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Dueckelmann AM, Hermann P, Biele C, Leichtle C, Waldner C, Braun T, Henrich W. Short and long-term menstrual, reproductive, and mental health outcomes after the intrauterine use of chitosan tamponade or the Bakri balloon for severe postpartum hemorrhage: an observational study. J Matern Fetal Neonatal Med 2024; 37:2354382. [PMID: 38782738 DOI: 10.1080/14767058.2024.2354382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024]
Abstract
OBJECTIVE This retrospective follow-up study analyzes the effect of intrauterine postpartum hemorrhage (PPH) therapy on menstrual, reproductive, and mental health outcomes. METHODS All women who delivered at a university hospital between 2016 and 2021 with PPH and who needed intrauterine therapy were included. A questionnaire on well-being, menses, fertility, and reproductive outcomes was mailed to the patients. Those who did not reply were surveyed by telephone. RESULTS A total of 214 women treated with chitosan-covered gauze (group A) and 46 women treated with a balloon tamponade (group B) were recruited, and their short-term courses were analyzed. For long-term follow-up, 71 women of group A (33%) and 21 women of group B (46%) could be reached. A total of 89% of group A and 95% of group B had regular menstrual bleeding in the most recent 12 months; 27% (group A) and 29% (group B) were trying to conceive again, and all of them did so successfully. There were 12 deliveries, 3 ongoing pregnancies, 3 miscarriages, and 2 terminations of pregnancies (TOP) in group A and 4 deliveries, 1 miscarriage, and 2 TOPs in group B. More than half of our study participants was sorted into grade II or III of the Impact of Events Scale, indicating they experienced clinical impacts in the form of psychological sequelae. One-quarter of patients had symptoms of post-traumatic stress disorder. CONCLUSION Chitosan gauze as well as balloon tamponade appear to have few adverse effects on subsequent menstrual and reproductive function. Women after PPH are at increased risk of long-term adverse psychological outcomes.
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Affiliation(s)
- Anna M Dueckelmann
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Paulina Hermann
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Carolin Biele
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Clara Leichtle
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Charlotte Waldner
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Thorsten Braun
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité - University Hospital Berlin, Berlin, Germany
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Meredith Weiss S, Aydin E, Lloyd-Fox S, Johnson MH. Trajectories of brain and behaviour development in the womb, at birth and through infancy. Nat Hum Behav 2024:10.1038/s41562-024-01896-7. [PMID: 38886534 DOI: 10.1038/s41562-024-01896-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/04/2024] [Indexed: 06/20/2024]
Abstract
Birth is often seen as the starting point for studying effects of the environment on human development, with much research focused on the capacities of young infants. However, recent imaging advances have revealed that the complex behaviours of the fetus and the uterine environment exert influence. Birth is now viewed as a punctuate event along a developmental pathway of increasing autonomy of the child from their mother. Here we highlight (1) increasing physiological autonomy and perceptual sensitivity in the fetus, (2) physiological and neurochemical processes associated with birth that influence future behaviour, (3) the recalibration of motor and sensory systems in the newborn to adapt to the world outside the womb and (4) the effect of the prenatal environment on later infant behaviours and brain function. Taken together, these lines of evidence move us beyond nature-nurture issues to a developmental human lifespan view beginning within the womb.
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Affiliation(s)
- Staci Meredith Weiss
- University of Cambridge, Department of Psychology, Cambridge, UK.
- University of Roehampton, School of Psychology, London, UK.
| | - Ezra Aydin
- University of Cambridge, Department of Psychology, Cambridge, UK
- Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Sarah Lloyd-Fox
- University of Cambridge, Department of Psychology, Cambridge, UK
| | - Mark H Johnson
- University of Cambridge, Department of Psychology, Cambridge, UK
- Centre for Brain and Cognitive Development, Birkbeck, University of London, London, UK
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Lubis PN, Saputra M, Rabbani MW. A systematic review of the benefits of breastfeeding against postpartum depression in low-middle-income countries. J Ment Health 2024:1-13. [PMID: 38869015 DOI: 10.1080/09638237.2024.2361232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 03/16/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND The positive impact of breastfeeding against postpartum depression has been increasingly reported. However, no studies have systematically and critically examined current evidence on breastfeeding practices' influences on postpartum depression in LMICs. AIM To review the influence of breastfeeding on postpartum depression in LMICs. METHODS We searched original research in English published over the last ten years (2012 - 2022) within 8 databases: EBSCOhost, EMBASE, Pubmed, Sage Journals, Science Direct, APA PsycArticles, Taylor & Francis, Google Scholar, and citation tracking. The risk of bias assessment used The Newcastle Ottawa Scale and The Modified Jadad Scale. We followed the PRISMA statement after the protocol had been registered on the PROSPERO. The review included 21 of 11015 articles. RESULTS Of 21 articles, 16 examined breastfeeding practices, 2 each investigated breastfeeding self-efficacy and breastfeeding education, and 1 each assessed breastfeeding attitude and breastfeeding support. 3 randomized control trials and 5 cohorts revealed that breastfeeding decreased the EPDS scores. However, 4 cross-sectional studies indicated that breastfeeding is nonsignificantly associated with postpartum depression. CONCLUSION This review indicated that breastfeeding may alleviate or prevent postpartum depression. Our findings indicated that integrating breastfeeding-related programs and policies into postpartum depression prevention may benefit public health. REGISTRATION PROSPERO (CRD42022315143).
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Affiliation(s)
| | - Maman Saputra
- Tulodo Organizations and Universitas Terbuka, Indonesia
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Kassa G, Batchelder A, Gross D. Prevalence and determinants of postpartum depression among adolescent and adult mothers in Northwest Ethiopia. Res Nurs Health 2024; 47:125-140. [PMID: 38095115 DOI: 10.1002/nur.22362] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 10/25/2023] [Accepted: 12/03/2023] [Indexed: 03/25/2024]
Abstract
Postpartum depression (PPD) is a common mental health issue in resource-limited settings that negatively affects the well-being of mothers and children. However, PPD often remains untreated, leading to long-term consequences for families. Therefore, we examined the prevalence and determinants of PPD among adolescent and adult mothers in northwest Ethiopia. Data were collected from 374 adolescent (10-19 years) and 760 adult (20-34 years) mothers 6 weeks after childbirth. Data were analyzed using binary and multiple logistic regression. Adolescent mothers had a significantly higher proportion of PPD (37.4%) than adult mothers (20.1%) and were more likely to report low self-esteem (13.1% vs. 8.2%) and low social support (28.3% vs. 23.3%). Factors associated with PPD differed between adolescent and adult mothers. Adolescent mothers with PPD were more likely to report household food insecurity, low self-esteem, low knowledge of postpartum complications, and working in agriculture or professional/technical occupations. For adult mothers, factors associated with PPD included distance to the nearest health facility, medium social support, inadequate dietary diversity, and food insecurity. Results suggest that targeted interventions by age group are needed to reduce the burden of PPD in Ethiopia.
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Affiliation(s)
- Getachew Kassa
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Anne Batchelder
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
| | - Deborah Gross
- School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
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Glasser S, Uziel M, Wagman S, Zaworbach H, Ferber Y, Levinson D, Lerner-Geva L. The first three years: The association of early postpartum depressive symptoms with infant and toddler development. Public Health Nurs 2024; 41:274-286. [PMID: 38131107 DOI: 10.1111/phn.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/19/2023] [Accepted: 12/01/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND The influence of postpartum depression (PPD) on child development has been a source of professional interest and practical relevance. OBJECTIVE This study investigated the association of early PPD symptoms with developmental domains. DESIGN AND METHOD This historical cohort study included 574,282 children attending Mother Child Healthcare Centers in Israel from January 1, 2014 to July 31, 2020, who underwent at least one developmental screening examination by public health nurses up to age 36 months, and whose mothers completed the Edinburgh Postnatal Depression Scale (EPDS) postnatally. Developmental milestone tasks included four domains: fine and gross motor, language/communication, and social/behavioral. RESULTS The rate of failure to complete age-appropriate tasks was higher among children whose mothers had scored ≥ 10 on the EPDS on the majority of tasks in every domain. DISCUSSION This large population-based study has demonstrated the association between early maternal postnatal depressive symptoms and failure to meet developmental milestones across domains, until three years. Recommendations for practice focus on the mother, the child, and health policy.
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Affiliation(s)
- Saralee Glasser
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Moshe Uziel
- Big Data Department, TIMNA Initiative, Ministry of Health, Jerusalem, Israel
| | - Shir Wagman
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Hani Zaworbach
- Big Data Department, TIMNA Initiative, Ministry of Health, Jerusalem, Israel
| | - Yona Ferber
- Public Health Services, Ministry of Health, Jerusalem, Israel
| | - Daphna Levinson
- Mental Health Services, Ministry of Health, Jerusalem, Israel
| | - Liat Lerner-Geva
- Women and Children's Health Research Unit, Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, affiliated with Tel Aviv University, Ramat Gan, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Míguez MC, Vázquez MB. Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum. Midwifery 2023; 126:103808. [PMID: 37672853 DOI: 10.1016/j.midw.2023.103808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 07/15/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Depression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum. DESIGN Longitudinal study. SETTING Interviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum. PARTICIPANTS 561 postpartum women. MEASUREMENTS AND FINDINGS Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE The clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.
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Mulugeta Y, Mohammed AA, Ibrahim IM, Getachew G, Ahmed KY. Postpartum depression and associated factors in Afar Region, northeast Ethiopia. Heliyon 2023; 9:e19914. [PMID: 37809513 PMCID: PMC10559328 DOI: 10.1016/j.heliyon.2023.e19914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 08/11/2023] [Accepted: 09/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background To effectively address the burden of postpartum depression (PPD), it is crucial to gain a comprehensive understanding of its magnitude and the factors associated with it in the pastoral and hot region of the Afar Region. This will help identify the progress made thus far and highlight areas that require further attention to accelerate efforts toward reducing the impact of PPD. Notably, no previous study has examined the prevalence and associated factors of PPD specifically in pastoral communities within Ethiopia, including the Afar Region. Accordingly, we investigated the prevalence and associated factors of PPD among postpartum women in the Afar Region, Northeast Ethiopia. Methods An institution-based cross-sectional study was conducted in the Awsi Rasu Zone of Afar Regional State from June to July 2021. The study employed a systematic random sampling method to select a total of 302 postpartum mothers who had visited the Expanded Program of Immunisation (EPI) clinics in public health facilities within the Awsi Rasu Zone of the Afar Region. The measurement of PPD was performed using the Edinburgh Postnatal Depression Scale (EPDS). Multivariable binary logistic regression modelling was used to investigate associations between sociodemographic, obstetric and health service, and psychosocial factors with PPD. Results The overall prevalence of PPD was 37.4% with a 95% confidence interval (CI) from 32.0% to 43.0%. Postpartum women who attained high school education were associated with a lower odds of PPD compared to those who did not attain formal schooling (adjusted odds ratio [AOR] = 0.31; 95% CI: 0.12, 0.82). Postpartum women with a family history of mental illness (AOR = 2.34; 95% CI: 1.24, 4.41), those who had trouble in infant feeding (AOR = 4.26; 95% CI: 2.32, 7.83), and those who experienced intimate partner violence (AOR = 3.09; 95% CI: 1.58, 6.04) were positively associated with PPD. Conclusion The results of our study revealed that the prevalence of PPD in the Awsi Rasu Zone of the Afar Region is higher than both the national and global averages. The findings also highlighted the need for targeted interventions addressing the needs of pastoral postpartum women who experience various stressors, such as feeding difficulties and intimate partner violence.
