault were each associated with postnatal maternal depressive symptoms and clinical maternal depression (EPDS ≥ 13). Maternal postnatal depression, lower maternal educational attainment, lower household income, household food insecurity, and living in a single-parent household were each associated with child social-emotional problems. Stratified analyses revealed maternal experiences (education, income, food insecurity, trauma) were associated with postnatal maternal depressive symptoms and child social-emotional problems only among dyads with in utero exposure to diabetes. Women with pre-existing diabetes or gestational diabetes in LMIC settings should be screened for health related social needs to reduce the prevalence of depression and to promote child social-emotional development.
Collapse
Affiliation(s)
- Yael K Rayport
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States of America
| | - Ayesha Sania
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States of America
| | - Maristella Lucchini
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States of America
| | - Carlie Du Plessis
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Mandy Potter
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Priscilla E Springer
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - Lissete A Gimenez
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States of America
| | - Hein J Odendaal
- Department of Obstetrics and Gynaecology, Faculty of Medicine and Health Science, Stellenbosch University, Cape Town, Western Cape, South Africa
| | - William P Fifer
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States of America
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY, United States of America
| | - Lauren C Shuffrey
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States of America
- Division of Developmental Neuroscience, New York State Psychiatric Institute, New York, NY, United States of America
| |
Collapse
|
77
|
Li J, Yin J, Waqas A, Huang Z, Zhang H, Chen M, Guo Y, Rahman A, Yang L, Li X. Quality of Life in Mothers With Perinatal Depression: A Systematic Review and Meta-Analysis. Front Psychiatry 2022; 13:734836. [PMID: 35242060 PMCID: PMC8886107 DOI: 10.3389/fpsyt.2022.734836] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 01/21/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The prevalence of perinatal depression is high and its adverse effects on mothers and infants are extensive. Several studies have explored the relationship between perinatal depression and health-related quality of life (HRQoL), but little is known about the nature and magnitude of this effect. The objectives of this study were to evaluate the HRQoL of mothers with perinatal depression and compare the HRQoL of depressed mothers with that of non-depressed mothers. METHODS A systematic review was performed according to the PRISMA guidelines. PubMed, EMBASE, Scopus, PsycINFO, Web of Science, Cochrane Central Register, the China National Knowledge Infrastructure, the VIP Database, and the Wan Fang Database were searched. The retrieval time was from the establishment of the database to July 2020. A series of meta-analyses were run for each outcome pertaining to HRQoL sub-measures. Subgroup analyses were conducted based on country income category and time period. RESULTS Of 7,945 studies identified, 12 articles were included in the meta-analysis, providing HRQoL data for 4,392 mothers. Compared with non-depressed mothers, mothers with perinatal depression reported significantly poor scores across all the quality-of-life domains. Mixed-effects analysis showed that there was no difference in the HRQoL scores of mothers with antepartum and postpartum depression. Mothers with perinatal depression in higher-income countries reported higher disability on role-physical (p = 0.02) and social functioning domains (p = 0.001) than those from lower-income countries. LIMITATIONS Due to insufficient data, no regression analysis was performed. The inability to accurately determine the difference in HRQoL between antepartum and postpartum depression was because of the restriction of the included studies. Moreover, most of the included studies were conducted in middle-income countries and may have an impact on the applicability of the results. Subgroup analyses are observational and not based on random comparisons. The results of subgroup analyses should be interpreted with caution. CONCLUSION HRQoL is compromised in mothers with perinatal depression. Continuous efforts are required to improve the HRQoL of perinatal depressed mothers.Systematic Review Registration: CRD42020199488.
Collapse
Affiliation(s)
- Jiaying Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| | - Juan Yin
- School of Nursing, Dalian University, Dalian, China
| | - Ahmed Waqas
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Zeyu Huang
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| | - Hongji Zhang
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| | - Manqing Chen
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| | - Yufei Guo
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| | - Atif Rahman
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Lei Yang
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| | - Xiaomei Li
- School of Nursing, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
78
|
Iorio M, Casini E, Damiani S, Fusar-Poli P, Borgatti R, Mensi MM. Perceived Family Functioning Profile in Adolescents at Clinical High Risk for Psychosis: Rigidity as a Possible Preventive Target. Front Psychiatry 2022; 13:861201. [PMID: 35492727 PMCID: PMC9051044 DOI: 10.3389/fpsyt.2022.861201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
The presence of a positive family relationship has been suggested as a protective factor from parental stress and from the development of full-blown psychosis. However, to date, there is limited research on family functioning in adolescents with psychosis and at clinical high risk for psychosis (CHR-P). This study is aimed at comparing family functioning and perceived stress in parents of adolescents with either CHR-P, early onset psychosis (EOP), or other psychiatric disorders (no CHR-P). As a secondary aim, it will correlate family functioning with parental perceived stress in order to find critical targets of intervention. We conducted a Reporting of Studies Conducted Using Observational Routinely-Collected Health Data (RECORD)-compliant, real-world, cross-sectional study. One-hundred and eleven adolescents aged 12-17 who access the institute of hospitalization and care with scientific character (IRCCS) Mondino Foundation Neuropsychiatric services (Pavia, Italy) between 2017 and 2020 and their parents (n = 222) were included. Sociodemographic characteristics of adolescents and their parents were collected. Family functioning was evaluated through the Family Adaptability and Cohesion Evaluation Scale-IV (FACES-IV) and the level of stress through the Perceived Stress Scale (PSS). Twenty adolescents had EOP, 38 had CHR-P, and 59 had no CHR-P. In total, 2.6% of CHR-P adolescents were adopted, 76.3% had separated-divorced parents, and 34.2% of parents had a depressive disorder. Among the FACES-IV sub-scale, maternal rigidity was progressively increased from no-CHR-P to CHR-P to EOP group, with statistical differences between EOP and the other two groups (p = 0.01). CHR-P mothers and fathers showed a high level of PSS values, without group difference. Lastly, PSS values correlated positively with the Rigidity, Disengagement, and Chaos scale of FACES-IV and negatively with the Communication scale (p < 0.05). Our results suggest that family functioning has a central role and could represent a worthwhile target of intervention for adolescents at CHR-P, leading the way to new preventive approaches.
