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Rees SJ, Mohsin M, Klein L, Steel Z, Tol W, Dadds M, Eapen V, da Costa Z, Savio E, Tam N, Silove D. The impact of maternal depressive symptoms and traumatic events on early childhood mental health in conflict-affected Timor-Leste. BJPsych Open 2022; 8:e51. [PMID: 35197139 PMCID: PMC8935917 DOI: 10.1192/bjo.2022.20] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Longitudinal studies are needed to examine the association between maternal depression, trauma and childhood mental health in conflict-affected settings. AIMS To examine maternal depressive symptoms, trauma-related adversities and child mental health by using a longitudinal path model in conflict-affected Timor-Leste. METHOD Women were recruited in pregnancy. At wave 1, 1672 of 1740 eligible women were interviewed (96% response rate). The final sample comprised 1118 women with complete data at all three time points. Women were followed up when the index child was aged 18 months (wave 2) and 36 months (wave 3). Measures included the Edinburgh Postnatal Depression Scale, lifetime traumatic events and the Child Behaviour Checklist. A longitudinal path analysis examined associations cross-sectionally and in a cross-lagged manner across time. RESULTS Maternal depressive symptom score was associated with child mental health (cross-sectional association at wave 2, β = 0.35, P < 0.001; cross-sectional association at wave 3, β = 0.33, P < 0.001). The maternal depressive symptom score at wave 1 was associated with child mental health at wave 2 (β = 0.12, P < 0.001), and the maternal depressive symptom score at wave 2 showed an indirect association with child mental health at wave 3 (indirect standardised coefficient 0.23, P < 0.001). There was a time-lagged relationship between child mental health at wave 2 and maternal depression at wave 3 (β = 0.08, P = 0.02). CONCLUSIONS Maternal depressive symptoms are longitudinally associated with child mental health, and traumatic events play a role. Maternal depression symptoms are also affected by child mental health. Findings suggest the need for skilled assessment for depression, trauma-informed maternity care and parenting support in a post-conflict country such as Timor-Leste.
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Affiliation(s)
- Susan J Rees
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Mohammed Mohsin
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia; and Mental Health Research Unit, Liverpool Hospital, New South Wales Health, Australia
| | - Louis Klein
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia; and Mental Health Research Unit, Liverpool Hospital, New South Wales Health, Australia
| | - Zachary Steel
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Wietse Tol
- Department of Mental Health, Centre for Global Health, Johns Hopkins University, USA
| | - Mark Dadds
- School of Psychology, Faculty of Science, University of Sydney, Australia
| | - Valsamma Eapen
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia; and Academic Mental Health Unit, Liverpool Hospital, New South Wales Health, Australia
| | - Zelia da Costa
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Elisa Savio
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Natalino Tam
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Australia
| | - Derrick Silove
- Brain Sciences, University of New South Wales, Australia
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Silove D, Mohsin M, Klein L, Tam NDJ, Dadds M, Eapen V, Tol WA, da Costa Z, Savio E, Soares R, Steel Z, Rees SJ. Longitudinal path analysis of depressive symptoms and functioning among women of child-rearing age in postconflict Timor-Leste. BMJ Glob Health 2020; 5:e002039. [PMID: 32337078 PMCID: PMC7170425 DOI: 10.1136/bmjgh-2019-002039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 11/11/2022] Open
Abstract
This longitudinal study indicates that exposure to the traumas of mass conflict and subsequent depressive symptoms play an important role in pathways leading to functional impairment in the postconflict period among women of child-rearing age. Our study, conducted in Timor-Leste, involved an analytic sample of 1292 women recruited at antenatal clinics in the capital and its surrounding districts. Women were re-interviewed at home 2 years later (77.3% retention). We applied the Edinburgh Postnatal Depression Scale, the Harvard Trauma Questionnaire for conflict-related traumatic events, the WHO Violence Against Women Instrument covering the past year for intimate partner violence and the WHO Disability Assessment Schedule (WHODAS V.2.0) to assess functional impairment. A longitudinal path analysis tested direct and indirect relationships involving past conflict-related trauma exposure, depressive symptoms measured over the two time points and functional impairment at follow-up. The prevalence of predefined clinically significant depressive symptoms diminished from 19.3% to 12.8%. Nevertheless, there was a tendency for depressive symptoms to persist over time (β=0.20; p<0.001). Follow-up depressive symptoms were associated with functional impairment (β=0.35; p<0.001). Reported conflict-related trauma occurring a minimum of 6 years earlier (β=0.23; p<0.001) and past-year physical intimate partner violence (β=0.26; p<0.001) were each associated with depressive symptoms at baseline and at follow-up. A measure of poverty specific to the context and reported health problems in the mother and infant also contributed to depressive symptoms. The findings highlight the association between ongoing trauma-related depressive symptoms and the capacity of women in the childbearing age to function in multiple areas of their lives in a postconflict country. Recognition of these relationships is important in the formulation and implementation of contemporary international recovery and development policies applied to postconflict countries.