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Affiliation(s)
| | - Ahmed Adem Mohammed
- Department of Nursing, College of Medicine and Health Science, Samara University, PO Box: 132, Samara, Ethiopia
| | - Ibrahim Mohammed Ibrahim
- Department of Midwifery, College of Medicine and Health Science, Samara University, PO Box: 132, Samara, Ethiopia
| | | | - Kedir Y. Ahmed
- Department of Public Health, College of Medicine and Health Science, Samara University, PO Box: 132, Samara, Ethiopia
- Rural Health Research Institute, Charles Sturt University, Orange, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Campbelltown, NSW, Australia
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He Q, Cheng G, He S, Tian G, Xie X, Jiang N, Min X, Li C, Li R, Shi Y, Zhou T, Yan Y. Association between maternal postpartum depression and children's physical growth in early childhood: a birth cohort study. Front Pediatr 2023; 11:1135876. [PMID: 37565240 PMCID: PMC10410140 DOI: 10.3389/fped.2023.1135876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 07/12/2023] [Indexed: 08/12/2023] Open
Abstract
Background Untreated maternal postpartum depression (PPD) has consequences for children's physical growth, but no published study has evaluated changes in this effect over time. Here we therefore aimed to evaluate the dynamic effects of PPD on the physical growth of children in a prospective birth cohort. Methods Between 2015 and 2019, 960 mother-child pairs in Changsha, China were followed up when the child was aged 1-48 months. Data were obtained through household surveys. The mothers' depressive symptoms were measured using the Edinburgh Postpartum Depression Scale (EPDS) at 1 month postpartum. Linear mixed models were used to examine the changes in the association of PPD and EPDS scores with physical growth in six different age groups of children between 1 and 48 months. Results A total of 604 mother-child pairs completed the follow-up, and 3.3% of mothers reported PPD. No associations were found between PPD and weight or height growth at any age. While EPDS scores were associated with weight gain (β = -0.014, 95% CI (-0.025, -0.002), P = 0.024) and height growth (β = -0.044, 95% CI (-0.084, -0.004), P = 0.030) rates at 1-3 months, no associations were found in older children. Limitations The number of mothers who reported PPD was relatively small, and the measurement of PPD was not continuously taken. Conclusions After adjustments for confounders, no dynamic association was found between PPD and children's weight and height growth. EPDS scores, in contrast, did negatively affect children's weight and height growth at age 1-3 months, but this effect was not long-lasting.
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Affiliation(s)
- Qiong He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
- Medical Record Management and Statistical Information Center, Xiangya Hospital, Central South University, Changsha, China
| | - Gang Cheng
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Simin He
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Gang Tian
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xiaowei Xie
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Ni Jiang
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Xianying Min
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Chao Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Rui Li
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Shi
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Tong Zhou
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
| | - Yan Yan
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Tauriello S, Moding K, Aronoff N, Kubiniec E, Anzman-Frasca S. Examining links between child temperament and feeding, eating, and weight outcomes: An updated systematic review of the literature. Eat Behav 2023; 49:101739. [PMID: 37209569 DOI: 10.1016/j.eatbeh.2023.101739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/28/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Weight outcomes have been associated with child temperament, defined as individual differences in reactivity and self-regulation. The current systematic review aims to provide an updated summary of the evidence linking temperamental negative reactivity, surgency, and regulation superfactors to early childhood feeding, eating, and weight outcomes. METHODS PubMed, PsycINFO and Embase databases, as well as scientific meeting programs, were searched using keywords and subject headings. Publication dates were limited to 2012-2019 as prior reviews were published in 2012 and 2014. Identified studies were eligible if they included children ages 0-5 years, a measure of child temperament, and a measure of parent/caregiver feeding, child eating, or child weight. 7113 studies were identified and 121 met inclusion criteria. RESULTS Feeding, eating, and weight outcomes were largely unrelated to overarching negative reactivity, surgency, and effortful control superfactors. Examination of individual temperament dimensions suggested difficult temperament was frequently linked to non-responsive feeding practices, whereas elevated emotionality and decreased self-regulation were linked to maladaptive eating behaviors, and lower inhibitory control to adiposity. Analyses with infants reported greater percentages of significant associations compared to children, and cross-sectional studies generally reported fewer significant associations than other study designs. CONCLUSIONS Difficult temperament, greater emotionality and lower self-regulation and inhibitory control were the aspects of temperament most consistently related to poorer early childhood feeding, eating, and weight outcomes. Associations tended to be stronger in infancy, and when examined within a non-cross-sectional study design. Findings can inform the development of tailored efforts to promote healthy eating and growth throughout childhood.
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Affiliation(s)
- Sara Tauriello
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Kameron Moding
- Department of Human Development and Family Studies, Purdue University, West Lafayette, IN, United States of America
| | - Nell Aronoff
- University Libraries, University at Buffalo, Buffalo, NY, United States of America
| | - Elizabeth Kubiniec
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America
| | - Stephanie Anzman-Frasca
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States of America; Center for Ingestive Behavior Research, University at Buffalo, Buffalo, NY, United States of America.
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Gebrekristos LT, Groves AK, McNaughton Reyes L, Moodley D, Beksinska M, Maman S. Intimate partner violence victimization during pregnancy increases risk of postpartum depression among urban adolescent mothers in South Africa. Reprod Health 2023; 20:68. [PMID: 37131269 PMCID: PMC10155407 DOI: 10.1186/s12978-023-01605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/29/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND It is estimated that 38.8% of mothers develop postpartum depression (PPD) in South Africa. While empirical evidence documents an association between intimate partner violence (IPV) victimization in pregnancy and PPD among adult women, the association has been underexamined among adolescent mothers (< 19 years). The study's purpose is to examine whether IPV victimization during pregnancy is associated with PPD among adolescent mothers. METHODS Adolescent mothers (14-19 years) were recruited at a regional hospital's maternity ward in KwaZulu Natal, South Africa between July 2017-April 2018. Participants completed behavioral assessments at two visits (n = 90): baseline (up to 4 weeks postpartum) and follow-up (6-9 weeks postpartum, when PPD is typically assessed). The WHO modified conflict tactics scale was used to create a binary measure of any physical and/or psychological IPV victimization that occurred during pregnancy. Participants with scores ≥ 13 on the Edinburgh Postpartum Depression Scale (EPDS) were classified as having symptoms of PPD. We used a modified Poisson regression with robust standard errors to assess PPD in association with IPV victimization during pregnancy, controlling for relevant covariates. RESULTS Nearly one-half (47%) of adolescent mothers reported symptoms of PPD by 6-9 weeks post-delivery. Further, IPV victimization during pregnancy was highly prevalent (40%). Adolescent mothers who reported IPV victimization during pregnancy had marginally higher risk of PPD at follow-up (RR: 1.50, 95 CI: 0.97-2.31; p = 0.07). The association was strengthened and significant in covariate-adjusted analysis (RR: 1.62, 95 CI: 1.06-2.49; p = 0.03). CONCLUSIONS Poor mental health was common among adolescent mothers, and IPV victimization during pregnancy was associated with PPD risk among adolescent mothers. Implementing IPV and PPD routine screenings during the perinatal period may aid in identifying adolescent mothers for IPV and PPD interventions and treatment. With the high prevalence of IPV and PPD in this vulnerable population and the potential negative impact on maternal and infant outcomes, interventions to reduce IPV and PPD are needed to improve adolescent mothers' well-being and their baby's health.
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Affiliation(s)
- Luwam T Gebrekristos
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, 3215 Market Street, Philadelphia, PA, 19140, USA.
| | - Allison K Groves
- Department of Community Health and Prevention, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Luz McNaughton Reyes
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Dhayendre Moodley
- Department of Obstetrics and Gynaecology, University of KwaZulu-Natal Nelson R. Mandela School of Medicine, Durban, South Africa
| | - Mags Beksinska
- MatCH Research Unit (MRU), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
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Pellowski JA, Wedderburn CJ, Groenewold NA, Roos A, Subramoney S, Hoffman N, Fouche JP, Joshi SH, Woods RP, Narr KL, Zar HJ, Donald KA, Stein DJ. Maternal perinatal depression and child brain structure at 2-3 years in a South African birth cohort study. Transl Psychiatry 2023; 13:96. [PMID: 36941258 PMCID: PMC10027817 DOI: 10.1038/s41398-023-02395-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 02/24/2023] [Accepted: 03/03/2023] [Indexed: 03/23/2023] Open
Abstract
Maternal perinatal depression is associated with risk of adverse child developmental outcomes and differences in offspring brain structure. Evidence from low- and middle-income countries is lacking as is an investigation of antenatal, postnatal, and persistent depression in the same sample. In a South African birth cohort, we investigated the effect of antenatal and postpartum maternal depressive symptoms on offspring brain structure at 2-3 years of age. Magnetic resonance imaging was performed, extracting cortical thickness and surface areas in frontal cortex regions of interest and subcortical volumes using FreeSurfer software. Maternal depressive symptoms were measured using the Edinburgh Postpartum Depression Scale and the Beck Depression Inventory II antenatally and at 6-10 weeks, 6 months, 12 months, and 18 months postpartum and analyzed dichotomously and continuously. Linear regressions were used controlling for child age, sex, intracranial volume, maternal education, age, smoking, alcohol use and HIV. 146 children were included with 38 (37%) exposed to depressive symptoms antenatally and 44 (35%) exposed postnatally. Of these, 16 (13%) were exposed to both. Postpartum, but not antenatal, depressive symptoms were associated with smaller amygdala volumes in children (B = -74.73, p = 0.01). Persistent maternal depressive symptoms across pregnancy and postpartum were also independently associated with smaller amygdala volumes (B = -78.61, p = 0.047). Differences in amygdala volumes among children exposed to postnatal as well as persistent maternal depressive symptomatology underscore the importance of identifying women at-risk for depression during the entire perinatal period.