Collapse
Affiliation(s)
- Melanie Iorio
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Erica Casini
- Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | - Stefano Damiani
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Renato Borgatti
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | - Martina Maria Mensi
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neurology and Psychiatry Unit, Institute of Hospitalization and Care With Scientific Character (IRCCS) Mondino Foundation, Pavia, Italy
| | | |
Collapse
|
79
|
Relationship between Maternal Mood Disorders and Dietary Intake of 3-Year-Olds. J Nutr Metab 2021; 2021:5597836. [PMID: 34956674 PMCID: PMC8709751 DOI: 10.1155/2021/5597836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 12/02/2021] [Indexed: 11/17/2022] Open
Abstract
Maternal depression affects parenting and children's early development, but its effect on dietary intake is unknown. While husbands' involvement in parenting and having friends to talk to may reduce childcare stress, this has not been thoroughly studied. In this study, mothers were stratified by the presence or absence of mood disorders, and the effects of support from their husbands and friends on the dietary intake of their 3-year-old children were examined. This cross-sectional analysis included 920 mother-child pairs examined at the National Center for Child Health and Development in Japan. Dietary intake was assessed using a brief dietary history questionnaire, and physical measurements were taken when the children were 3 years old. The Kessler Psychological Distress Scale was used to screen for maternal mood disorders, 3 years after delivery. The presence or absence of the husband's assistance with housework and childcare, mental support, and friends was obtained from a self-administered questionnaire when the child was 3 years old. Differences in the children's physical measurements, energy, and food intake with the presence or absence of support for subjects with or without mood disorders were compared. Mothers with support from husbands or friends had significantly fewer mood disorders. Support from friends and family did not affect the children's physical development and whether or not mothers had mood disorder symptoms. However, children's vegetable intake was higher if mothers were supported. Children of mothers with mood disorders had a significantly higher vegetable intake and fruit intake, depending on the support from friends (P=0.046, P=0.037); thus, such support may increase children's vegetable and fruit intake. The results of this study revealed the importance of supportive friends and family regarding childcare.
Collapse
|
80
|
Rochat TJ, Dube S, Herbst K, Hoegfeldt CA, Redinger S, Khoza T, Bland RM, Richter L, Linsell L, Desmond C, Yousafzai AK, Craske M, Juszczak E, Abas M, Edwards T, Ekers D, Stein A. An evaluation of a combined psychological and parenting intervention for HIV-positive women depressed in the perinatal period, to enhance child development and reduce maternal depression: study protocol for the Insika Yomama cluster randomised controlled trial. Trials 2021; 22:914. [PMID: 34903257 PMCID: PMC8666837 DOI: 10.1186/s13063-021-05672-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 09/30/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The combination of poverty, HIV and depression in the perinatal period represents a major public health challenge in many Southern African countries. In some areas, up to a third of HIV-positive women experience perinatal depression. Perinatal depression is associated with negative effects on parenting and key domains of child development including cognitive, behavioural and growth, especially in socio-economically disadvantaged communities. Several studies have documented the benefits of psychological interventions for perinatal depression in low- and middle-income countries, but none have evaluated an integrated psychological and parenting intervention for HIV-positive women using task-sharing. This randomised controlled trial aims to evaluate the effect of a home-based intervention, combining a psychological treatment for depression and a parenting programme for perinatally depressed HIV-positive women. METHODS This study is a cluster randomised controlled trial, consisting of 48-60 geospatial clusters. A total of 528 pregnant HIV-positive women aged ≥ 16 years who meet the criteria for depression on the Edinburgh Postnatal Depression Scale (EPDS, score ≥ 9)) are recruited from antenatal clinics in rural KwaZulu-Natal, South Africa. The geospatial clusters are randomised on an allocation ratio of 1:1 to either the intervention or Enhanced Standard of Care (ESoC). The intervention group receives 10 home-based counselling sessions by a lay counsellor (4 antenatal and 6 postnatal sessions) and a booster session at 16 months. The intervention combines behavioural activation for depression with a parenting programme, adapted from the UNICEF/WHO Care for Child Development programme. The ESoC group receives two antenatal and two postnatal counselling support and advice telephone calls. In addition, measures have been taken to enhance the routine standard of care. The co-primary outcomes are child cognitive development at 24 months assessed on the cognitive subscale of the Bayley Scales of Infant Development-Third Edition and maternal depression at 12 months measured by the EPDS. ANALYSIS The primary analysis will be a modified intention-to-treat analysis. The primary outcomes will be analysed using mixed-effects linear regression. DISCUSSION If this treatment is successful, policymakers could use this model of mental healthcare delivered by lay counsellors within HIV treatment programmes to provide more comprehensive services for families affected by HIV. TRIAL REGISTRATION ISRCTN registry # 11284870 (14/11/2017) and SANCTR DOH-27-102020-9097 (17/11/2017).
Collapse
Affiliation(s)
- Tamsen J. Rochat
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Samukelisiwe Dube
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
| | - Kobus Herbst
- Africa Health Research Institute, Durban, KwaZulu-Natal South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
| | | | - Stephanie Redinger
- SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Thandeka Khoza
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Ruth Margret Bland
- Institute of Health and Wellbeing and Royal Hospital for Children, University of Glasgow, Glasgow, UK
| | - Linda Richter
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Chris Desmond
- Priceless, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Ed Juszczak
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Melanie Abas
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Taygen Edwards
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - David Ekers
- Tees Esk and Wear Valleys NHS FT, Darlington, UK
| | - Alan Stein
- DSI-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
- DSI-MRC South African Population Research Infrastructure Network (SAPRIN), Durban, South Africa
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
81
|
Marti-Castaner M, Hvidtfeldt C, Villadsen SF, Laursen B, Pedersen TP, Norredam M. Disparities in postpartum depression screening participation between immigrant and Danish-born women. Eur J Public Health 2021; 32:41-48. [PMID: 34864938 PMCID: PMC9090168 DOI: 10.1093/eurpub/ckab197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Qualitative studies suggest that immigrant women experience barriers for postpartum depression (PPD) screening. This study examines the prevalence of participation in PPD screening in the universal home-visiting programme in Denmark, in relation to migrant status and its association with acculturation factors, such as length of residence and age at migration. METHODS The sample consists of 77 694 births from 72 292 mothers (2015-18) that participated in the programme and were registered in the National Child Health Database. Lack of PPD screening using the Edinburgh Postpartum Depression Scale (EPDS) was examined in relation to migrant group and acculturation factors. We used Poisson regression with cluster robust standard errors to estimate crude and adjusted relative risk. RESULTS In total, 27.8% of Danish-born women and 54.7% of immigrant women lacked screening. Compared with Danish-born women, immigrant women in all groups were more likely to lack PPD screening (aRR ranging from 1.81 to 1.90). Women with low acculturation were more likely to lack screening. Women who migrated as adults [aRR = 1.27 (95% CI 1.16, 1.38)] and women who had resided in Demark for <5 years [aRR = 1.37 (95% CI 1.28, 1.46)] were more likely to lack screening. CONCLUSIONS Immigrant women in Denmark, particularly recent immigrants, are at increased risk of not being screened for PPD using the EPDS. This can lead to under-recognition of PPD among immigrant women. More work is needed to understand how health visitors recognize the mental health needs of immigrant women who are not screened, and whether this gap results in reduced use of mental health services.
