Dietary diversity and mental health in preschoolers in rural China

Parenting style and child mental health at preschool age: evidence from rural China

BACKGROUND

Mental health problems among children at preschool age are a common issue across the world. As shown in literature, a caregiver's parenting style can play a critical role in child development. This study aims to examine the associations between a caregiver's parenting style and the mental health problems (or not) of their child when he/she is at preschool age in rural China.

METHODS

Participants were children, aged 49 to 65 months, and their primary caregivers. The primary caregivers of the sample children completed the Parenting Styles and Dimensions Questionnaire, Short Version, the Strengths and Difficulties Questionnaire, and a questionnaire that elicited their socio-demographic characteristics. The level of cognitive development of each sample child was assessed using the Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition. Pearson correlation analysis, linear regression analysis, and multivariable regression analysis were used to analyze the data.

RESULTS

The prevalence of mental health problems among sample children at preschool age was high (31.6%). If a caregiver practices an authoritative parenting style, it was found to be negatively associated with the mental health problems of their child. In contrast, a caregiver's authoritarian parenting style was positively associated with the mental health problems of their child. Compared to those in a subgroup of primary caregivers that used a combination of low authoritative and low authoritarian parenting style, primary caregivers that used a combination of high authoritarian and low authoritative or a combination of high authoritative and high authoritarian were found to have positive association with child health problems. A number of demographic characteristics were found to be associated with the adoption of different parenting styles.

CONCLUSION

Different parenting styles (including authoritative, authoritarian, and combination of authoritative and authoritarian) of the sample caregivers had different associations with the mental health problems of the sample children. Parenting programs that aim to improve the parenting styles (favoring authoritative parenting styles) should be promoted in an effort to improve the status of child mental health in rural China.

Maternal and household factors affecting the dietary diversity of preschool children in eastern Ethiopia: a cross-sectional study

OBJECTIVE

Investigate the association between the dietary diversity of preschool children and proximate factors including household food insecurity, maternal food choice, preferences, khat use, and levels of depressive symptoms.

DESIGN

Cross-sectional survey of randomly selected households.

SETTING

Haramaya Health and Demographic Surveillance site in Eastern Ethiopia, predominantly smallholder farming households.

PARTICIPANTS

678 preschool children (24-59 months) and their mothers.

METHODS

The key outcome, the adequacy of dietary diversity of preschool children, was calculated using a 24-hour parental dietary recall. Binary logistic regression was then used to identify maternal and household factors associated with dietary adequacy versus inadequacy.

RESULTS

The majority (80.53%) of surveyed children had low dietary diversity (mean Dietary Diversity (MDD)) score of 3.06±1.70 on a 7-point scale). Approximately 80% of households exhibited food insecurity. Households with greater food security (adjusted OR (AOR)=1.96, 95% CI 1.19 to 3.23), healthier maternal food choice (AOR=2.19, 95% CI 1.12 to 4.31) and broader maternal food preferences (AOR=4.95, 95% CI 1.11 to 21.95) were all associated with higher dietary diversity of their preschool children (p≤0.05). Other covariates associated with adequate child dietary diversity included improved household drinking water sources (AOR=1.84, 95% CI 1.16 to 2.92) and family planning use (AOR=1.69, 95% CI 1.00 to 2.86). Despite predictions, however, maternal depression and khat consumption were not identified as factors.

CONCLUSIONS

The dietary diversity of preschool children is extremely low-a pattern observed in both food-secure and food-insecure households. Key factors include maternal selection of food for convenience and ease, preferences that do not include animal protein or healthier food choices, and lack of access to improved drinking water sources. Interventions around maternal food choice and preferences could improve preschool children's nutritional health.

Internal consistency of the Strengths and Difficulties Questionnaire in Amazonian children

OBJECTIVE

To describe the frequency of behavioral problems and the internal consistency of the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in Amazonian preschool children during the covid-19 pandemic.

METHODS

Data from the Maternal and Child Health and Nutrition in Acre (MINA-Brazil) study, a population-based birth cohort in the Western Brazilian Amazon, were used. The SDQ-P was applied in 2021 at the five-year follow-up visit to parents or caregivers of 695 children (49.4% of which were girls). This instrument is a short behavioral screening questionnaire composed of 25 items reorganized into five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems, and prosocial behavior. Cases of behavioral problems were defined according to the original SDQ cut-offs based on United Kingdom norms. Moreover, cut off points were estimated based on the SDQ-P percentile results of our study sample. Internal consistency was assessed by calculating Cronbach's alpha coefficient and McDonald's omega for each scale.