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Affiliation(s)
- 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, University of Cape Town School of Public Health and Family Medicine, Cape Town, SA, South Africa.
| | - Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, England
- The Neuroscience Institute, University of Cape Town, SA, Cape Town, South Africa
| | - Nynke A Groenewold
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- The Neuroscience Institute, University of Cape Town, SA, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, SA, South Africa
| | - Annerine Roos
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- The Neuroscience Institute, University of Cape Town, SA, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, SA, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, SA, Cape Town, South Africa
| | - Sivenesi Subramoney
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
| | - Nadia Hoffman
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, SA, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, SA, Cape Town, South Africa
| | - Jean-Paul Fouche
- The Neuroscience Institute, University of Cape Town, SA, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, SA, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, SA, Cape Town, South Africa
| | - Shantanu H Joshi
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Roger P Woods
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Katherine L Narr
- Departments of Neurology, Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- South African Medical Research Council (SAMRC) Unit on Child and Adolescent Health, University of Cape Town, Cape Town, SA, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Cape Town, South Africa
- The Neuroscience Institute, University of Cape Town, SA, Cape Town, South Africa
| | - Dan J Stein
- The Neuroscience Institute, University of Cape Town, SA, Cape Town, South Africa
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, SA, South Africa
- South African Medical Research Council (SAMRC) Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, SA, Cape Town, South Africa
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12
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Roddy Mitchell A, Gordon H, Lindquist A, Walker SP, Homer CSE, Middleton A, Cluver CA, Tong S, Hastie R. Prevalence of Perinatal Depression in Low- and Middle-Income Countries: A Systematic Review and Meta-analysis. JAMA Psychiatry 2023; 80:425-431. [PMID: 36884232 PMCID: PMC9996459 DOI: 10.1001/jamapsychiatry.2023.0069] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
Importance Women who experience depression during or within a year of pregnancy are at increased risk of morbidity and mortality. Although those living in low- and middle-income countries are thought to be at increased risk of perinatal depression, the true prevalence remains unclear. Objective To determine the prevalence of depression among individuals living in low- and middle-income countries during pregnancy and up 1 year post partum. Data Sources MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and the Cochrane Library were searched from database inception until April 15, 2021. Study Selection Studies were included that reported the prevalence of depression using a validated method during pregnancy or up to 12 months post partum in countries defined by the World Bank as low, lower-middle, and upper-middle income. Data Extraction and Synthesis This study followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Two reviewers independently assessed study eligibility, extracted data, and assessed studies for bias. Prevalence estimates were calculated using a random-effects meta-analysis model. Subgroup analyses were performed among women who were considered at increased risk of developing perinatal depression. Main Outcomes and Measures Point prevalence of perinatal depression was the main outcome measured as percentage point estimates with corresponding 95% CIs. Results The search identified 8106 studies, of which data were extracted from 589 eligible studies reporting outcomes of 616 708 women from 51 countries. The pooled prevalence of perinatal depression across all studies was 24.7% (95% CI, 23.7%-25.6%). The prevalence of perinatal depression varied slightly by country income status. The highest prevalence was found in lower-middle-income countries, with a pooled prevalence of 25.5% (95% CI, 23.8%-27.1%; 197 studies from 23 countries including 212 103 individuals). In upper-middle-income countries, the pooled prevalence was 24.7% (95% CI, 23.6%-25.9%; 344 studies from 21 countries including 364 103 individuals) and in low-income countries, the pooled prevalence was 20.7% (95% CI, 18.4%-23.0%; 50 studies from 7 countries including 40 502 individuals). The East Asia and the Pacific region had the lowest prevalence of perinatal depression at 21.4% (95% CI, 19.8%-23.1%) and was significantly increased in the Middle East and North Africa at 31.5% (95% CI, 26.9%-36.2%; between-group comparison: P < .001). In subgroup analyses, the highest prevalence of perinatal depression was found among women who experienced intimate partner violence, at 38.9% (95% CI, 34.1%-43.6%). revalence of depression was also high among women with HIV (35.1% [95% CI, 29.6%-40.6%]) and those who had experienced a natural disaster (34.8% [95% CI, 29.4%-40.2%]). Conclusions and Relevance This meta-analysis found that depression was common in low- and middle-income countries, affecting 1 in 4 perinatal women. Accurate estimates of the prevalence of perinatal depression in low- and middle-income countries are essential in informing policy, allocating scarce resources, and directing further research to improve outcomes for women, infants, and families.
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Affiliation(s)
- Alexandra Roddy Mitchell
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Hannah Gordon
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Anthea Lindquist
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Susan P Walker
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Caroline S E Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Victoria, Australia
| | - Anna Middleton
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Catherine A Cluver
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Stephen Tong
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Roxanne Hastie
- Department of Obstetrics and Gynaecology, The University of Melbourne, Heidelberg, Victoria, Australia.,Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia.,Department of Obstetrics and Gynaecology, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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13
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Veiga GRS, da Silva GAP, Padilha BM, Lima MDC. Determining factors of child linear growth from the viewpoint of Bronfenbrenner's Bioecological Theory. J Pediatr (Rio J) 2022; 99:205-218. [PMID: 36572387 DOI: 10.1016/j.jped.2022.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/28/2022] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE To analyze the factors associated with children's linear growth, according to the different subsystems of the 6Cs model and Bronfenbrenner's Bioecological Theory. DATA SOURCES Narrative review, carried out in the Scielo, Lilacs, Pubmed, and Science Direct databases, based on research using the terms Bioecological Theory, child growth, and risk factors, combined with the use of Boolean operators. SUMMARY OF FINDINGS According to the 6Cs model, proposed based on Bronfenbrenner's Bioecological Theory, the determining factors of children's linear growth are in six interrelated subsystems - cell, child, clan, community, country/state and culture. The empirical studies included in this review made it possible to analyze protection and risk factors within the subsystems. Among the protective factors: are adequate birth weight and satisfactory weight gain, breastfeeding for six months or more; proper hygienic habit of hand washing, proper elimination of feces, and access to clean water. As risk factors: low, birth weight and size, prematurity, multiple deliveries, short interval between deliveries, non-exclusive breastfeeding until the 3rd month, frequency and severity of infectious processes and anemia, little parental education, short maternal statur, inadequate maternal nutritional status, domestic violence, family poverty, food, and nutritional insecurity, living in rural areas or at high altitudes. CONCLUSION Children's linear growth is determined by interrelated factors that encompass aspects prior to the child's birth, as well as socioeconomic, political, family and community issues.
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Affiliation(s)
- Gabriela Rossiter Stux Veiga
- Universidade Federal de Pernambuco, Pós-graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil; Faculdade de Nutrição, Universidade Federal de Alagoas, Maceió, AL, Brazil.
| | | | | | - Marilia de Carvalho Lima
- Universidade Federal de Pernambuco, Pós-graduação em Saúde da Criança e do Adolescente, Recife, PE, Brazil
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14
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Papadopoulos A, Nichols ES, Mohsenzadeh Y, Giroux I, Mottola MF, Van Lieshout RJ, Duerden EG. Prenatal and postpartum maternal mental health and neonatal motor outcomes during the COVID-19 pandemic. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 10:100387. [PMID: 35873090 PMCID: PMC9297659 DOI: 10.1016/j.jadr.2022.100387] [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] [Received: 02/15/2022] [Revised: 05/30/2022] [Accepted: 07/07/2022] [Indexed: 11/30/2022] Open
Abstract
Background Rates of prenatal and postpartum stress and depression in pregnant individuals have increased during the COVID-19 pandemic. Perinatal maternal mental health has been linked to worse motor development in offspring, with motor deficits appearing in infancy and early childhood. We aimed to evaluate the relationship between prenatal and postpartum stress and depression and motor outcome in infants born during the COVID-19 pandemic. Methods One hundred and seventeen participants completed an online prospective survey study at two timepoints: during pregnancy and within 2 months postpartum. Depression was self-reported using the Edinburgh Perinatal/Postpartum Depression Scale (EPDS), and stress via the Perceived Stress Scale (PSS). Mothers reported total infant motor ability (fine and gross) using the interRAI 0–3 Developmental Domains questionnaire. Results Prenatal (EPDS median=10.0, interquartile range[IQR]=6.0 – 14.0, B=-0.035, 95%CI=-0.062 to -0.007, p = 0.014) and postpartum maternal depression outcomes (median=7, IQR=4–12, B=-0.037, 95%CI= -0.066 to -0.008, p = 0.012) were significantlynegatively associated with total infant motor ability. Neither pregnancy nor postpartum perceived stress was associated with infant motor function. A cluster analysis revealed that preterm and low-birth weight infants whose mothers reported elevated depressive symptoms during pregnancy and in the postpartum period had the poorest motor outcomes. Conclusions Prenatal and postpartum depression, but not stress, was associated with early infant motor abilities. Preterm and low-birth weight infants whose mothers reported elevated depressive symptoms maybe at-risk of experiencing poor motor outcomes. These results highlight the importance of identifying pre- and postnatal maternal mental health issues, especially during the ongoing COVID-19 pandemic.
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15
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Burger M, Einspieler C, Niehaus DJH, Unger M, Jordaan ER. Maternal mental health and infant neurodevelopment at 6 months in a low-income South African cohort. Infant Ment Health J 2022; 43:849-863. [PMID: 36268625 PMCID: PMC9828192 DOI: 10.1002/imhj.22021] [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: 10/12/2021] [Accepted: 06/13/2022] [Indexed: 01/12/2023]
Abstract
Maternal mental health disorders and the adverse consequences for infant neurodevelopment have received substantial research attention in high-income countries over the past five decades. In Africa, where relatively little work has been done on this topic, researchers have largely focused on infant physical health outcomes. This longitudinal study investigated the neurodevelopment of infants at 6 months post-term with exposure to mothers with a clinical diagnosis of persistent mental health disorders residing in low-income communities in Cape Town, South Africa. Adjusted models revealed no significant differences on the Bayley Scales of Infant and Toddler Development (BSID-III) domains (cognitive, motor, language, socio-emotional, and adaptive behavior) between infants exposed to maternal mental health disorders (n = 62) and the comparison group (n = 35) at 3 and 6 months. Subgroup analyses found no significant differences on the BSID-III domains between infants with exposure to mood disorders (n = 31), as well as infants with exposure to comorbid (i.e., a combination of two or three) mental health disorders (n = 14) and the comparison group. However, infants with exposure to psychotic disorders (n = 14) scored significantly lower on the cognitive and the motor domains and the fine motor subscale. These novel data provide an important contribution to the scientific literature especially in the field of maternal psychotic disorders in Africa.
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Affiliation(s)
- Marlette Burger
- Faculty of Medicine and Health SciencesPhysiotherapy Division, Department of Health and Rehabilitation SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Christa Einspieler
- Research Unit iDN––Interdisciplinary Developmental Neuroscience, Division of PhoniatricsMedical University of GrazGrazAustria
| | - Dana J. H. Niehaus
- Faculty of Medicine and Health SciencesDepartment of Psychiatry, Stellenbosch UniversityStellenboschSouth Africa
| | - Marianne Unger
- Faculty of Medicine and Health SciencesPhysiotherapy Division, Department of Health and Rehabilitation SciencesStellenbosch UniversityStellenboschSouth Africa
| | - Esme R. Jordaan
- Biostatistics UnitSouth African Medical Research CouncilParowSouth Africa,Statistics and Population StudiesUniversity of the Western CapeCape TownSouth Africa
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16
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Sparling TM, Deeney M, Cheng B, Han X, Lier C, Lin Z, Offner C, Santoso MV, Pfeiffer E, Emerson JA, Amadi FM, Mitu K, Corvalan C, Verdeli H, Araya R, Kadiyala S. Systematic evidence and gap map of research linking food security and nutrition to mental health. Nat Commun 2022; 13:4608. [PMID: 35941261 PMCID: PMC9359994 DOI: 10.1038/s41467-022-32116-3] [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] [Received: 09/28/2021] [Accepted: 07/18/2022] [Indexed: 11/24/2022] Open
Abstract
Connections between food security and nutrition (FSN) and mental health have been analytically investigated, but conclusions are difficult to draw given the breadth of literature. Furthermore, there is little guidance for continued research. We searched three databases for analytical studies linking FSN to mental health. Out of 30,896 records, we characterized and mapped 1945 studies onto an interactive Evidence and Gap Map (EGM). In these studies, anthropometry (especially BMI) and diets were most linked to mental health (predominantly depression). There were fewer studies on infant and young child feeding, birth outcomes, and nutrient biomarkers related to anxiety, stress, and mental well-being. Two-thirds of studies hypothesized FSN measures as the exposure influencing mental health outcomes. Most studies were observational, followed by systematic reviews as the next largest category of study. One-third of studies were carried out in low- and middle-income countries. This map visualizes the extent and nature of analytical studies relating FSN to mental health and may be useful in guiding future research. There is a broad range of research available on the relationship between food security and mental health. Here the authors carry out a systematic mapping of evidence on food security and nutrition related to mental health and identifies trends in themes, setting, and study design over the 20 year period studied.