Collapse
Affiliation(s)
- Maria Marti-Castaner
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Sarah Fredsted Villadsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bjarne Laursen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Trine Pagh Pedersen
- Department of Health and Social Context, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marie Norredam
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
82
|
Leonard R, Linden M, Grant A. Effectiveness of family-focused home visiting for maternal mental illness: A systematic review and meta-analysis. J Psychiatr Ment Health Nurs 2021; 28:1113-1127. [PMID: 33253463 DOI: 10.1111/jpm.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Maternal mental illness reduces a mothers' ability to bond with their infant and may adversely affect other family members. Family-focused practice is an approach which has the potential to support mothers with mental illnesses and reduce the risk of familial transmission of mental illness to children. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Findings suggest that current interventions are not effective in reducing depression or stress among mothers. The majority of interventions included in this review employed relatively low levels of family-focused practice. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: While there is a growing integration of family-focused practice into home visiting guidelines, this may be based on poor evidence. There is a need for the development of rigorously tested interventions which seek to include the whole family. ABSTRACT: Introduction The evidence on effectiveness of family-focused home visiting for maternal mental illness has yet to be comprehensively synthesized. Aim The aim of this study was to assess current home visiting treatments and interventions for mothers with mental illness and their families. Method The primary and secondary outcomes of interest were depression and maternal stress, respectively, both were included in meta-analyses. We identified 13 (n = 5,540 participants) studies which met inclusion criteria. Eight studies were included in meta-analyses; five studies were reported narratively. Results Findings from the meta-analysis suggest that home visiting interventions are not effective in reducing depression (SMD -0.13, 95% CI -0.33 to 0.07, p = .21) and maternal stress (MD 0.59, 95% CI -5.19 to 6.38, p = .84). Discussion and Implications for practice Findings suggest that current interventions are not effective in reducing depression or stress among mothers. While there is a growing integration of family-focused practice into home visiting guidelines, this may be based on poor evidence.
Collapse
Affiliation(s)
- Rachel Leonard
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Mark Linden
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| | - Anne Grant
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University, Belfast, UK
| |
Collapse
|
83
|
Silva EP, Emond A, Ludermir AB. Depression in childhood: The role of children's exposure to intimate partner violence and maternal mental disorders. CHILD ABUSE & NEGLECT 2021; 122:105305. [PMID: 34517271 DOI: 10.1016/j.chiabu.2021.105305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/08/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Intimate partner violence (IPV) is a global problem with high prevalence rates, and is linked to maternal mental disorders (MMD). Children's exposure to IPV (CEIPV) can have impacts on their physical and mental health, including depression. OBJECTIVE To analyze the associations between exposure to both CEIPV and MMD and depression in schoolchildren. PARTICIPANTS AND SETTING 630 mother-child pairs were evaluated in a poor urban district in Recife, Northeast Brazil. METHODS A cohort study investigated the effects of IPV during pregnancy, postpartum and six to nine years after delivery. Women were asked about their experience of IPV, their own mental health, and the exposure of their child to violence. The child's mood was reported by the mother, using the Short Mood and Feelings Questionnaire (SMFQ). Ten types of CEIPV, and the age of onset of exposure, were compared with the child's subsequent risk of depression. RESULTS IPV was associated with MMD in 31.9% of the women at some period of time. Depressive symptoms were reported in 15.7% of school-age children. All types of CEIPV were associated with depression at school age. Multivariable analyses of exposure to IPV and MMD at different ages showed that exposure to both IPV and MMD in the first year of life had the strongest association with childhood depression (OR = 9.1; 95% CI: 2.4-33.9). CONCLUSIONS The frequency of CEIPV and MMD, and the high prevalence of depression at school age, shows the importance of assessing MMD and identifying exposure to IPV in pregnancy and the early years.
Collapse
Affiliation(s)
- Elisabete Pereira Silva
- Universidade Federal de Pernambuco, Hospital das Clínicas, 2o andar - Av. Prof. Moraes Rêgo, s/n. Cidade Universitária, 50.670-420, Recife, PE, Brazil.
| | - Alan Emond
- Centre for Academic Child Health, Bristol Medical School, University of Bristol, 1-5 Whiteladies Road Clifton, Bristol BS8 1NU, United Kingdom
| | - Ana Bernarda Ludermir
- Universidade Federal de Pernambuco, Av. da Engenharia, s/n, Bloco "D" - 1° Andar - Cidade Universitária, 50.740-600, Recife, PE, Brazil
| |
Collapse
|
84
|
The impact of maternal adverse childhood experiences and prenatal depressive symptoms on foetal attachment: Preliminary evidence from expectant mothers across eight middle-income countries. J Affect Disord 2021; 295:612-619. [PMID: 34509077 DOI: 10.1016/j.jad.2021.08.066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 08/02/2021] [Accepted: 08/25/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Mothers from middle-income countries (MIC) are estimated to have higher rates of adverse childhood experiences (ACEs) and depression during pregnancy compared to mothers from high income countries. Prenatal depression can adversely impact on a mother's feelings towards her foetus and thus may be partially responsible for intergenerational transmission of risk associated with maternal ACEs. However, the extent to which prenatal depressive symptoms mediate the association between maternal ACEs and foetal attachment is unknown. METHODS Data on foetal attachment, ACEs, and prenatal depression came from mothers in their third trimester of pregnancy (n = 1,185) located across eight MICs, participating in the prospective birth cohort Evidence for Better Lives Study - Foundational Research (EBLS-FR). Data were from the baseline measurement. RESULTS Full-sample path mediation analyses, adjusting for relevant covariates, suggested a full mediating effect of prenatal depression. However, at the individual-country level, both positive and negative effects of ACEs on foetal attachment were observed after the inclusion of depressive symptoms as a mediator, suggesting cultural and geographical factors may influence a mother's empathic development after ACE exposure. LIMITATIONS As no follow-up measurements of depressive symptoms or postnatal attachment were included in the analyses, the findings cannot be extrapolated to the postnatal period and beyond. Further, causality cannot be inferred as the study was observational. CONCLUSIONS The findings reinforce the importance of screening for prenatal depression during antenatal care in MICs. Addressing prenatal depression within maternal health care may support foetal attachment and contribute to reducing the intergenerational transmission of disadvantage.