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Affiliation(s)
- Derrick Silove
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Mohammed Mohsin
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Louis Klein
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Natalino De Jesus Tam
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Mark Dadds
- Psychology, The University of Sydney, Sydney, New South Wales, Australia
| | - Valsamma Eapen
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Sch Publ Hlth, Baltimore, Maryland, USA
| | - Zelia da Costa
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Elisa Savio
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Rina Soares
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Child and Maternal Health, Alola Foundation, Dili, Timor-Leste
| | - Zachary Steel
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Richmond Hospital, St John of God Health Care, North Richmond, New South Wales, Australia
| | - Susan J Rees
- Psychiatry, University of New South Wales, Sydney, New South Wales, Australia.,Mental Health Academic Unit, Liverpool Hospital, Sydney, New South Wales, Australia
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Rees S, Mohsin M, Tay AK, Soares E, Tam N, da Costa Z, Tol W, Silove D. Associations between bride price stress and intimate partner violence amongst pregnant women in Timor-Leste. Global Health 2017; 13:66. [PMID: 28847312 PMCID: PMC5574248 DOI: 10.1186/s12992-017-0291-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 08/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Reducing violence against women is a global public health priority, particularly in low-income and conflict-affected societies. However, more needs to be known about the causes of intimate partner violence (IPV) in these settings, including the stress of bride price obligations. METHODS The representative study of women attending ante-natal clinics in Dili, Timor-Leste was conducted between June, 2013 and September, 2014 with 1672 pregnant women, a response rate of 96%. We applied contextually developed measures for the stress of bride price and poverty, and the World Health Organisation measure for intimate partner violence. RESULTS Compared to those with no problems with bride price, women with moderate or serious problems with that custom reported higher rates of IPV (18.0% vs. 43.6%). Adjusting for socio-demographic factors, multivariate analysis revealed that ongoing poverty (OR = 1.75, 95% CI: 1.20-2.56) was significantly associated with IPV. Importantly, the strongest association with IPV was problems with bride price (OR = 2.73, 95% CI: 1.86-4.01). CONCLUSIONS This is the first large consecutively sampled study to demonstrate a strong association between the stressors of bride price and poverty with IPV. Notably, bride price stress had the strongest association with IPV. Revealing this hitherto unrecognized factor of bride price stress may prove pivotal in guiding policy and interventions aimed at reducing IPV, and thereby improve the health and psychosocial status of women in low income and conflict-affected settings.
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Affiliation(s)
- Susan Rees
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
- Sydney, NSW 2052 Australia
| | - Mohammed Mohsin
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Elisa Soares
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Natalino Tam
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Zelia da Costa
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
| | - Wietse Tol
- Johns Hopkins University, Baltimore, USA
| | - Derrick Silove
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, School of Psychiatry, University of New South Wales, Cnr Forbes and Campbell Streets, Liverpool, NSW 2170 Australia
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