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Affiliation(s)
- Thalia M Sparling
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
| | - Megan Deeney
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Bryan Cheng
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Xuerui Han
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Chiara Lier
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Zhuozhi Lin
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Maryland, MD, USA
| | - Claudia Offner
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | | | | | | | | | - Khadija Mitu
- Department of Anthropology, University of Chittagong, Chittagong, Bangladesh
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, USA
| | - Ricardo Araya
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suneetha Kadiyala
- London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
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17
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Insan N, Weke A, Rankin J, Forrest S. Perceptions and attitudes around perinatal mental health in Bangladesh, India and Pakistan: a systematic review of qualitative data. BMC Pregnancy Childbirth 2022; 22:293. [PMID: 35387619 PMCID: PMC8988352 DOI: 10.1186/s12884-022-04642-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 04/01/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Perinatal mental health (PMH) is a worldwide public health issue crossing cultural boundaries. However, the prevalence of PMH conditions vary considerably. These disparities stem in part from poor understanding and stigma surrounding PMH which hinder pregnant women from seeking mental health care and may exacerbate their conditions. Bangladesh, India and Pakistan are South Asian countries with a higher burden of PMH conditions than in the Global North-West and very different social and cultural norms around gender and mental health. The aim of this systematic review (PROSPERO Ref: CRD42020167903) was to identify, synthesise and appraise the available literature on perceptions and attitudes of perinatal (pregnant and postpartum) women, their families and healthcare providers surrounding PMH in Bangladesh, India and Pakistan. METHODS Five electronic databases, MEDLINE, Embase, PsycINFO, Scopus and Web of science, and grey literature were searched using predefined search terms. Qualitative or quantitative articles with a qualitative component reporting perceptions and attitudes surrounding PMH in Bangladesh, India and Pakistan were eligible for inclusion, if published in English between January 2000 and January 2021. The Critical Appraisal Skills Programme Qualitative Research Checklist and Newcastle-Ottawa Scale for cross-sectional studies were used to assess study quality. Findings were synthesised using thematic synthesis, as described by Thomas and Harden 2008. RESULTS Eight studies were included. Five overarching themes comprising 17 sub-categories were identified. These descriptive themes were: perceived causes of PMH, perceived symptoms of PMH, perceptions of motherhood, accessing PMH care and emotional sharing and coping strategies. Sociocultural expectations underpin many of the themes identified in this review including the importance of familial and societal causes of PMH, emphasis on physical symptoms, sacredness of motherhood, lack of awareness, stigma, shame, limited resources allocated for mental health and lack of emotional sharing. CONCLUSIONS There is a complex range of perceptions and attitudes around PMH which influence women's experiences and access to PMH care. These findings will inform policy and practice through targeted interventions to tackle stigmatising attitudes and increasing education and training for healthcare providers.
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Affiliation(s)
- Nafisa Insan
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK.
| | - Anthony Weke
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Simon Forrest
- Department of Sociology, Durham University, Durham, UK
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18
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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.
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Blum S, Mack JT, Weise V, Kopp M, Asselmann E, Martini J, Garthus-Niegel S. The impact of postpartum obsessive-compulsive symptoms on child development and the mediating role of the parent-child relationship: A prospective longitudinal study. Front Psychiatry 2022; 13:886347. [PMID: 36203839 PMCID: PMC9532008 DOI: 10.3389/fpsyt.2022.886347] [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: 02/28/2022] [Accepted: 07/25/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The first 2 years of life are a particularly sensitive period for the parent-child relationship as well as a healthy, age-appropriate child development. Both have been shown to be linked to postpartum depressive and anxiety symptoms, while the role of obsessive-compulsive symptoms, which are also common, is still largely understudied. In addition, fathers have been neglected in this area of research. This study, which includes both mothers and fathers, aims to investigate the longitudinal associations between postpartum obsessive-compulsive symptoms and different domains of child development, as well as the mediating role of the parent-child relationship. METHODS Data were drawn from the prospective longitudinal study DREAM, with 674 mothers and 442 fathers from the general population completing self-report questionnaires at four measurement points. Longitudinal associations between parental postpartum obsessive-compulsive symptoms 8 weeks postpartum, the parent-child relationship 14 months postpartum, and child development 24 months postpartum were investigated using regression and mediation analyses. A number of potential confounding variables were considered, i.e., age, academic degree, postpartum depressive and anxiety symptoms of the parents, preterm birth and temperament of the child, as well as COVID-19 pandemic-driven adversities. RESULTS When adjusting for confounders, neither maternal nor paternal postpartum obsessive-compulsive symptoms had adverse effects on the respective parent-child relationship and child development. Further, no mediating role of the parent-child relationship between parental postpartum obsessive-compulsive symptoms and child development could be confirmed. Instead, we found that the mother- and father-child relationship were differentially related to specific child developmental domains. For mothers, a poorer mother-child relationship was prospectively related to poorer fine motor development. For fathers, a poorer father-child relationship prospectively predicted a poorer overall development as well as poorer gross motor, fine motor, problem-solving, and personal-social development. CONCLUSION Our results suggest that negative effects on the parent-child relationship and child development may only become apparent in full-blown postpartum obsessive-compulsive disorder. Given the differential impact on specific developmental domains, our findings also suggest that it is crucial to consider both parents in clinical practice as well as in future research, rather than focusing only on the mother-child dyad.
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Affiliation(s)
- Sophie Blum
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Judith T Mack
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Victoria Weise
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marie Kopp
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Eva Asselmann
- Department of Psychology, HMU Health and Medical University, Potsdam, Germany
| | - Julia Martini
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychiatry and Psychotherapy, Faculty of Medicine, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.,Institute for Systems Medicine and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany.,Department of Child Health and Development, Norwegian Institute of Public Health, Oslo, Norway
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20
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Sparling TM, Cheng B, Deeney M, Santoso MV, Pfeiffer E, Emerson JA, Amadi FM, Mitu K, Corvalan C, Verdeli H, Araya R, Kadiyala S. Global Mental Health and Nutrition: Moving Toward a Convergent Research Agenda. Front Public Health 2021; 9:722290. [PMID: 34722437 PMCID: PMC8548935 DOI: 10.3389/fpubh.2021.722290] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/09/2021] [Indexed: 01/05/2023] Open
Abstract
Both malnutrition and poor mental health are leading sources of global mortality, disease, and disability. The fields of global food security and nutrition (FSN) and mental health have historically been seen as separate fields of research. Each have undergone substantial transformation, especially from clinical, primary care orientations to wider, sociopolitical approaches to achieve Sustainable Development Goals. In recent years, the trajectories of research on mental health and FSN are further evolving into an intersection of evidence. FSN impacts mental health through various pathways such as food insecurity and nutrients important for neurotransmission. Mental health drives FSN outcomes, for example through loss of motivation and caregiving capacities. They are also linked through a complex and interrelated set of determinants. However, the heterogeneity of the evidence base limits inferences about these important dynamics. Furthermore, interdisciplinary projects and programmes are gaining ground in methodology and impact, but further guidance in integration is much needed. An evidence-driven conceptual framework should inform hypothesis testing and programme implementation. The intersection of mental health and FSN can be an opportunity to invest holistically in advancing thinking in both fields.
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Affiliation(s)
- Thalia M Sparling
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bryan Cheng
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Megan Deeney
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Marianne V Santoso
- Department of Anthropology, Northwestern University, Evanston, IL, United States
| | - Erin Pfeiffer
- Independent Consultant, Winston-Salem, NC, United States
| | | | | | - Khadija Mitu
- Department of Anthropology, University of Chittagong, Chittagong, Bangladesh
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Helen Verdeli
- Global Mental Health Lab, Teachers College, Columbia University, New York, NY, United States
| | - Ricardo Araya
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Suneetha Kadiyala
- Innovative Methods and Metrics for Agriculture, Nutrition and Health Actions (IMMANA), London School of Hygiene and Tropical Medicine, London, United Kingdom
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21
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Paternal and maternal long-term psychological outcomes after uterine artery embolization for severe post-partum hemorrhage. Sci Rep 2021; 11:13990. [PMID: 34234162 PMCID: PMC8263630 DOI: 10.1038/s41598-021-92847-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 06/15/2021] [Indexed: 02/02/2023] Open
Abstract
This study intend to compare the long-term psychological impact (depression, post-traumatic stress disorder) on both partners between patients that underwent uterine artery embolization (UAE) for post-partum hemorrhage (PPH) and uneventful deliveries. Women who experienced severe PPH treated by UAE in our institution between 2003 and 2013 were identified in our obstetrical database. These cases were matched to controls with uneventful deliveries. Matching criteria were maternal age, parity, ethnicity, year of delivery, birthweight, gestational age and mode of delivery. Patients and their partners completed validated questionnaires measuring post-traumatic stress (TSQ), as well as depression symptoms (MINI). A total of 63 cases of PPH and 189 matched controls (1:3) participated in a study exploring gynecological and obstetrical outcomes. With a mean of 8 years post-index delivery, patients after PPH showed increased risk of depression (p = 0.015) and post-traumatic stress disorder (22.2% versus 4.8%, p < 0.005) compared to controls. PPH remains strongly associated with post-traumatic stress disorder, even after adjustment for depression (adjusted odds ratio 5.1; 95% confidence intervals 1.5–17.5). Similarly, partners of patients with PPH showed a propensity to depression (p = 0.029) and post-traumatic stress disorder (11.5% versus 1.5%, p = 0.019). In conclusion, both women and their partners are at increased risk of long-term psychological adverse outcomes after PPH. Couples may benefit from psychological support.
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The Influence of Maternal Cognitions Upon Motor Development in Infants Born Preterm: A Scoping Review. Pediatr Phys Ther 2021; 33:137-147. [PMID: 34151889 DOI: 10.1097/pep.0000000000000806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This scoping review summarizes the extent, nature, and type of evidence linking broadly defined maternal cognitions to motor outcomes in infants born preterm. Maternal cognitions are beliefs, perceptions, or psychosocial attributes that inform parenting practices. METHODS Arksey and O'Malley's 5-step method was applied. Thirteen articles between 1980 and November 2019 met inclusion criteria. RESULTS Two key themes emerged with infants born preterm: (1) quality of the social and physical caregiving environment influence developmental outcomes with implications for motor development; and (2) complex interactions between environmental factors, prematurity-related biomedical risks, and maternal cognitions contribute to eventual motor outcomes. CONCLUSION Further research is needed to understand how maternal cognitions either scaffold or constrain early motor opportunities for infants born preterm and at risk for motor delays. WHAT THIS ADDS TO THE EVIDENCE This review summarizes studies that explore potential links between maternal cognitions and motor development in infants born preterm.