Collapse
|
85
|
Nguyen HTT, Hoang AP, Do LTK, Schiffer S, Nguyen HTH. The Rate and Risk Factors of Postpartum Depression in Vietnam From 2010 to 2020: A Literature Review. Front Psychol 2021; 12:731306. [PMID: 34777111 PMCID: PMC8578872 DOI: 10.3389/fpsyg.2021.731306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Postpartum depression (PPD) is commonly seen in women after birth and can lead to adverse effects on both the health of mothers and child(ren) development. In Vietnam, there have been a number of studies examining the rate and risk factors of PPD, but none has provided a systematic review. Aim: This current literature review aims to summarize and synthesize the current state of knowledge of studies conducted in Vietnam to provide a comprehensive understanding of the PPD phenomena during the last 10 years. Data Sources: A literature search was conducted relying on the most common online databases—MEDLINE/PubMed, ScienceDirect, and Google Scholar, which included articles if they (i) examined prevalence or risk factors of PPD; (ii) were conducted among Vietnamese participants using either quantitative, qualitative, or mixed-method, and (iii) were published from 2010 to 2020. After the filtering process, 18 articles were eligible to be reviewed. Results: Research studies in Vietnam on PPD are conducted among women at and after 1-month delivery. The rate of PPD reported in Vietnam among mothers at postnatal time points from 1 to 12 months ranged from 8.2 to 48.1%. Risk factors can be clustered into three groups: personal factors, family factors, and environmental factors. Recommendation: Further research studies should focus on examining PPD at an earlier stage within the first month after birth. The investigation of risk factors in a comprehensive manner for Vietnamese mothers would also be recommended.
Collapse
Affiliation(s)
| | - Anh Phuong Hoang
- College of Health Sciences, Vin University, Hanoi, Vietnam.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam
| | - Ly Thi Kim Do
- 47B General Surgery Department, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | | | | |
Collapse
|
86
|
Bolarinwa OA, Tadesse Tessema Z, Frimpong JB, Seidu AA, Opoku Ahinkorah B. Multi-Level Analysis and Spatial Interpolation of Distributions and Predictors of Childhood Diarrhea in Nigeria. ENVIRONMENTAL HEALTH INSIGHTS 2021; 15:11786302211045286. [PMID: 34690501 PMCID: PMC8529312 DOI: 10.1177/11786302211045286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Diarrhea is one of the health problems contributing to Nigeria's under-5 mortality rate, ranked as the eighth highest globally. As our search is concerned, there is limited evidence on the spatial distribution of childhood diarrhea in Nigeria. Therefore, this study aimed to examine the spatial distribution and predictors of diarrhea among under-5 children in Nigeria. MATERIALS AND METHODS Using data from the child's recode file of the 2018 Nigeria Demographic and Health Survey, a sample of 28 583 children of women of reproductive age was considered as the sample size for this study. The outcome variable used in this study was childhood diarrhea. We employed both multilevel and spatial analyses to ascertain the factors associated with childhood diarrhea as well as its spatial clustering. RESULTS The regional distribution of the prevalence of diarrhea among children in Nigeria ranged from 0% to 62%. The hotspots for childhood diarrhea were in Yobe, Bauchi, Gombe, Kano, Sokoto, Imo, and Taraba. The likelihood of a child having diarrhea in Nigeria was higher among women whose partners have secondary education and above [aOR = 1.18; 95%CI = 1.05-1.33], women currently working [aOR = 1.24; 95%CI = 1.13-1.35], women practicing Islam [aOR = 1.24; 95%CI = 1.04-1.46], and women who were exposed to mass media [aOR = 1.29; 95%CI = 1.18-1.42], compared to women whose partners had no formal education, women not currently working, women practicing Christianity, and those who were not exposed to mass media. Children born to mothers who reside in North East [aOR = 2.55; 95%CI = 2.10-3.10], and communities with medium socioeconomic status [aOR = 1.44; 95%CI = 1.09-1.91] were more likely to experience diarrhea compared to those born to mothers residing in the North Central and in communities with low socioeconomic status. CONCLUSION High proportions of childhood diarrhea among under-5 children in Nigeria were located in Yobe, Bauchi, Gombe, Kano, Sokoto, Imo, and Taraba. Policies and interventions that seek to reduce or eliminate diarrhea diseases among under-5 children in Nigeria should take a keen interest in the factors identified as predictors of childhood diarrhea in this study as this will help in achieving the aims of WASH, ORT corners, and SDG 3 by the year 2030.
Collapse
Affiliation(s)
- Obasanjo Afolabi Bolarinwa
- Department of Public Health Medicine,
School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South
Africa
- Obaxlove Consult, Lagos, Nigeria
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and
Biostatistics, Institute of Public Health, College of Medicine and Health Sciences,
University of Gondar, Gondar, Ethiopia
| | - James Boadu Frimpong
- Department of Health, Physical
Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health,
University of Cape Coast, Cape Coast, Ghana
- College of Public Health, Medical and
Veterinary Services, James Cook University, Townsville, QLD, Australia
| | | |
Collapse
|
87
|
Maternal post-natal depressive symptoms at 2 months: Effects of French antenatal preventive measures in the E.L.F.E. cohort. J Affect Disord 2021; 293:238-244. [PMID: 34217961 DOI: 10.1016/j.jad.2021.06.055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 03/08/2021] [Accepted: 06/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Given the high incidence of perinatal maternal depression, implementation of preventive actions is crucial. In France, two prenatal preventive measures are available to the general population: early prenatal interview (EPI) and antenatal classes (ANC). OBJECTIVE To explore the independent associations between EPI and / or ANC and maternal depressive symptoms at 2 months postpartum. METHOD We used data from the Etude Longitudinale Française depuis l'Enfance (ELFE), a French national representative cohort of children and their parents, followed-up from birth to early adulthood. Data concerning characteristics were collected from the mothers during the maternity stay and between 6/8 weeks' post-partum. The level of depressive symptoms was scored by the French version of the Edinburgh Postnatal Depression Scale (EPDS) between 6/8 weeks' post-partum. We considered EPDS score ≥10 indicative of postnatal psychological distress (PPD) and EPDS ≥12 for postnatal depressive symptoms (PNDS). After data imputation, multivariate logistic regression analysis was performed. RESULTS Among the 16,411 mothers included in our sample, 26% benefited both from EPI and ANC, 31.1 % of ANC, 7.7% of an EPI and 35% of neither; 20,1% presented PPD and 12,1% PNDS. The likelihood of presenting PPD was significantly higher in mothers who had neither had EPI nor ANC (OR = 1.15 (95% CI : 1.01-1.30). There was no association between receiving or not an EPI and/or ANC and presenting PNDS. CONCLUSIONS Antenatal preventive measures may be helpful to prevent PPD at 2 months' post- partum, while PNDS do not seem to be influenced by these actions.