RESULTS

According to the cut-offs based on our studied population distribution, 10% of all children had high or very high total difficulty scores, whereas it was almost twice when the original SDQ cut-offs based on United Kingdom norms, were applied (18%). Differences were also observed in the other scales. Compared to girls, boys showed higher means of externalizing problem and lower means of prosocial behavior. The five-factor model showed a moderate internal consistency of the items for all scales (0.60 ≤ α ≤ 0.40), except for total difficulty scores, which it considered substantial (α > 0.61).

CONCLUSIONS

Our results support the usefulness of SDQ in our study population and reinforce the need for strategies and policy development for mental health care in early life in the Amazon.

Emotional and Behavioural Problems among Preschool Children in Northeast Peninsular Malaysia: Parent Report Version

The rising prevalence of mental health disorders among children is a serious concern. Young children who exhibit early warning signs of mental health issues are more likely to develop symptoms in the same or overlapping regions years later. The research aimed to identify emotional and behavioural problems and associated factors in Malaysian preschools. A sample of young children aged 4-6 years from public and private preschools was chosen using a multistage random sampling method. Data were collected from 18 preschools via a parent survey using the Strengths and Difficulties Questionnaire (SDQ). The sample involved 557 children in the SDQ assessment (92%). The overall estimated prevalence of emotional and behavioural problems was 8.4%. Peer problems were the most prevalent attribute, with a percentage of 19.7%. Conduct problems were found in 5.2%, hyperactivity problems in 5.6%, prosocial behaviours in 13.5%, and emotional problems in 6.8%. Girls showed a significant increase in behavioural and emotional problems compared to boys. Having one parent working, having more than two siblings, and having a single-parent family were associated with emotional and behavioural problems. The prevalence of emotional and behavioural problems in Malaysian children was relatively low compared to data from previous studies and other Asian countries but consistent with European studies. Measuring mental health disparities in young children helps stakeholders launch local early intervention programmes.

Attitudes toward depression among rural primary healthcare providers in hunan areas, China: a cross sectional study

BACKGROUND

Mental health services are not sufficient for depression patients in rural areas of China, training in mental health knowledge for primary healthcare providers has been encouraged, but the effect of this encouragement has rarely been reported.

METHODS

A cross-sectional survey was conducted in primary healthcare facilities that sought to include all the primary healthcare providers (registered physicians and nurses) in two cities in Hunan province, China by administering questionnaires that covered depression symptoms, typical depression cases, and the Revised Depression Attitude Questionnaire.

RESULTS

In total, 315 primary healthcare providers agreed to participate in the study and finished the questionnaires, of which 12.1% had training in depression. In addition, 62.9% of the rural primary healthcare providers were able to recognize most general depression symptoms, and 8.3% were able to recognize all general depression symptoms. The primary healthcare providers in the survey held a neutral to slightly negative attitude towards depression as indicated by their professional confidence (mean scores 16.51 ± 4.30), therapeutic optimism/pessimism (mean scores 29.02 ± 5.98), and general perspective (mean scores 18.12 ± 3.12) scores. Fewer rural primary healthcare providers knew (28.3%) or applied (2.9%) psychological intervention in the clinic.

CONCLUSIONS

Our study indicated that primary healthcare providers knew about general depression symptoms, but lacked psychological intervention skills and held low confidence in and pessimistic attitudes toward depression care. We therefore speculate that existing psychological training for primary healthcare providers is insufficient in quantity and quality, making the need to explore more effective types of training urgently.

Dietary diversity is associated with nutrient adequacy, blood biomarkers and anthropometric status among preschool children in poor ethnic minority area of Northwest China

Introduction

This study aimed to evaluate the status of dietary diversity, nutrient adequacy, blood biomarkers of nutrients, and anthropometric status, as well as to determine the predictors of dietary diversity score (DDS) and mean adequacy ratio (MAR) among preschool children in poor ethnic minority areas of northwest China.

Methods

A total of 578 healthy preschool children aged 3-6 from 17 kindergartens were selected to assess dietary intake, anthropometric status (height-for-age z-score (HAZ), weight-for-age z-score (WAZ), weight-for-height z-score (WHZ), and blood biomarkers. DDS and nutrient adequacy ratio (NAR) were adopted to assess dietary diversity and micronutrient adequacy, respectively.

