Maternal depression increases infant risk of diarrhoeal illness: --a cohort study

Maternal common mental disorder and infant growth--a cross-sectional study from Malawi

The objective of the study was to investigate the association between maternal common mental disorder (CMD) and infant growth in rural Malawi. A cross-sectional study was conducted at a district hospital child health clinic. Participants were consecutive infants due for measles vaccination, and their mothers. Mean infant weight-for-age and length-for-age z-scores were compared between infants of mothers with and without CMD as measured using the self-reporting questionnaire (SRQ). Of 519 eligible infants/mothers, 501 were included in the analysis. Median infant age was 9.9 months. 29.9% of mothers scored 8 or above on the SRQ indicating CMD. Mean length-for-age z-score for infants of mothers with CMD (-1.50 SD 1.24) was significantly lower than for infants of mothers without CMD (-1.11 SD 1.12) Student's t-test: P = 0.001. This association was confirmed in multivariate analysis. Mean weight-for-age z-score for infants of mothers with CMD (-1.77 SD 1.16) was lower than for infants of mothers without CMD (-1.59 SD 1.09) but this difference was not significant on univariate (Student's t-test: P = 0.097) or multivariate analysis. The study demonstrates an association between maternal CMD and infant growth impairment in rural sub-Saharan Africa.

Psychological distress in mothers and fathers of preschool children: a 5-year follow-up study after birth

OBJECTIVE

Maternal and paternal psychological distress influence children's development and health beyond the perinatal period. The aim of our study was to describe psychological health during a 5-year period in parents of preschool children. Secondarily, we wanted to explore differences between mothers and fathers and identify predictors for increased psychological distress in parents.

DESIGN

Prospective cohort study.

SETTING

A county in Southern Norway 1998-2004.

POPULATION

One hundred and twenty-three mothers and 112 fathers were candidates for the follow-up study.

METHODS

Parental psychological responses were assessed using the General Health Questionnaire (GHQ-28), State Anxiety Inventory-X1 and Impact of Event Scale at 0-4 days, 6 weeks, 6 months and 5 years after delivery of a healthy child.

MAIN OUTCOME MEASURE

Parental psychological distress defined by GHQ-28 Likert sum score at 5-year follow-up.

RESULTS

Clinically important psychological distress (GHQ case score > or = 6) was reported by more mothers (29%) than by fathers (11%) (P = 0.004). In multivariate analysis, psychological distress (GHQ-28 Likert sum score) after 5 years was predicted by initial psychological distress, being single and low educational level in mothers, and unemployment and low quality of relationship with partner in fathers.

CONCLUSIONS

Fathers reported significantly lower frequency of clinically important psychological distress and more stable scores than mothers throughout the period. The results indicate that selected psychometric screening may be warranted for parents with known psychosocial risk factors.

Mothers' knowledge of young child development in a developing country

BACKGROUND

Although interventions on child development target supporting mothers' relationships with their children, little is known about maternal knowledge of child development in developing countries. The purpose of this study was to determine maternal knowledge about child development in Turkey.

METHODS

The Caregiver Knowledge of Child Development Inventory (CKCDI) developed for this study consisted of questions on when children begin to demonstrate developmental skills and when caregivers should provide opportunities for developmental stimulation.

RESULTS

In total, 1200 mothers of children aged <or=3 years chosen by random population-based sampling were administered the CKCDI in their homes. Of the 1055 mothers with complete data (88%), 64% had at most secondary school education and 11% were employed. The median CKCDI questionnaire score was 19 (highest possible score 40). Mothers believed that most developmental skills and activities should occur at later than normative ages and most mothers did not know that sight (52%), vocalization (79%), social smiling (59%) and overall brain development (68%) begins in the early months of life. In a linear regression model with CKCDI score as the dependent and age of child, number of children, maternal and paternal age and education as the independent variables, higher maternal education and lower number of children were found to be independent predictors of higher CKCDI scores (P < 0.001).

CONCLUSIONS

These results illustrate the degree to which caregivers from Turkey may be lacking information on early childhood development and that caregiver knowledge needs to be further investigated so that culture-specific and effective interventions can be planned.

No health without mental health

About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.

Maternal depression and infant growth: a review of recent evidence

Depressive disorder occurring during pregnancy and the post-natal period (maternal depression) is common in both developed and developing countries. It can cause functional impairment at a time when the mother is performing tasks vital to her infant's growth and development. This article reviews recent research investigating whether there is an association between maternal depression and infant growth impairment. A search was made using Medline for articles published in the last 10 years, and the results were scrutinized for relevance and quality. Eight studies from developing countries, and three from the UK, are described. Cohort studies from both India and Pakistan provide evidence that maternal depression is an independent risk factor for poor infant growth. However, studies from other developing countries are limited and conflicting in their findings. The UK-based research suggests that such an association occurs in mothers/infants living in conditions of socio-economic deprivation. This review discusses the potential mechanisms by which the relationship between maternal depression and infant growth outcomes may be explained: the effect of infant growth 'failure' upon maternal mood; the impact of maternal depression upon health-seeking behaviours, breastfeeding and mother-child interaction; the relationship between antenatal depression and low infant birthweight; and economic, socio-cultural and confounding factors that may explain the variation between results from different settings.