Collapse
|
88
|
Kim ET, Lillie M, Gallis J, Hembling J, McEwan E, Opiyo T, Acayo P, Baumgartner JN. Correlates of early stimulation activities among mothers of children under age two in Siaya County, Kenya: Maternal mental health and other maternal, child, and household factors. Soc Sci Med 2021; 287:114369. [PMID: 34517203 DOI: 10.1016/j.socscimed.2021.114369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/16/2021] [Accepted: 09/02/2021] [Indexed: 11/18/2022]
Abstract
RATIONALE The first two to three years of life are critical for early child development (ECD), which affects later life trajectories in health, development, and earning potential. Global calls for early stimulation activities to support optimal development among young children are increasing and there is a need to better understand the factors associated with maternal engagement in early stimulation activities, particularly maternal mental health. OBJECTIVE This study examined important factors associated with early stimulation activities performed by mothers of children ages 0-2 in rural Kenya. METHODS Baseline cohort data from an evaluation of an integrated maternal mental health and an ECD intervention included 374 interviews with mothers of children under 24 months. Descriptive and multivariable analyses were performed. RESULTS Maternal mental health was not associated with maternal early stimulation activities. Having worked in the past week was associated with more frequent early stimulation activities. At the child level, female sex was associated with more frequent early stimulation activities but prematurity at birth was associated with less frequent early stimulation activities. At the household level, ownership of children's toys and books was associated with more frequent early stimulation activities. CONCLUSIONS This study indicates that both mothers and families could benefit from availability of ECD-friendly resources such as homemade toys and children's books (particularly for low-income families), and tailored messaging to support early stimulation activities for both girl and boy children and for those prematurely-born. Local governments and community-based programs can aim to both raise awareness about the importance of early childhood development and educate caregivers on specific age-appropriate early stimulation activities that promote optimal growth. Future research should also explore the reciprocal and temporal relationships between maternal mental health and early stimulation activities to inform and elucidate their potential synergistic impact on ECD.
Collapse
Affiliation(s)
- Eunsoo Timothy Kim
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27708, USA.
| | - Margaret Lillie
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | - John Gallis
- Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27708, USA
| | | | | | | | | | | |
Collapse
|
89
|
Pitchik HO, Tofail F, Akter F, Sultana J, Shoab A, Huda TMN, Forsyth JE, Kaushal N, Jahir T, Yeasmin F, Khan R, Das JB, Khobair Hossain M, Hasan MR, Rahman M, Winch PJ, Luby SP, Fernald LCH. Effects of the COVID-19 pandemic on caregiver mental health and the child caregiving environment in a low-resource, rural context. Child Dev 2021; 92:e764-e780. [PMID: 34490612 PMCID: PMC8653040 DOI: 10.1111/cdev.13651] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Early child development has been influenced directly and indirectly by the COVID‐19 pandemic, and these effects are exacerbated in contexts of poverty. This study estimates effects of the pandemic and subsequent population lockdowns on mental health, caregiving practices, and freedom of movement among female caregivers of children 6–27 months (50% female), in rural Bangladesh. A cohort (N = 517) was assessed before and during the pandemic (May–June, 2019 and July–September, 2020). Caregivers who experienced more food insecurity and financial loss during the pandemic reported larger increases in depressive symptoms (0.26 SD, 95% CI 0.08–0.44; 0.21 SD, 0.04–0.40) compared to less affected caregivers. Stimulating caregiving and freedom of movement results were inconsistent. Increases in depressive symptoms during the pandemic may have consequences for child development.
Collapse
Affiliation(s)
- Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, California, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Fahmida Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Akm Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Tarique M N Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jenna E Forsyth
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Natasha Kaushal
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tania Jahir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Farzana Yeasmin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Rizwana Khan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jyoti B Das
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Md Rezaul Hasan
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Peter J Winch
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Lia C H Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, California, USA
| |
Collapse
|
90
|
Effect of a lay counselor delivered integrated maternal mental health and early childhood development group-based intervention in Siaya County, Kenya: A quasi-experimental longitudinal study. J Affect Disord 2021; 292:284-294. [PMID: 34134027 PMCID: PMC8863180 DOI: 10.1016/j.jad.2021.06.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/17/2021] [Accepted: 06/01/2021] [Indexed: 12/03/2022]
Abstract
BACKGROUND Maternal mental health is linked to early childhood development; yet there is a gap in evidence-based interventions for low-resource settings. This study estimates the impact of 'Integrated Mothers and Babies Course and Early Childhood Development' (iMBC/ECD), a cognitive-behavioral, group-based intervention, on maternal depression and early childhood social-emotional development in Siaya County, Kenya. METHODS This quasi-experimental study enrolled 417 pregnant women and mothers of children under age 2 across two sub-counties in Siaya County. The intervention area had 193 women in 23 groups implementing iMBC/ECD and the control area had 224 women in 30 groups exposed to ECD only content. Mother/index child dyads were followed for two years. To estimate the causal treatment effect from the non-randomized design, we implemented the propensity score weighting method with inverse probability weights. RESULTS At baseline, 10.2% of participants endorsed moderate/severe depressive symptoms. At 14-months post-intervention, 7.4% endorsed moderate/severe depression. Overall, iMBC/ECD intervention did not have a significant impact on reducing maternal depression or improving children's social and emotional development. However, sub-group analyses revealed that iMBC/ECD was associated with lowered depressive symptoms among women with no/low education, four or more children and/or no experience of intimate partner violence in the past year. Women with high program attendance (more than half of 14 sessions) also experienced consistently fewer depressive symptoms compared to those with lower attendance. LIMITATIONS Non-randomized study, sub-group analyses are exploratory. CONCLUSIONS The iMBC/ECD program may have the potential to improve maternal mental health and early child development for more targeted vulnerable populations.
Collapse
|
91
|
Yang C, Zhao A, Lan H, Ren Z, Zhang J, Szeto IMY, Wang P, Zhang Y. Association Between Dietary Quality and Postpartum Depression in Lactating Women: A Cross-Sectional Survey in Urban China. Front Nutr 2021; 8:705353. [PMID: 34513900 PMCID: PMC8427431 DOI: 10.3389/fnut.2021.705353] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/30/2021] [Indexed: 12/23/2022] Open
Abstract
Background: Evidence on the effects of dietary quality on the risk of postpartum depression in the Chinese population is limited. This study aimed to examine the association between dietary quality and postpartum depression in Chinses lactating women. Methods: A total of 939 participants from 10 cities were included in this analysis. A one-time 24-h dietary recall was used to obtain the data on food consumption and dietary quality was assessed based on Diet Balance Index. The Edinburgh postnatal depression scale was considered at a cutoff point of 10 to detect postpartum depression. Poisson regression models were used to explore the association of dietary quality with postpartum depression. Results: Depressed women tended to have a more inadequate intake of vegetables and have more insufficient food variety. The median (25th, 75th) of the overall high bound score (HBS), low bound score (LBS), and diet quality distance (DQD) was 9 (5, 14), 30 (25, 37), and 40 (34, 47), respectively. Compared with subjects with the lowest quartile of LBS, those with the highest quartile of LBS had a higher risk of postpartum depression [adjusted prevalence ratio (aPR), 1.08; 95% confidence interval (95% CI), 1.01, 1.15; P for trend, 0.043]. We also observed a significant association between DQD and postpartum depression (Q4 vs. Q1: aPR, 1.07; 95% CI: 1.00, 1.14; P for trend, 0.036). Conclusion: Poor dietary quality was associated with postpartum depression in Chinese lactating women.