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Kautz-Turnbull C, Petrenko CLM, Handley ED, Coles CD, Kable JA, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Chambers CD. Partner influence as a factor in maternal alcohol consumption and depressive symptoms, and maternal effects on infant neurodevelopmental outcomes. Alcohol Clin Exp Res 2021; 45:1265-1275. [PMID: 33999430 DOI: 10.1111/acer.14612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 03/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Few studies have investigated the partner's influence on risk factors such as alcohol consumption and depression during pregnancy. Partner substance use and lower relationship satisfaction predict higher maternal alcohol use and depressive symptoms. Because prenatal alcohol use and maternal depression affect infant outcomes, it is imperative to examine how the partner affects these maternal risk factors. The current study examined the effect of a latent construct of partner influence on maternal alcohol use and depressive symptoms, and the effects on infant development of these maternal factors. METHODS Participants were 246 pregnant women from 2 sites in Western Ukraine from whom longitudinal data were collected as part of a multisite study. In the first trimester, mothers reported on relationship satisfaction, partner substance use, and socioeconomic status (SES). In the third trimester, they reported on alcohol use and depressive symptoms. Infants were assessed using the Bayley Scale of Infant Development (average age = 6.93 months). A latent construct titled partner influence was formed using partner substance use and measures of relationship satisfaction, including the frequency of quarreling, happiness in the relationship, and the ease of talking with the partner. Using structural equation modeling, a model was specified in which partner influence and SES predicted maternal alcohol use and depressive symptoms, which in turn predicted infant neurodevelopmental outcomes. RESULTS Higher partner influence significantly predicted lower prenatal alcohol use and lower depressive symptoms, controlling for the effect of SES. Higher maternal prenatal alcohol use significantly predicted lower infant mental and psychomotor development. Maternal depressive symptoms did not predict infant development over and above the effect of alcohol use. CONCLUSIONS Partner influence is an important contributor to prenatal alcohol use and maternal depressive symptoms, over and above the effect of SES. The significant paths from prenatal alcohol exposure to infant neurodevelopmental outcomes underscore the importance of partner influence during pregnancy.
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Affiliation(s)
| | | | | | - Claire D Coles
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie A Kable
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Wladimir Wertelecki
- Department of Medical Genetics, University of South Alabama, Mobile, AL, USA.,OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Rivne Province, Ukraine.,OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Khmelnytsky Province, Ukraine
| | | | - Natalya Zymak-Zakutnya
- OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Khmelnytsky Province, Ukraine
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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Alarcón-Guevara S, Peñafiel-Sam J, Chang-Cabanillas S, Pereyra-Elías R. Maternal depressive symptoms are not associated with child anaemia: A cross-sectional population study in Peru, 2015. Child Care Health Dev 2021; 47:228-242. [PMID: 33150967 DOI: 10.1111/cch.12827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 10/20/2020] [Accepted: 10/28/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Approximately, one in three Peruvian children aged 6 to 59 months old have anaemia. Maternal depression, which may be disabling and affect the proper care of children, is associated with chronic malnutrition in their offspring. Therefore, the aim of this study is to evaluate if there is an association between depressive symptoms of mothers with the presence of anaemia in their children. METHODS Analytical cross-sectional study of the Peruvian Demographic Health Survey 2015, which is nationally representative. Depressive symptoms were measured with the Patient Health Questionnaire-9 (PHQ-9) using a score of 10 as cut-off. The presence of anaemia was measured using HemoCue® and was considered positive when the haemoglobin was less than 11 g/dl. RESULTS Crude and adjusted prevalence ratios (PR and aPR) were calculated with 95% confidence interval (CI), using generalized linear models of the Poisson family. We analysed 6683 mother-child binomials. The prevalence of anaemia in the children and depressive symptoms in women were 28.7% (95% CI: 27.3-30.2) and 6.9% (95% CI: 6.1-7.9), respectively. We found no statistically significant association between these variables in the bivariable analysis or in the different multivariable models (aPR: 1.05, 95% CI: 0.85-1.30). The sample did not have moderate or severe malnutrition. CONCLUSIONS There is no statistically significant difference between the prevalence of anaemia in children of mothers with or without depressive symptoms. We recommend continuing research in this field to determine more associate factors to childhood anaemia in order to improve primary prevention interventions. Ideally, conducting longitudinal studies such as prospectives cohorts to determine risk factors should be done.
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Affiliation(s)
| | | | | | - Reneé Pereyra-Elías
- School of Medicine, Universidad Peruana de Ciencias Aplicadas, Lima, Peru.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
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Islam MS, Zafar Ullah AN, Mainali S, Imam MA, Hasan MI. Determinants of stunting during the first 1,000 days of life in Bangladesh: A review. Food Sci Nutr 2020; 8:4685-4695. [PMID: 32994930 PMCID: PMC7500796 DOI: 10.1002/fsn3.1795] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 06/26/2020] [Accepted: 06/30/2020] [Indexed: 11/09/2022] Open
Abstract
Stunting is a major problem in Bangladesh, with a prevalence of 31% in 2017. The prevalence of stunting in children aged under two has reduced by only 6% since 2004. After children reach 2 years of age, the consequences of stunting become almost irreversible. This paper seeks to examine and analyze the determinants associated with stunting during the first 1,000 days of life in Bangladesh to assist in developing evidence-based interventions in Bangladesh. A literature review was conducted comprehensively on all relevant peer-reviewed and gray literature of studies conducted in Bangladesh. The existing literature was searched and examined using the World Health Organization (WHO) conceptual framework for stunting. Evidence indicates that low maternal weight, lack of maternal education, severe food insecurity, lack of access to suitable nutrition, nonexclusive breastfeeding, pathogen-specific diarrhea, and low weight and height at birth are associated with early childhood stunting in Bangladesh. The relation of the quality of drinking water with stunting is not clear in Bangladesh. Literature about the association between stunting and determinants such as the political economy, education systems, and agriculture and food systems is not found. This synthesis shows that the factors of stunting are multifaceted. As such, a multi-sectoral approach is essential in Bangladesh, employing evidence-based interventions to address the determinants that contribute to the risk of stunting to achieve the global nutrition target by 2025.
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Affiliation(s)
| | | | | | - Md Akhter Imam
- Monitoring, Evaluation and Research Bangladesh National Nutrition Council Dhaka Bangladesh
| | - Md Imran Hasan
- Center for Medical Research and Development Dhaka Bangladesh
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Burger M, Hoosain M, Einspieler C, Unger M, Niehaus D. Maternal perinatal mental health and infant and toddler neurodevelopment - Evidence from low and middle-income countries. A systematic review. J Affect Disord 2020; 268:158-172. [PMID: 32174474 DOI: 10.1016/j.jad.2020.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive lack of awareness of maternal mental health and its impact on child development in low- and middle-income countries (LAMICs). The aim of this systematic review was to analyze evidence for various maternal perinatal mental health disorders and their association with different domains of infant and toddler neurodevelopment during the first two postnatal years in LAMICs. METHODS A comprehensive literature search was conducted within six databases from Jan 1990-April 2019. All included studies were narratively synthesized. RESULTS Twenty-four studies, nine cross sectional and 15 longitudinal cohort studies, were included. Three studies were conducted in low-income, 11 in lower-middle-income and ten in upper-middle-income countries. The majority of studies assessed maternal mental health postnatally and 14 of these 22 studies found a significant association with infant and toddler neurodevelopment. Five of the ten studies reporting on exposure to prenatal mental health found a significant association. The most common maternal mental health disorder studied was depression, while the main neurodevelopmental outcomes assessed were motor, cognitive and language development. LIMITATIONS Meta-analysis could not be conducted due to the variability in the reported maternal mental health disorders and the different times of assessment of exposures and outcomes. CONCLUSIONS Maternal perinatal mental health disorders and their association with different domains of neurodevelopment in LAMICs is still inconclusive due to a limited number of papers. Mother-infant dyads in LAMICs are exposed to multiple and cumulative risk factors and causal pathways between maternal mental health and infant neurodevelopment are still poorly understood.
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Affiliation(s)
- Marlette Burger
- Physiotherapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Munira Hoosain
- Occupational Therapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Christa Einspieler
- Research Unit iDN - interdisciplinary Developmental Neuroscience, Division of Phoniatrics, Medical University of Graz, Auenbruggerplatz 26, 8036 Graz, Österreich.
| | - Marianne Unger
- Physiotherapy Division, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
| | - Dana Niehaus
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
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Gelaye B, Sanchez SE, Andrade A, Gómez O, Coker AL, Dole N, Rondon MB, Williams MA. Association of antepartum depression, generalized anxiety, and posttraumatic stress disorder with infant birth weight and gestational age at delivery. J Affect Disord 2020; 262:310-316. [PMID: 31733923 PMCID: PMC7048002 DOI: 10.1016/j.jad.2019.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/06/2019] [Accepted: 11/02/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Low- and middle-income countries bear a disproportionate burden of preterm birth (PTB) and low infant birth weight (LBW) complications where affective and anxiety disorders are more common in the antepartum period than in industrialized countries. OBJECTIVE To evaluate the extent to which early pregnancy antepartum depression, generalized anxiety disorder, and posttraumatic stress disorder (PTSD) are associated with infant birth weight and gestational age at delivery among a cohort of pregnant women in Peru. METHODS Our prospective cohort study consisted of 4408 pregnant women. Antepartum depression, generalized anxiety, and PTSD were assessed in early pregnancy using the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7 and PTSD Checklist - Civilian Version, respectively. Pregnancy outcome data were obtained from medical records. Multivariable linear and logistic regression procedures were used to estimate adjusted measures of association (β coefficients and odds ratios) and 95% confidence intervals (CI). RESULTS After adjusting for confounders, women with antepartum generalized anxiety (32.6% prevalence) had higher odds of LBW (adjusted odds ratio (OR)=1.47; 95%CI: 1.10-1.95) and were more likely to deliver small for gestational age (OR = 1.39; 95%CI: 1.01-1.92) infants compared to those without anxiety. Compared to those without PTSD, women with PTSD (34.5%) had higher odds of delivering preterm (OR = 1.28; 95%CI: 1.00-1.65) yet PTSD was not associated with LBW nor gestational age at delivery. Women with antepartum depression (26.2%) were at no increased risk of delivering a preterm, low-birth-weight or small-for-gestational-age infant. LIMITATIONS Our ability to make casual inferences from this observational study is limited; however, these findings are consistent with prior studies. CONCLUSION Generalized anxiety disorder during pregnancy appeared to increase odds of delivering a low-birth-weight or small-for-gestational-age infant, while PTSD was associated with increased odds of delivering preterm. Our findings, and those of others, suggest antenatal care should be tailored to screen for and provide additional mental health services to patients.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; The Chester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital; Boston, MA, USA.
| | - Sixto E. Sanchez
- Universidad San Martin de Porres, Lima, Peru,Asociación Civil Proyectos en Salud, Lima, Peru
| | - Ana Andrade
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Oswaldo Gómez
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ann L. Coker
- Department of Obstetrics & Gynecology, University of Kentucky College of Medicine, Lexington, KY
| | - Nancy Dole
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, US (retired)
| | - Marta B. Rondon
- Universidad Peruana Cayetano Heredia and Instituto Nacional Materno Perinatal, Lima, Peru
| | - Michelle A. Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Slomian J, Honvo G, Emonts P, Reginster JY, Bruyère O. Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes. ACTA ACUST UNITED AC 2020; 15:1745506519844044. [PMID: 31035856 PMCID: PMC6492376 DOI: 10.1177/1745506519844044] [Citation(s) in RCA: 406] [Impact Index Per Article: 101.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The postpartum period represents the time of risk for the emergence of
maternal postpartum depression. There are no systematic reviews of the
overall maternal outcomes of maternal postpartum depression. The aim of this
study was to evaluate both the infant and the maternal consequences of
untreated maternal postpartum depression. Methods: We searched for studies published between 1 January 2005 and 17 August 2016,
using the following databases: MEDLINE via Ovid, PsycINFO, and the Cochrane
Pregnancy and Childbirth Group trials registry. Results: A total of 122 studies (out of 3712 references retrieved from bibliographic
databases) were included in this systematic review. The results of the
studies were synthetized into three categories: (a) the maternal
consequences of postpartum depression, including physical health,
psychological health, relationship, and risky behaviors; (b) the infant
consequences of postpartum depression, including anthropometry, physical
health, sleep, and motor, cognitive, language, emotional, social, and
behavioral development; and (c) mother–child interactions, including
bonding, breastfeeding, and the maternal role. Discussion: The results suggest that postpartum depression creates an environment that is
not conducive to the personal development of mothers or the optimal
development of a child. It therefore seems important to detect and treat
depression during the postnatal period as early as possible to avoid harmful
consequences.