Results

The mean DDS (ranging from 1 to 9) was relatively low (4.67 ± 1.56). Most participants consumed starchy staples, but few participants consumed organ meat. DDS was associated with serum potassium, serum iron, WAZ, HAZ, all NARs, and MAR (all p < 0.05). Living in urban areas (β = 0.158), higher household wealth (β = 0.116), and more caregivers' nutritional knowledge (β = 0.022) were positively associated with DDS (all p < 0.01), while living in urban areas (β = 0.031), higher education of caregivers (β = 0.0.027), and higher DDS (β = 0.049) were positively associated with MAR (all p < 0.01).

Discussion

In conclusion, dietary diversity was associated with nutrient adequacy and other health outcomes. Nutritional education and poverty alleviation are integral to improving the nutritional status of preschool children.

‘Mens sana in corpore Sano’: Home food consumption implications over child cognitive performance in vulnerable contexts

Diet directly affects children’s physical and mental development. Nonetheless, how food insecurity and household food consumption impact the cognitive performance of children at risk of social exclusion remains poorly understood. In this regard, children in Guatemala face various hazards, mainly related to the socioeconomic difficulties that thousands of families have in the country. The main objective of this study was to analyze the differences in cognitive performance considering food insecurity and household food consumption in a sample of rural and urban Guatemalan children and adolescents at risk of social exclusion. Child cognitive performance was assessed in 134 children and adolescents (age M = 11.37; SD = 3.54) from rural and urban settings. Language, attention, and executive functions were assessed using neuropsychological tasks. Differences in cognitive performance in each level of food insecurity and household diet consumption were compared using the Mann–Whitney U test. A stepwise multivariate regression analysis was conducted to determine which factors may influence cognitive scores. The results showed that rural and urban groups did not differ in terms of food insecurity. However, considering just rural areas, differences were found between groups with food security and insecurity in attention and executive function tasks. Moreover, differences were found in food consumption for certain groups of food (e.g., meat, U = 1,146, p < 0.001, g = 0.72). Regarding regressions, protein food consumption (e.g., meat and fish), which is related to having a more balanced diet, was a relevant factor in executive performance. Contrary to what we expected, performance in attentional tasks was not related to the consumption of any food group. These findings could help politicians and decision-makers to select actions focused on improving diet balance and food security in families at risk of social exclusion. It is necessary to carry out more specific studies on the factors related to diet that affect the cognitive development of minors at risk of social exclusion. In addition, it is necessary to study the implementation of alternative interventions that include low-cost nutrients, thus ensuring that minors have access to a more balanced diet.

Association between food intake and mental health problems among preschoolers in China

Objective

Our knowledge of associations between specific types of food and mental health problems in preschool children, an important developmental period, remains scarce. Using a large sample size and a brief measure, we aimed to examine associations between food groups and mental health problems in preschoolers.

Methods

A descriptive cross-sectional study was conducted among 19,548 preschoolers in nine counties in China using a two-stage cluster sampling method. Information on food frequencies, physical activity, sedentary behavior, and sleep conditions was collected by a parent-reported questionnaire. Mental health status was assessed by a parent-reported Strength and Difficulty Questionnaire (SDQ). Height and weight were measured, and BMI was calculated. Relationships between specific types of food groups and mental health status were examined using multivariable regression modeling.

Results

Of the present study sample, 47.45% of children were girls. Boys had higher scores relating to total difficulties, conduct problems, hyperactivity, and peer problems than girls but lower scores in emotional symptoms and prosocial behavior. Children with more types of food categories tended to get lower SDQ total scores even after adjusting for confounding variables (p < 0.0001). The subscale scores of SDQ varied depending on the types and numbers of food consumed. Notably, boys' mental health problems were more likely to be associated with their consumed food type. Processed meat frequency intake among boys and girls was positively related to prosocial behavior (Girls: pickled food: p = 0.003, fried food: p < 0.0001, barbecued food: p = 0.006, smoked food: p = 0.005; Boys: pickled food: p = 0.3, fried food: p < 0.0001, barbecued food: p = 0.006, smoked food: p = 0.005) and negatively associated with the SDQ total and the other subscale scores (Girls: pickled food: p ≤ 0.02, fried food: p ≤ 0.005 except for emotions (p = 0.1), barbecued food: p ≤ 0.047, smoked food: p ≤ 0.04 (except for emotions (p = 0.06) and conduct behaviors (p = 0.2)); Boys: pickled food: p < 0.01 except for hyperactivity (p = 0.5), fried food: p ≤ 0.005 except for emotions (p = 0.1), barbecued food: p ≤ 0.007 except for hyperactivity (p = 0.8), smoked food: p ≤ 0.001 except for hyperactivity (p = 0.1) and peer problem (p = 0.08)). Adequate intake frequency of confectionery (2-4 times/week) was beneficial to their emotions, conduct, and total difficulties and was also beneficial for peer and prosocial behavior for boys (Girls: emotions: p = 0.02, conduct: p = 0.02, hyperactivity: p = 0.4, peer: p = 0.06, total difficulties: p = 0.01, prosocial behavior: p = 0.1; Boys: emotions: p = 0.009, conduct: p = 0.0009, hyperactivity: p = 0.7, peer: p = 0.02: total difficulties: p = 0.003, prosocial behavior: p = 0.0002).