Collapse
Affiliation(s)
- Chenlu Yang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Ai Zhao
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Hanglian Lan
- Inner Mongolia Dairy Technology Research Institute Co.Ltd., Hohhot, China
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co.Ltd., Hohhot, China
| | - Zhongxia Ren
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Jian Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Ignatius Man-Yau Szeto
- Inner Mongolia Dairy Technology Research Institute Co.Ltd., Hohhot, China
- Yili Maternal and Infant Nutrition Institute, Inner Mongolia Yili Industrial Group Co.Ltd., Hohhot, China
| | - Peiyu Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Yumei Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Beijing Key Laboratory of Toxicological Research and Risk Assessment for Food Safety, School of Public Health, Peking University, Beijing, China
| |
Collapse
|
92
|
Orri M, Besharati S, Ahun MN, Richter LM. Analysis of Maternal Postnatal Depression, Socioeconomic Factors, and Offspring Internalizing Symptoms in a Longitudinal Cohort in South Africa. JAMA Netw Open 2021; 4:e2121667. [PMID: 34410394 PMCID: PMC8377574 DOI: 10.1001/jamanetworkopen.2021.21667] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE Few studies from low-and-middle income countries have investigated long-term associations between maternal postnatal depression and offspring internalizing (ie, depressive and anxiety) symptoms, and none have investigated interactions in this association. OBJECTIVE To investigate the association between maternal postnatal depression and offspring internalizing symptoms from adolescence to adulthood and the interaction with exposure to socioeconomic adversity and with the child's sex. DESIGN, SETTING, AND PARTICIPANTS This secondary analysis used data from Birth to Twenty Plus (BT20+), a prospective birth cohort study of children born in Soweto, South Africa, and followed up until age 28 years. Data were collected from 1990 to 2018, and data were analyzed for this study from February 16 through December 15, 2020. EXPOSURES Maternal postnatal depression self-reported by mothers 6 months after childbirth. MAIN OUTCOMES AND MEASURES The main outcome was offspring internalizing symptoms, assessed at offspring ages 14 years, 22 years, and 28 years and modeled longitudinally. Participants with the highest probability of experiencing high internalizing symptoms (ie, those in the top 20% of the distribution) from age 14 to 28 years were categorized as belonging to the high internalizing symptoms trajectory (vs the low trajectory). Socioeconomic adversity was measured with an index (continuous variable) including low maternal education, household crowding, low assets, and low maternal age. This variable was further stratified into more than 1 SD above the mean index, more than 1 SD below the mean index, and from 1 SD below to 1 SD above the mean index to conduct subgroup analyses. Associations were investigated using multivariable regression models. RESULTS Among 1087 participants born in Soweto, South Africa (543 [50.0%] male participants; 544 [50.0%] female participants), 118 individuals (10.8%) showed a high trajectory of internalizing symptoms from age 14 to 28 years vs 969 individuals (89.1%) with a low trajectory. Children exposed to maternal postnatal depression had statistically significantly increased odds of following the high trajectory (adjusted odds ratio [aOR] per 1-SD increase in maternal postnatal depression, 1.20; 95% CI, 1.02-1.41). This increase in odds differed by exposure to socioeconomic adversity and by child sex: for male participants, the increase in odds was greater in a context of higher vs lower socioeconomic adversity (eg, for >1 SD above the mean: aOR, 3.28; 95% CI, 1.06-10.14 vs for >1 SD below the mean: aOR, 0.98; 95% CI, 0.64-1.50; P for interaction = .12), while for female participants, the increase in odds was greater in a context of lower vs higher socioeconomic adversity (eg, for >1 SD below the mean: aOR, 1.82; 95 % CI, 1.12-2.98 vs for >1 SD above the mean: aOR, 0.59; 95 % CI, 0.30-1.17; P for interaction = .002) (P for 3-way interaction = .003). CONCLUSIONS AND RELEVANCE This study found that postnatal depression was associated with higher odds of persistently increased internalizing symptoms among offspring from adolescence to adulthood in a middle-income country, with variation by socioeconomic adversity and sex. These findings suggest that better understanding of these associations is needed to implement targeted interventions and maximize the impact of public health initiatives aimed at breaking the intergenerational transmission of mental health problems.
Collapse
Affiliation(s)
- Massimiliano Orri
- McGill Group for Suicide Studies, Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Québec, Canada
- Bordeaux Population Health Research Centre, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Sahba Besharati
- Department of Psychology, University of the Witwatersrand School of Human and Community Development, Johannesburg, South Africa
| | - Marilyn N. Ahun
- Department of Social and Preventive Medicine, Université de Montréal School of Public Health, Montréal, Québec, Canada
| | - Linda M. Richter
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
93
|
Jensen SKG, Betancourt TS. Recognizing the Complexity of Psychosocial Factors Associated With Children's Development-the Case of Maternal Depression. JAMA Netw Open 2021; 4:e2122310. [PMID: 34410400 DOI: 10.1001/jamanetworkopen.2021.22310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Sarah K G Jensen
- Boston College School of Social Work, Chestnut Hill, Massachusetts
| | | |
Collapse
|
94
|
Bliznashka L, Yousafzai AK, Asheri G, Masanja H, Sudfeld CR. Effects of a community health worker delivered intervention on maternal depressive symptoms in rural Tanzania. Health Policy Plan 2021; 36:473-483. [PMID: 33313814 PMCID: PMC8128007 DOI: 10.1093/heapol/czaa170] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2020] [Indexed: 01/21/2023] Open
Abstract
Maternal depression affects one in four women in sub-Saharan Africa, yet evidence on effective and scalable interventions is limited. Our objective was to evaluate the effect of a community health worker (CHW) delivered home visit responsive stimulation, health and nutrition intervention, and conditional cash transfers (CCTs) for antenatal care and child growth monitoring attendance on maternal depressive symptoms. We conducted a cluster-randomized controlled trial in 12 villages in rural Ifakara, Tanzania (September 2017 to May 2019). Study villages were randomly assigned to one of three arms: (1) CHW, (2) CHW + CCT and (3) Control. Pregnant women and mothers with a child <12 months were enrolled. Maternal depressive symptoms were assessed using a Tanzanian-adapted version of the Hopkins Symptoms Checklist-25 (HSCL-25) after 18 months of follow-up. We used linear mixed-effects models to estimate intervention effects on HSCL-25 scores. Results showed that the CHW intervention significantly reduced HSCL-25 scores as compared with control [unadjusted mean difference (MD) −0.31, 95% confidence interval (CI) −0.47, −0.15]. The CHW + CCT intervention also appeared to lower HSCL-25 scores (MD −0.17, 95% CI −0.33, −0.01), but results were not statistically significant. Our findings showed that a low-intensity CHW-delivered home visit responsive stimulation, health and nutrition intervention, which did not explicitly aim to improve mental health, reduced maternal depressive symptoms, though the precise mechanisms of action remain unknown. CCTs for antenatal care and child growth monitoring appeared to provide limited to no additional benefit. Community-based integrated interventions that broadly consider maternal and child health, development and well-being have the potential to promote maternal mental health in rural Tanzania and similar settings.