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Affiliation(s)
- Justine Slomian
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Germain Honvo
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Patrick Emonts
- 2 Department of Obstetrics and Gynaecology, CHU Liège, Liège, Belgium
| | - Jean-Yves Reginster
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Olivier Bruyère
- 1 Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.,3 Department of Sport Science, University of Liège, Liège, Belgium
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Depression among women of reproductive age in rural Bangladesh is linked to food security, diets and nutrition. Public Health Nutr 2020; 23:660-673. [PMID: 31915095 PMCID: PMC7058425 DOI: 10.1017/s1368980019003495] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To quantify the relationship between screening positive for depression and several indicators of the food and nutrition environment in Bangladesh. DESIGN We used cross-sectional data from the Food and Agricultural Approaches to Reducing Malnutrition (FAARM) trial in Bangladesh to examine the association of depression in non-peripartum (NPW) and peripartum women (PW) with food and nutrition security using multivariable logistic regression and dominance analysis. SETTING Rural north-eastern Bangladesh. PARTICIPANTS Women of reproductive age. RESULTS Of 2599 women, 40 % were pregnant or up to 1 year postpartum, while 60 % were not peripartum. Overall, 20 % of women screened positive for major depression. In the dominance analysis, indicators of food and nutrition security were among the strongest explanatory factors of depression. Food insecurity (HFIAS) and poor household food consumption (FCS) were associated with more than double the odds of depression (HFIAS: NPW OR = 2·74 and PW OR = 3·22; FCS: NPW OR = 2·38 and PW OR = 2·44). Low dietary diversity (<5 food groups) was associated with approximately double the odds of depression in NPW (OR = 1·80) and PW (OR = 1·99). Consumption of dairy, eggs, fish, vitamin A-rich and vitamin C-rich foods was associated with reduced odds of depression. Anaemia was not associated with depression. Low BMI (<18·5 kg/m2) was also associated with depression (NPW: OR = 1·40). CONCLUSIONS Depression among women in Bangladesh was associated with many aspects of food and nutrition security, also after controlling for socio-economic factors. Further investigation into the direction of causality and interventions to improve diets and reduce depression among women in low- and middle-income countries are urgently needed.
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Berens AE, Kumar S, Tofail F, Jensen SKG, Alam M, Haque R, Kakon SH, Petri WA, Nelson CA. Cumulative psychosocial risk and early child development: validation and use of the Childhood Psychosocial Adversity Scale in global health research. Pediatr Res 2019; 86:766-775. [PMID: 31103019 PMCID: PMC6859196 DOI: 10.1038/s41390-019-0431-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/30/2019] [Accepted: 05/03/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Evidence suggests that cumulative early psychosocial adversity can influence early child development (ECD). The Childhood Psychosocial Adversity Scale (CPAS) is a novel measure of cumulative risk designed for use in global ECD research. We describe its development and assess validity from its first application in Bangladesh, where it predicts cognitive development scores among young children. METHODS Items were generated from literature review and qualitatively assessed for local relevance. Two-hundred and eighty-five mother-child dyads from an urban slum of Dhaka completed the CPAS at child ages 18, 24, 48, and/or 60 months. The CPAS was assessed for internal consistency, retest reliability, and convergent, incremental, and predictive validity. RESULTS The CPAS includes subscales assessing child maltreatment, caregiver mental health, family conflict, domestic violence, and household/community psychosocial risks. In Bangladesh, subscales had good internal consistency (Cronbach's α > 0.70). Full-scale score had good 2-week test-retest reliability (intra-class correlation coefficient = 0.89; F(38,38) = 8.45, p < 0.001). Using multivariate regression, 48-month CPAS score significantly predicted 60-month intelligence quotient, accounting for more variance than socioeconomic status or malnutrition. CONCLUSIONS The CPAS is a novel tool assessing cumulative childhood psychosocial risk. Evidence supports validity of its use in ECD research in Bangladesh, and ongoing work is applying it in additional countries.
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Affiliation(s)
- Anne E Berens
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Swapna Kumar
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Fahmida Tofail
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Sarah K G Jensen
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Masud Alam
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Rashidul Haque
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - Shahria H Kakon
- International Centre for Diarrhoeal Disease Research Bangladesh, Dhaka, Bangladesh
| | - William A Petri
- Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
| | - Charles A Nelson
- Division of Developmental Medicine, Boston Children's Hospital, Boston, MA, USA.
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
- Harvard Graduate School of Education, Cambridge, MA, USA.
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Aoyagi S, Tsuchiya KJ. Does maternal postpartum depression affect children's developmental outcomes? J Obstet Gynaecol Res 2019; 45:1809-1820. [DOI: 10.1111/jog.14064] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 06/23/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Sona‐Sanae Aoyagi
- School of EducationMeisei University Tokyo Japan
- Fujikura Social Health Research Institute Ltd. Tokyo Japan
| | - Kenji J. Tsuchiya
- Center for Child Mental DevelopmentHamamatsu University School of Medicine Hamamatsu Japan
- United Graduate School of Child DevelopmentHamamatsu University School of Medicine Hamamatsu Japan
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le Roux K, Christodoulou J, Stansert-Katzen L, Dippenaar E, Laurenzi C, le Roux IM, Tomlinson M, Rotheram-Borus MJ. A longitudinal cohort study of rural adolescent vs adult South African mothers and their children from birth to 24 months. BMC Pregnancy Childbirth 2019; 19:24. [PMID: 30634932 PMCID: PMC6330475 DOI: 10.1186/s12884-018-2164-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 12/26/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Adolescent motherhood has been repeatedly linked to poor child outcomes in high income countries and urban areas in low- and middle-income countries. We examine the structural, personal, and caretaking challenges of adolescent mothers and their children in rural South Africa compared to adult mothers over the first 24 months post-birth. METHODS A cohort of sequential births (n = 470/493) in the rural OR Tambo District was recruited and reassessed at 3, 6, 9, 12, and at 24 months post-birth, with a retention rate above 84% at all timepoints. Maternal and child outcomes were examined over time using multiple linear and logistic regressions. RESULTS Adolescent mothers reflect 17% of births (n = 76/458). Adolescent mothers were more likely to have water in their households, but less likely to live with a partner and to be seropositive for HIV than adult mothers. Risks posed by mental health symptoms, alcohol, and partner violence were similar. Adolescents exclusively breastfed for shorter time and it took longer for them to secure a child grant compared to adult mothers. Although obtaining immunizations was similar, growth was significantly slower for infants of adolescent mothers compared to adult mothers over time. CONCLUSIONS In rural South Africa, almost one in five pregnant women is an adolescent. Caretaking tasks influencing child growth, especially breastfeeding and securing the child grant appear as the greatest problems for adolescent compared to adult mothers.
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Affiliation(s)
- Karl le Roux
- Walter Sisulu University Family Medicine Department, Zithulele Hospital, Mqanduli District, 5080 South Africa
| | | | - Linnea Stansert-Katzen
- Walter Sisulu University Family Medicine Department, Zithulele Hospital, Mqanduli District, 5080 South Africa
| | - Elaine Dippenaar
- Walter Sisulu University Family Medicine Department, Zithulele Hospital, Mqanduli District, 5080 South Africa
| | - Christina Laurenzi
- Walter Sisulu University Family Medicine Department, Zithulele Hospital, Mqanduli District, 5080 South Africa
| | - Ingrid M. le Roux
- Walter Sisulu University Family Medicine Department, Zithulele Hospital, Mqanduli District, 5080 South Africa
| | - Mark Tomlinson
- Department of Psychology, Stellenbosch University, Private Bag X1, Matieland, 7602 South Africa
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Chang SR, Lin WA, Lin HH, Shyu MK, Lin MI. Sexual dysfunction predicts depressive symptoms during the first 2 years postpartum. Women Birth 2018; 31:e403-e411. [DOI: 10.1016/j.wombi.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/12/2017] [Accepted: 01/03/2018] [Indexed: 11/16/2022]
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Hutchison SM, Mâsse LC, Pawluski JL, Oberlander TF. Perinatal selective serotonin reuptake inhibitor (SSRI) effects on body weight at birth and beyond: A review of animal and human studies. Reprod Toxicol 2018; 77:109-121. [DOI: 10.1016/j.reprotox.2018.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 02/04/2018] [Accepted: 02/09/2018] [Indexed: 02/07/2023]
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Sacchi C, De Carli P, Vieno A, Piallini G, Zoia S, Simonelli A. Does infant negative emotionality moderate the effect of maternal depression on motor development? Early Hum Dev 2018; 119:56-61. [PMID: 29579558 DOI: 10.1016/j.earlhumdev.2018.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/19/2022]
Abstract
Maternal depression represents an important social/environmental factor in early childhood; however, its effect on children's motor development may vary depending on the role of infants' dispositional variables. The objective of this study is to investigate the effect of the interaction between maternal depressive symptoms in the first two years of a child's life and the child's temperamental negative emotionality on motor development during this time. Using a cross-sectional study, we assessed 272 infants aged 0 to 24 months old and their mothers. We measured the following variables: maternal depression, infant's negative emotionality, and motor development. A three-way interaction effect highlights that negative emotionality in infants and maternal depression together affect children's overall motor growth trajectory. Infants with low negative emotionality display no effect of maternal depression on motor development. Conversely, infants with high negative emotionality seem to be more susceptible to the effect of maternal depression. Specifically, high maternal depression tends to foster the negative effect of infant's negativity on motor development across time, albeit not significantly. Finally, the absence of maternal depression significantly buffers negative temperament in infants. Findings highlighted the importance of integrating different perspectives when describing early motor growth. In fact, only when considering the interdependence of potential predictors their effect on the motor growth significantly emerges. Screening for early temperamental vulnerability might help in tailoring interventions to prevent maternal depression from affecting infants' motor development.
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Affiliation(s)
- C Sacchi
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padova, Italy.
| | - P De Carli
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padova, Italy.
| | - A Vieno
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padova, Italy.
| | - G Piallini
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padova, Italy.
| | - S Zoia
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne Famiglia, Azienda Sanitaria Universitaria Integrata di Trieste, via Sai 7, 34100 Trieste, Italy.
| | - A Simonelli
- Department of Developmental Psychology and Socialization, University of Padova, Via Venezia 8, 35131 Padova, Italy.