Conclusion

Diverse food categories and adequate frequency of confectionery were found to be beneficial for children's mental health, with the exception of processed meat. These findings provide novel information and supportive data for children's dietary guidelines and the improvement of mental health.

Association between patterns of eating habits and mental health problems in Chinese adolescents: A latent class analysis

Objective

We aimed to investigate the association between different eating habit patterns and mental health problems among Chinese middle and high school students, and further to estimate the interaction effect of different grouping variables on eating habits.

Methods

One thousand three hundred and forty-eight adolescents from Jilin Province in China were involved in this cross-sectional study. Mental health and eating habits were assessed using General Health Questionnaire and questions on Nutrition Knowledge, Attitude and Practice, respectively. Latent class analysis (LCA) was performed to identify eating habit patterns. Binary logistic regression and generalized linear models were used to explore the association between eating habit patterns, energy-adjusted nutrient intakes and mental health problems. Interaction analysis was performed to analyze the association between eating habits and mental health in different groups.

Results

Based on the LCA results, a 3-class parallel model was identified: 648 adolescents (48.1%) were classified in class-1 “Healthy Eating Behavior/Eating at Home,” 452 adolescents (33.5%) in class-2 “Healthy Eating Behavior/Eating at School” and 248 adolescents (18.4%) in class-3 “Unhealthy Eating Behavior/Random Place.” Compared with class-1, participants in class-2 and class-3 were at higher risk of mental health problems, especially for class-3 (p < 0.05). The energy and nutrient intakes by different latent classes showed that adolescents who ate unhealthy had lower daily intake of energy, protein, carbohydrate, fiber, Vitamins and minerals (p < 0.05). The interaction between age, sleep duration and different eating habits was statistically significant (p for interaction < 0.1).

Conclusion

“Unhealthy eating behavior/random place pattern” was positively correlated with mental health problems of adolescents. The adolescents with health diet were accompanied by fewer mental health problems, especially for that eating at home. And there were interactions between eating habits and age, sleep duration on the mental health problems.

Inverse Association between Dietary Diversity Score Calculated from the Diet Quality Questionnaire and Psychological Stress in Chinese Adults: A Prospective Study from China Health and Nutrition Survey

Specific nutrients or dietary patterns influence an individual’s psychological stress. As a major aspect of a healthy diet, the influence of dietary diversity on psychological stress remains uncertain. Within these contexts, we aimed to examine the association between the dietary diversity score and psychological stress, using prospective data from the China Health and Nutrition Survey (CHNS). We included 7434 adult participants, with complete dietary information, in the 2011 wave, and followed-up with perceived stress scale (PSS-14) in the 2015 wave. The dietary intake of foods was coded into 29 food groups, using the DQQ for China, and the dietary diversity scores were obtained, using DQQ, by calculating the number of food groups consumed during one 24-h dietary recall. The univariate analysis, and logistic regression model were used to examine the relationship between psychological stress and diet diversity. Approximately half of the participants (4204, 56.55%) perceived a higher level of stress (PSS-14 total score > 25). Dietary diversity was lower in the higher-stress group (p for trend <0.0001). Unconditional multivariate logistic regression demonstrated that participants with higher daily dietary diversity were less likely to experience higher-level psychological stress, compared with participants with lower daily dietary diversity (ORs range: 0.480−0.809). Dietary diversity was found to be inversely associated with psychological stress, in this prospective analysis of a national population. Further studies are required to figure out the mechanism and effectiveness of dietary diversity on psychological stress.