Collapse
Affiliation(s)
- Lilia Bliznashka
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA
| | - Aisha K Yousafzai
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA
| | - Geofrey Asheri
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Plot 463, Kiko Avenue Mikocheni, Dar es Salaam, Tanzania
| | - Christopher R Sudfeld
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA.,Department of Nutrition, Harvard T.H. Chan School of Public Health, 655 Huntington Avenue, Building 1, 11th Floor, Boston, MA 02115, USA
| |
Collapse
|
95
|
Saur AM, Dos Santos MA. Risk factors associated with stress symptoms during pregnancy and postpartum: integrative literature review. Women Health 2021; 61:651-667. [PMID: 34311677 DOI: 10.1080/03630242.2021.1954132] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Stressful events during prenatal and postpartum have been associated with an increase in the susceptibility to the onset of various diseases, threatening mental and physical health of mother and baby. The aim of this study was to synthesize and analyze the literature related to risk factors associated with stress symptoms during pregnancy and immediate postpartum by means of an integrative review. The search was conducted from January 2013 to July 2020, consulting the following databases: PubMed, PsycINFO, CINAHL, Web of Science and LILACS. In total, 1,677 studies were identified, resulting in 38 articles included in this review. The risk factors most associated with stress in pregnancy and postpartum were related to emotional factors (including mental health, traumatic events and obstetric complications); social and economic factors; mother's health conditions and life style behaviors, and social support and partner related stress. The results are discussed under the light of the biopsychosocial model, which proposes that biological, psychological, and social domains should be considered in order to minimize psychosocial risk conditions. It is concluded that strategies to promote psychological care, education, additional social support and health behaviors should be considered to prevent adverse birth outcomes and to increase maternal well-being.
Collapse
Affiliation(s)
- Adriana Martins Saur
- Department of Psychology, University of São Paulo, Faculty of Philosophy, Sciences and Letters at Ribeirão Preto, Brazil
| | | |
Collapse
|
96
|
Mokwena KE. Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children's Rights in South Africa. CHILDREN-BASEL 2021; 8:children8070609. [PMID: 34356588 PMCID: PMC8303702 DOI: 10.3390/children8070609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.
Collapse
Affiliation(s)
- Kebogile Elizabeth Mokwena
- Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi Drive, Ga-Rankuwa, Pretoria 0204, South Africa
| |
Collapse
|
97
|
Concha N, Jovchelovitch S. Grandmothers: Central scaffolding sources impacting maternal and infant feeding practices in Colombia. MATERNAL & CHILD NUTRITION 2021; 17 Suppl 1:e13162. [PMID: 34241952 PMCID: PMC8269147 DOI: 10.1111/mcn.13162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/29/2021] [Accepted: 02/01/2021] [Indexed: 01/03/2023]
Abstract
A growing body of evidence highlights that maternal and child nutrition programmes need to extend beyond the mother-child dyad by adopting a family systems approach, particularly in the Global South. Guided by a sociocultural and community psychology understanding of health, the paper explores factors identifying grandmothers as central resources for nutrition programmes. The study was conducted in a Colombian urban periphery applying a qualitative longitudinal design (prenatal and postpartum). It is based on interviews with adolescent mothers and mothers in their 20s (n = 35 at T1; n = 21 at T2), grandmothers (n = 15 at T1; n = 12 at T2) and community/public stakeholders (n = 17). Many of the participants live in low-income households headed by grandmothers, who adjust feeding practices to the extent of their economic capacity. Findings reveal grandmothers play a central role in decision-making and in enabling a holistic support system for the dyad. This is defined as grandmothers' scaffolding; it covers nutrition advice, breastfeeding and infant feeding, cultural practices, caregiving and maternal mental health. The study helps build the evidence-base for the transferability of a family systems approach to Global South regions by using sociocultural and community psychology concepts to fortify the rationale for including grandmothers in maternal and child nutrition programmes. It argues for the need to continue raising the visibility of key actors like grandmothers and for nutrition programmes to align themselves more flexibly with the needs of families experiencing poverty.
Collapse
Affiliation(s)
- Natalia Concha
- Department of Psychological and Behavioural ScienceThe London School of Economics and Political ScienceLondonUK
| | - Sandra Jovchelovitch
- Department of Psychological and Behavioural ScienceThe London School of Economics and Political ScienceLondonUK
| |
Collapse
|
98
|
Andhavarapu M, Orwa J, Temmerman M, Musana JW. Maternal Sociodemographic Factors and Antenatal Stress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18136812. [PMID: 34201920 PMCID: PMC8297233 DOI: 10.3390/ijerph18136812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 05/27/2021] [Accepted: 05/29/2021] [Indexed: 11/24/2022]
Abstract
Antenatal stress has been associated with adverse birth outcomes such as fetal growth restriction, low birth weight, and preterm birth. Understanding key determinants of stress in a vulnerable pregnant population has the potential of informing development of targeted cost-effective interventions to mitigate against these adverse birth outcomes. We conducted a secondary analysis of data from 150 pregnant women attending antenatal care services at a rural referral hospital in Kenya. The participants completed a sociodemographic and clinical questionnaire, the Cohen’s Perceived Stress Scale (PSS) and gave a hair sample for cortisol and cortisone analysis. The association between selected sociodemographic predictors (age, parity, marital status, maternal education, household income, polygyny, and intimate partner violence) and outcomes (hair cortisol, hair cortisone, and PSS score) was examined using univariate, bivariate and multivariate models. We found a negative association between PSS scores and household income (β = −2.40, p = 0.016, 95% CI = −4.36, −0.45). There was a positive association of the ratio of hair cortisone to cortisol with Adolescent age group (β = 0.64, p = 0.031, 95% CI = 0.06, 1.22), and a negative association with Cohabitation (β = −1.21, p = 0.009, 95% CI = −2.11, −0.31). We conclude that household income influenced psychological stress in pregnancy. Adolescence and cohabitation may have an influence on biological stress, but the nature of this effect is unclear.