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Milner EM, Fiorella KJ, Mattah BJ, Bukusi E, Fernald LC. Timing, intensity, and duration of household food insecurity are associated with early childhood development in Kenya. MATERNAL & CHILD NUTRITION 2018; 14:e12543. [PMID: 29063732 PMCID: PMC6866123 DOI: 10.1111/mcn.12543] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 09/13/2017] [Accepted: 09/17/2017] [Indexed: 01/30/2023]
Abstract
This study examines the association between 3 dimensions of food insecurity (timing, intensity, and duration) and 3 domains of child development (gross motor, communication, and personal social). Longitudinal data from 303 households (n = 309 children) visited 9 times over 2 years were collected. Children in households experiencing severe food insecurity 3 months prior (timing) had significantly lower gross motor (β -0.14; 95% CI [0.27, -0.0033]; p = .045), communication (β -0.16; 95% CI [-0.30, -0.023]; p = .023), and personal social (β -0.20; 95% CI [-0.33, -0.073]; p = .002) Z-scores, using lagged longitudinal linear models controlling for current food insecurity; these results were attenuated in full models, which included maternal education, household asset index, and child anthropometry. Children in households that experienced greater aggregate food insecurity over the past 2 years (intensity) had significantly lower gross motor (β -0.047; 95% CI [-0.077, -0.018]; p = .002), communication (β -0.042; 95% CI [-0.076, -0.0073]; p = .018), and personal social (β -0.042; 95% CI [-0.074, -0.010]; p = .010) Z-scores; these results were also attenuated in full models. Children with more time exposed to food insecurity (duration) had significantly lower gross motor (β -0.050; 95% CI [-0.087, -0.012]; p = .010), communication (β -0.042; 95% CI [-0.086, 0.0013]; p = .057), and personal social (β -0.037; 95% CI [-0.077, 0.0039]; p = .076) Z-scores; these results were no longer significant in full models. Our findings suggest that acute and chronic food insecurity and child development are related, but that many associations are attenuated with the inclusion of relevant covariates.
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Affiliation(s)
- Erin M. Milner
- School of Public HealthUniversity of California, BerkeleyBerkeleyCaliforniaUSA
| | | | - Brian J. Mattah
- Mfangano Island Research GroupOrganic Health ResponseMbitaKenya
| | | | - Lia C.H. Fernald
- School of Public HealthUniversity of California, BerkeleyBerkeleyCaliforniaUSA
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Farías-Antúnez S, Xavier MO, Santos IS. Effect of maternal postpartum depression on offspring's growth. J Affect Disord 2018; 228:143-152. [PMID: 29248820 DOI: 10.1016/j.jad.2017.12.013] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 11/16/2017] [Accepted: 12/06/2017] [Indexed: 02/08/2023]
Abstract
BACKGROUND Previous studies have linked maternal depression to different child offspring's growth outcomes. However, its effect has not been well established. The aim of this review was to evaluate the available evidence on the effect of maternal postpartum depression on offspring weight and height growth outcomes. METHODS A systematic review of longitudinal studies that evaluated the effect of maternal depression on child's growth outcomes was conducted in PubMed, LILACs, Web of Science, Science Direct and PsyInfo databases, using maternal postpartum depression related keywords, according to each database searching tool. RESULTS A total of 9608 articles were screened and 20 met the final inclusion criteria. The child's first-year growth was the most affected by the exposure to maternal depression. Children of depressed mothers had a higher chance of being underweight and stunted in the first year of life. Maternal depression was also associated with child's linear growth impairment after the first year. LIMITATIONS As a literature review, a publication bias could not be ruled out. The diversity of the published data made it unfeasible for a pooled effect to be estimated. CONCLUSIONS Considering the results observed on child's first year of life growth, physicians should engage in assessing maternal depression, as it is a treatable and manageable disease, thus avoiding unnecessary harm on child's physical development.
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Affiliation(s)
| | | | - Iná Silva Santos
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Brazil
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Saeed Q, Shah N, Inam S, Shafique K. Maternal depressive symptoms and child nutritional status: A cross-sectional study in socially disadvantaged Pakistani community. J Child Health Care 2017; 21:331-342. [PMID: 29119823 DOI: 10.1177/1367493517721063] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Malnutrition is a primary cause of child morbidity and mortality. The effects of maternal depressive symptoms on children's health, especially their nutritional status, have received less attention in developing countries but needs to be evaluated to understand the public health implications of maternal depression. The aim of the current study was to investigate the association between maternal depressive symptoms and children's nutritional status using data from low socioeconomic community in Pakistan. Maternal depressive symptoms defined as Aga Khan University Anxiety and Depression Scale score of 20 or greater was assessed for mothers with children under two years of age. Logistic regression models estimated the association between maternal depressive symptoms and stunting and underweight. Of 325 mothers, 40% scored positive on the depressive scale. The prevalence of stunting and underweight in children under two years was 36.6% and 35.4%, respectively. Maternal depressive symptoms were significantly associated with children being stunted and underweight. Mothers with depressive symptoms were more than three times likely to have stunted (odds ratio (OR) 3.15, 95% confidence interval (CI) 1.91-5.18, p value < .001) and underweight (OR 3.26, 95% CI 1.99-5.34, p value < .001) children compared to non-depressed mothers. Maternal-related factors such as poor education, unemployment, and low household income were found to be significantly associated with higher odds of children's short stature and underweight.
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Affiliation(s)
- Qamar Saeed
- 1 School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Nadia Shah
- 1 School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Sumera Inam
- 1 School of Public Health, Dow University of Health Sciences, Karachi, Pakistan
| | - Kashif Shafique
- 1 School of Public Health, Dow University of Health Sciences, Karachi, Pakistan.,2 University of Glasgow, Glasgow, UK
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Williams A, Sarker M, Ferdous ST. Cultural Attitudes toward Postpartum Depression in Dhaka, Bangladesh. Med Anthropol 2017; 37:194-205. [PMID: 28409647 DOI: 10.1080/01459740.2017.1318875] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Depression is the leading cause of disability worldwide, yet in many cultures, it remains unaddressed and unacknowledged. Postpartum depression is particularly delicate because of its association with gender and expectations of motherhood. This ethnographic study in Dhaka, Bangladesh sought to understand local perceptions of postpartum depression and cultural influences around mental health care seeking. The results describe the role of culture and stigma in the conceptualization of mental health within both the community and medical spheres. Mental health continues to be unacknowledged and neglected in Bangladeshi communities. We recommend community-based psychosocial programming for new mothers living in slums.
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Affiliation(s)
- Anaise Williams
- a Mailman School of Public Health , Department of Population and Family Health, Columbia University , New York , New York , USA
| | - Malabika Sarker
- b James P. Grant School of Public Health , BRAC University , Dhaka , Bangladesh
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Hadfield K, O'Brien F, Gerow A. Is level of prematurity a risk/plasticity factor at three years of age? Infant Behav Dev 2017; 47:27-39. [PMID: 28324848 DOI: 10.1016/j.infbeh.2017.03.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Revised: 03/06/2017] [Accepted: 03/07/2017] [Indexed: 11/29/2022]
Abstract
Children born preterm have poorer outcomes than children born full-term, but the caregiving environment can ameliorate some of these differences. Recent research has proposed that preterm birth may be a plasticity factor, leading to better outcomes for preterm than full-term infants in higher quality environments. This analysis uses data from two waves of an Irish study of children (at 9 months and 3 years of age, n=11,134 children) and their caregivers (n=11,132 mothers, n=9998 fathers) to investigate differences in how caregiving affects social, cognitive, and motor skills between full-term, late preterm, and very preterm children. Results indicate that parental emotional distress and quality of attachment are important for child outcomes. Both being born very preterm and late preterm continue to be risk factors for poorer outcomes at 3 years of age. Only fathers' emotional distress significantly moderated the effect of prematurity on infants' cognitive and social outcomes-no other interactions between prematurity and environment were significant. These interactions were somewhat in line with diathesis stress, but the effect sizes were too small to provide strong support for this model. There is no evidence that preterm birth is a plasticity factor.
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Affiliation(s)
- Kristin Hadfield
- Resilience Research Centre, Dalhousie University, Halifax, NS, Canada.
| | - Fearghal O'Brien
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, MD, United States
| | - Aaron Gerow
- Faculty of Computer Science, Dalhousie University, Halifax, NS, Canada
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41
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Maternal postpartum depressive symptoms predict delay in non-verbal communication in 14-month-old infants. Infant Behav Dev 2016; 46:33-45. [PMID: 27870989 DOI: 10.1016/j.infbeh.2016.11.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 11/05/2016] [Accepted: 11/05/2016] [Indexed: 11/21/2022]
Abstract
We investigated the potential relationship between maternal depressive symptoms during the postpartum period and non-verbal communication skills of infants at 14 months of age in a birth cohort study of 951 infants and assessed what factors may influence this association. Maternal depressive symptoms were measured using the Edinburgh Postnatal Depression Scale, and non-verbal communication skills were measured using the MacArthur-Bates Communicative Development Inventories, which include Early Gestures and Later Gestures domains. Infants whose mothers had a high level of depressive symptoms (13+ points) during both the first month postpartum and at 10 weeks were approximately 0.5 standard deviations below normal in Early Gestures scores and 0.5-0.7 standard deviations below normal in Later Gestures scores. These associations were independent of potential explanations, such as maternal depression/anxiety prior to birth, breastfeeding practices, and recent depressive symptoms among mothers. These findings indicate that infants whose mothers have postpartum depressive symptoms may be at increased risk of experiencing delay in non-verbal development.
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Piallini G, Brunoro S, Fenocchio C, Marini C, Simonelli A, Biancotto M, Zoia S. How Do Maternal Subclinical Symptoms Influence Infant Motor Development during the First Year of Life? Front Psychol 2016; 7:1685. [PMID: 27847489 PMCID: PMC5088190 DOI: 10.3389/fpsyg.2016.01685] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 10/13/2016] [Indexed: 11/13/2022] Open
Abstract
An unavoidable reciprocal influence characterizes the mother-child dyad. Within this relationship, the presence of depression, somatization, hostility, paranoid ideation, and interpersonal sensitivity symptoms at a subclinical level and their possible input on infant motor competences has not been yet considered. Bearing in mind that motor abilities represent not only an indicator of the infant's health-status, but also the principal field to infer his/her needs, feelings and intentions, in this study the quality of infants' movements were assessed and analyzed in relationship with the maternal attitudes. The aim of this research was to investigate if/how maternal symptomatology may pilot infant's motor development during his/her first year of life by observing the characteristics of motor development in infants aged 0-11 months. Participants included 123 mothers and their infants (0-11 months-old). Mothers' symptomatology was screened with the Symptom Checklist-90-Revised (SCL-90-R), while infants were tested with the Peabody Developmental Motor Scale-Second Edition. All dyads belonged to a non-clinical population, however, on the basis of SCL-90-R scores, the mothers' sample was divided into two groups: normative and subclinical. Descriptive, t-test, correlational analysis between PDMS-2 scores and SCL-90-R results are reported, as well as regression models results. Both positive and negative correlations were found between maternal perceived symptomatology, Somatization (SOM), Interpersonal Sensitivity (IS), Depression (DEP), Hostility (HOS), and Paranoid Ideation (PAR) and infants' motor abilities. These results were further verified by applying regression models to predict the infant's motor outcomes on the basis of babies' age and maternal status. The presence of positive symptoms in the SCL-90-R questionnaire (subclinical group) predicted good visual-motor integration and stationary competences in the babies. In particular, depressive and hostility feelings in mothers seemed to induce an infant motor behavior characterized by a major control of the environmental space. When mothers perceived a higher level of hostility and somatization, their babies showed difficulties in sharing action space, such as required in the development of stationary positions and grasping abilities. In a completely different way, when infants can rely on a mother with low-perceived symptoms (normative group) his/her motor performances develop with a higher degree of freedom/independence. These findings suggest, for the first time, that even in a non-clinical sample, mother's perceived-symptoms can produce important consequences not in infant motor development as a whole, but in some specific areas, contributing to shape the infant's motor ability and his/her capability to act in the world.