Collapse
Affiliation(s)
- Maheshwari Andhavarapu
- Department of Obstetrics & Gynaecology, The Aga Khan University, Nairobi 00100, Kenya; (M.T.); (J.W.M.)
- Correspondence: ; Tel.: +254-720-885527
| | - James Orwa
- Department of Population Health, The Aga Khan University, Nairobi 00100, Kenya;
| | - Marleen Temmerman
- Department of Obstetrics & Gynaecology, The Aga Khan University, Nairobi 00100, Kenya; (M.T.); (J.W.M.)
| | - Joseph Wangira Musana
- Department of Obstetrics & Gynaecology, The Aga Khan University, Nairobi 00100, Kenya; (M.T.); (J.W.M.)
| |
Collapse
|
99
|
Bluett-Duncan M, Kishore MT, Patil DM, Satyanarayana VA, Sharp H. A systematic review of the association between perinatal depression and cognitive development in infancy in low and middle-income countries. PLoS One 2021; 16:e0253790. [PMID: 34170948 PMCID: PMC8232443 DOI: 10.1371/journal.pone.0253790] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022] Open
Abstract
The association between perinatal depression and infant cognitive development has been well documented in research based in high-income contexts, but the literature regarding the same relationship in low and middle-income countries (LMICs) is less developed. The aim of this study is to systematically review what is known in this area in order to inform priorities for early intervention and future research in LMICs. The review protocol was pre-registered on Prospero (CRD42018108589) and relevant electronic databases were searched using a consistent set of keywords and 1473 articles were screened against the eligibility criteria. Sixteen articles were included in the review, seven focusing on the antenatal period, eight on the postnatal period, and one which included both. Five out of eight studies found a significant association between antenatal depression (d = .21-.93) and infant cognitive development, while four out of nine studies found a significant association with postnatal depression (d = .17-.47). Although the evidence suggests that LMICs should prioritise antenatal mental health care, many of the studies did not adequately isolate the effects of depression in each period. Furthermore, very few studies explored more complex interactions that may exist between perinatal depression and other relevant factors. More high-quality studies are needed in LMIC settings, driven by current theory, that test main effects and examine moderating or mediating pathways to cognitive development.
Collapse
Affiliation(s)
- Matthew Bluett-Duncan
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, United Kingdom
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - M. Thomas Kishore
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Divya M. Patil
- Department of Epidemiology, School of Public Health, University of Washington, Washington, DC, United States of America
| | - Veena A. Satyanarayana
- Department of Clinical Psychology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Helen Sharp
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, United Kingdom
| |
Collapse
|
100
|
Pitchik HO, Tofail F, Rahman M, Akter F, Sultana J, Shoab AK, Huda TMN, Jahir T, Amin MR, Hossain MK, Das JB, Chung EO, Byrd KA, Yeasmin F, Kwong LH, Forsyth JE, Mridha MK, Winch PJ, Luby SP, Fernald LC. A holistic approach to promoting early child development: a cluster randomised trial of a group-based, multicomponent intervention in rural Bangladesh. BMJ Glob Health 2021; 6:bmjgh-2020-004307. [PMID: 33727278 PMCID: PMC7970287 DOI: 10.1136/bmjgh-2020-004307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/13/2021] [Accepted: 02/10/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction In low- and middle-income countries, children experience multiple risks for delayed development. We evaluated a multicomponent, group-based early child development intervention including behavioural recommendations on responsive stimulation, nutrition, water, sanitation, hygiene, mental health and lead exposure prevention. Methods We conducted a 9-month, parallel, multiarm, cluster-randomised controlled trial in 31 rural villages in Kishoreganj District, Bangladesh. Villages were randomly allocated to: group sessions (‘group’); alternating groups and home visits (‘combined’); or a passive control arm. Sessions were delivered fortnightly by trained community members. The primary outcome was child stimulation (Family Care Indicators); the secondary outcome was child development (Ages and Stages Questionnaire Inventory, ASQi). Other outcomes included dietary diversity, latrine status, use of a child potty, handwashing infrastructure, caregiver mental health and knowledge of lead. Analyses were intention to treat. Data collectors were independent from implementers. Results In July–August 2017, 621 pregnant women and primary caregivers of children<15 months were enrolled (group n=160, combined n=160, control n=301). At endline, immediately following intervention completion (July–August 2018), 574 participants were assessed (group n=144, combined n=149, control n=281). Primary caregivers in both intervention arms participated in more play activities than control caregivers (age-adjusted means: group 4.22, 95% CI 3.97 to 4.47; combined 4.77, 4.60 to 4.96; control 3.24, 3.05 to 3.39), and provided a larger variety of play materials (age-adjusted means: group 3.63, 3.31 to 3.96; combined 3.81, 3.62 to 3.99; control 2.48, 2.34 to 2.59). Compared with the control arm, children in the group arm had higher total ASQi scores (adjusted mean difference in standardised scores: 0.39, 0.15 to 0.64), while in the combined arm scores were not significantly different from the control (0.25, –0.07 to 0.54). Conclusion Our findings suggest that group-based, multicomponent interventions can be effective at improving child development outcomes in rural Bangladesh, and that they have the potential to be delivered at scale. Trial registration number The trial is registered in ISRCTN (ISRCTN16001234).
Collapse
Affiliation(s)
- Helen O Pitchik
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Fahmida Tofail
- Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Mahbubur Rahman
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Fahmida Akter
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Jesmin Sultana
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Abul Kasham Shoab
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tarique Md Nurul Huda
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Tania Jahir
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Md Ruhul Amin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Md Khobair Hossain
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Jyoti Bhushan Das
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Esther O Chung
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Farzana Yeasmin
- Infectious Diseases Division, International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Dhaka District, Bangladesh
| | - Laura H Kwong
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Jenna E Forsyth
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
| | - Malay K Mridha
- Center for Non-communicable Diseases and Nutrition, BRAC James P Grant School of Public Health, BRAC University, Dhaka, Dhaka District, Bangladesh
| | - Peter J Winch
- International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stephen P Luby
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Lia Ch Fernald
- Division of Community Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| |
Collapse
|