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Affiliation(s)
- Giulia Piallini
- Department of Developmental Psychology and Socialization, University of Padua Padua, Italy
| | - Stefania Brunoro
- Department of Developmental Psychology and Socialization, University of Padua Padua, Italy
| | - Chiara Fenocchio
- Department of Developmental Psychology and Socialization, University of Padua Padua, Italy
| | - Costanza Marini
- Department of Developmental Psychology and Socialization, University of Padua Padua, Italy
| | - Alessandra Simonelli
- Department of Developmental Psychology and Socialization, University of Padua Padua, Italy
| | - Marina Biancotto
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne Famiglia, Azienda Sanitaria Universitaria Integrata di Trieste Trieste, Italy
| | - Stefania Zoia
- Struttura Complessa Tutela Salute Bambini Adolescenti Donne Famiglia, Azienda Sanitaria Universitaria Integrata di Trieste Trieste, Italy
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Pelto GH, Armar-Klemesu M. Identifying interventions to help rural Kenyan mothers cope with food insecurity: results of a focused ethnographic study. MATERNAL AND CHILD NUTRITION 2016; 11 Suppl 3:21-38. [PMID: 26778800 PMCID: PMC5066745 DOI: 10.1111/mcn.12244] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/23/2015] [Accepted: 09/03/2015] [Indexed: 01/26/2023]
Abstract
Abstract An ethnographic study was conducted in two areas in southern and western Kenya to identify potential interventions to improve the quality, availability and affordability of foods consumed by infants and young children. A cultural–ecological model of determinants of nutrition identified the sectors of information for data collection related to infant and young child (IYC) diet and feeding‐related behaviours, and the focused ethnographic study manual was used to guide the research. The results provide qualitative evidence about facilitators and constraints to IYC nutrition in the two geographical areas and document their inter‐connections. We conclude with suggestions to consider 13 potential nutrition‐sensitive interventions. The studies provide empirical ethnographic support for arguments concerning the importance of combining nutrition‐specific and nutrition‐sensitive interventions through a multi‐sectoral, integrated approach to improve the nutrition of infants and young children in low‐income, resource‐constrained populations. They also document the value of ethnography as a component of landscape analysis in nutrition programme and policy planning. In addition to constraints on infant and young child diet that originate in environmental and technological conditions in both agro‐ecological zones, other factors that affect feeding practices include features of social organisation, household access to social support, caregivers income‐earning activities and their own health. The results of the ethnographies, which highlight the importance of obtaining the knowledge and perspectives of caregivers of infants and young children, reveal the interactions of the multiple factors that affect child nutrition and the need for simultaneous nutrition‐sensitive interventions to complement nutrition‐specific intervention actions. Most caregivers in both areas not only understood the importance of diet and food quality for child survival, they also regarded it as essential for child growth and development. This indicates that caregivers in these rural Kenyan communities have adopted the basic biomedical interpretation of the importance of child nutrition as an integral part of their ‘knowledge frameworks’.
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Affiliation(s)
- Gretel H Pelto
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Margaret Armar-Klemesu
- Noguchi Memorial Institute for Medical Research, College of Health Sciences, University of Ghana, Legon, Ghana
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Preventing infant and child morbidity and mortality due to maternal depression. Best Pract Res Clin Obstet Gynaecol 2016; 36:156-168. [DOI: 10.1016/j.bpobgyn.2016.05.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/15/2016] [Indexed: 01/26/2023]
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Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry 2016; 3:973-982. [PMID: 27650773 PMCID: PMC5155709 DOI: 10.1016/s2215-0366(16)30284-x] [Citation(s) in RCA: 596] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Abstract
Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Ricardo Araya
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle A Williams
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
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Abstract
Swedish fathers are largely involved in their infant’s care, and Sweden has a generous parental leave, with 2 months especially assigned for fathers. The prevalence of depressive symptoms postpartum for fathers appears to be similar as for mothers in Sweden. This study aimed to describe fathers’ experiences of the first year postpartum, when they showed depressive symptoms 3 to 6 months postpartum. Semistructured interviews with 19 fathers were conducted and analyzed with content analysis. The fathers experienced loss of control and powerlessness due to discrepancies between their expectations and the reality they met after birth. They found the everyday-life turbulent, with much stress and worries for the infant, conflicts between family and work, and lack of support in everyday life. In addition, the fathers struggled with impaired partner-relationship, losses, and contradictory messages from both the society and their partners. These findings indicate that the fathers had difficulties to balance the competing demands of family, work, and their own needs. Thus, it is important to identify fathers with depressive symptoms at the Child Health Care Centers and attend to fathers’ needs of support and acknowledge them as parents equal to mothers.
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Affiliation(s)
| | | | - Fia Simon
- Karolinska Institutet, Stockholm, Sweden
| | - Lene Lindberg
- Karolinska Institutet, Stockholm, Sweden
- Stockholm County Council, Stockholm, Sweden
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47
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Chang SR, Chen KH, Lee CN, Shyu MK, Lin MI, Lin WA. Relationships between perineal pain and postpartum depressive symptoms: A prospective cohort study. Int J Nurs Stud 2016; 59:68-78. [DOI: 10.1016/j.ijnurstu.2016.02.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 02/13/2016] [Accepted: 02/17/2016] [Indexed: 12/27/2022]
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Onarheim KH, Iversen JH, Bloom DE. Economic Benefits of Investing in Women's Health: A Systematic Review. PLoS One 2016; 11:e0150120. [PMID: 27028199 PMCID: PMC4814064 DOI: 10.1371/journal.pone.0150120] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 02/09/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Globally, the status of women's health falls short of its potential. In addition to the deleterious ethical and human rights implications of this deficit, the negative economic impact may also be consequential, but these mechanisms are poorly understood. Building on the literature that highlights health as a driver of economic growth and poverty alleviation, we aim to systematically investigate the broader economic benefits of investing in women's health. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, we systematically reviewed health, gender, and economic literature to identify studies that investigate the impact of women's health on micro- and macroeconomic outcomes. We developed an extensive search algorithm and conducted searches using 10 unique databases spanning the timeframe 01/01/1970 to 01/04/2013. Articles were included if they reported on economic impacts stemming from changes in women's health (table of outcome measures included in full review, Table 1). In total, the two lead investigators independently screened 20,832 abstracts and extracted 438 records for full text review. The final review reflects the inclusion of 124 articles. RESULTS The existing literature indicates that healthier women and their children contribute to more productive and better-educated societies. This study documents an extensive literature confirming that women's health is tied to long-term productivity: the development and economic performance of nations depends, in part, upon how each country protects and promotes the health of women. Providing opportunities for deliberate family planning; healthy mothers before, during, and after childbirth, and the health and productivity of subsequent generations can catalyze a cycle of positive societal development. CONCLUSIONS This review highlights the untapped potential of initiatives that aim to address women's health. Societies that prioritize women's health will likely have better population health overall, and will remain more productive for generations to come.
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Affiliation(s)
- Kristine Husøy Onarheim
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- * E-mail:
| | - Johanne Helene Iversen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - David E. Bloom
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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Hassan BK, Werneck GL, Hasselmann MH. Maternal mental health and nutritional status of six-month-old infants. Rev Saude Publica 2016; 50:7. [PMID: 27007683 PMCID: PMC4794770 DOI: 10.1590/s1518-8787.2016050006237] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 08/22/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To analyze if maternal mental health is associated with infant nutritional status at six month of age. METHODS A cross-sectional study with 228 six-month-old infants who used primary health care units of the city of Rio de Janeiro, Southeastern Brazil. Mean weight-for-length and mean weight-for-age were expressed in z-scores considering the 2006 World Health Organization reference curves. Maternal mental health was measured by the 12-item General Health Questionnaire. The following cutoff points were used: ≥ 3 for common mental disorders, ≥ 5 for more severe mental disorders, and ≥ 9 for depression. The statistical analysis employed adjusted linear regression models. RESULTS The prevalence of common mental disorders, more severe mental disorders and depression was 39.9%, 23.7%, and 8.3%, respectively. Children of women with more severe mental disorders had, on average, a weight-for-length 0.37 z-scores lower than children of women without this health harm (p = 0.026). We also observed that the weight-for-length indicator of children of depressed mothers was, on average, 0.67 z-scores lower than that of children of nondepressed women (p = 0.010). Maternal depression was associated with lower mean values of weight-for-age z-scores (p = 0.041). CONCLUSIONS Maternal mental health is positively related to the inadequacy of the nutritional status of infants at six months.
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Affiliation(s)
- Bruna Kulik Hassan
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Guilherme Loureiro Werneck
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Maria Helena Hasselmann
- Departamento de Nutrição Social, Instituto de Nutrição, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Fisher J, Tran T, Nguyen TT, Nguyen H, Tran TD. Common mental disorders among women, social circumstances and toddler growth in rural Vietnam: a population-based prospective study. Child Care Health Dev 2015; 41:843-52. [PMID: 25708782 DOI: 10.1111/cch.12235] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Common mental disorders (CMD) and adverse social circumstances are widespread among mothers of infants and toddlers in resource-constrained settings. These can undermine early childhood development through compromised caregiving and insufficient access to essential resources. The aim was to examine the effect of maternal CMD and social adversity in the post-partum year on toddler's length-for-age index in a rural low-income setting. METHODS A population-based prospective cohort study of women in Ha Nam province, Vietnam who completed baseline assessments in either late pregnancy or 4-6 weeks post partum and were followed up, with their toddlers, 15 months later. CMD were assessed at both points by psychiatrist-administered Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Diagnoses. Anthropometric indices were calculated from toddler's age, sex, weight and length using World Health Organization Child Growth Standards. Social adversities were assessed by study-specific questions and locally validated psychometric instruments. The hypothesized model of factors governing toddler's length-for-age Z score (LAZ) was tested using path analysis. RESULTS In total, 211/234 (90.1%) mother-toddler pairs provided complete data. Baseline prevalence of CMD among women was 33.6% and follow-up was 18.5%. The mean LAZ among toddlers was -1.03 and stunting prevalence (LAZ < -2) was 15.6%. Maternal CMD at baseline were indirectly related to toddler LAZ via maternal CMD at follow-up (regression coefficient = -0.05, 95% CI -0.11 to -0.01). Maternal CMD at follow-up was associated significantly with toddler LAZ (regression coefficient = -0.15, 95% CI -0.28 to -0.05). Poorer quality of marital relationship, mothers' experiences of childhood abuse and <30 days dedicated post-partum care were associated indirectly with lower toddler LAZ via maternal CMD. CONCLUSIONS Maternal post-natal CMD are associated with child growth measured by LAZ in this resource-constrained setting. Social adversities affect child growth indirectly through increasing the risk of maternal CMD. Interventions to reduce stunting in low-income settings may need to address maternal CMD and social adversities in order to improve impact.
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Affiliation(s)
- J Fisher
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - T Tran
- Research and Training Centre for Community Development, Hanoi, Vietnam
| | - T T Nguyen
- Research and Training Centre for Community Development, Hanoi, Vietnam
| | - H Nguyen
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - T D Tran
- Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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