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

Economic costs of perinatal depression and anxiety in a lower middle income country: Pakistan

BACKGROUND

Women's mental health during the perinatal period is a major public health problem in Pakistan. Many challenges and competing priorities prevent progress to address the large treatment gap. Aim To quantify the long-term impacts of untreated perinatal depression and anxiety in economic terms, thus highlighting its overall burden based on country-specific evidence.

METHODS

Cost estimates were generated for a hypothetical cohort of women giving birth in 2017, and their children. Women and children experiencing adverse events linked to perinatal mental health problems were modelled over 40 years. Costs assigned to adverse events included were those linked to losses in quantity and quality-of-life, productivity, and healthcare-related expenditure. Present values were derived using a discount rate of 3 %. Data were taken from published cohort studies, as well as from sources of population, economic and health indicators.

RESULTS

The total costs were $16.5 billion for the cohort and $2680 per woman giving birth. The by far largest proportion referred to quality-of-life losses ($15.8 billion). Productivity losses and out-of-pocket expenditure made up only a small proportion of the costs, due to low wages and market prices. When the costs of maternal suicide were included, total costs increased to $16.6 billion.

LIMITATIONS

Important evidence gaps prevented the inclusion of all cost consequences linked to perinatal mental health problems.

CONCLUSIONS

Total national costs are much higher compared with those in other, higher middle-income countries, reflecting the excessive disease burden. This study is an important first step to inform resource allocations.

Association Between Physical Activity During Pregnancy and Perinatal Depressive Symptoms in Pregnant Individuals With Overweight and Obesity

INTRODUCTION

Current research on the association between physical activity and perinatal depression is inconclusive. This study examined the association between objectively measured physical activity during pregnancy and perinatal depressive symptoms among individuals with overweight and obesity.

METHODS

Data came from the Health in Pregnancy and Postpartum study (N = 205). Physical activity was measured using the SenseWear Armband at 16 weeks' or fewer and 32 weeks' gestation and categorized into 1) never meeting 2018 physical activity guidelines, 2) meeting the guidelines at one time point, or 3) meeting the guidelines at both time points. Antenatal depressive symptoms were assessed at 32 weeks' gestation, and postpartum depressive symptoms were assessed at 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. A score of 10 or higher was defined as probable at least minor depression (hereafter, probable depression).

RESULTS

Nearly one-half of the participants (45.4%) met physical activity guidelines both in early and late pregnancy. Pregnant individuals who met physical activity guidelines at one (adjusted odds ratio, 0.07; 95% confidence interval, 0.01-0.76) or both time points (adjusted odds ratio, 0.08; 95% confidence interval, 0.01-0.69) during pregnancy had lower odds of probable depression at 6 months postpartum than individuals who never met physical activity guidelines during pregnancy. No significant associations were found between prenatal physical activity and probable antenatal or postpartum depression at 12 months.

CONCLUSIONS

Antenatal physical activity was associated with lower odds of probable depression at 6 months after childbirth. Physicians should use evidence-based strategies to encourage pregnant people, especially those who are at risk for postpartum depression, to meet physical activity guidelines.

A Single-Arm Pilot Study of Multicomponent Psychoeducational Intervention for Postpartum Depression and Anxiety in a Rural Community

BACKGROUND

The prevalence of postpartum depression (PPD) and anxiety (PPA) is rising in India and efforts at generating local evidence for psychological intervention are scanty. We conducted a single-arm pilot study in an Indian rural community to test the impact of multicomponent psychoeducational intervention (MCPI) on women with PPD and PPA.

METHODS

Forty-three women with PPD/PPA/both received MCPI, which comprised three phases with in-person sessions held once weekly for a minimum of six and a maximum of ten weeks. Primary outcome variables were scores on depression and anxiety, assessed using the Edinburg postnatal depression scale and the state and trait anxiety inventory, along with evaluating the compliance rate to the intervention. The Mini-international neuropsychiatric interview (MINI) neuropsychiatric interview was used to confirm the diagnosis of depression and anxiety. Secondary outcome variables assessed were social support, functionality, parental stress, interpersonal violence, and marital satisfaction. We used Cohen's d effect size method for assessing the mean differences.

RESULTS

MCPI resulted in the improvement of 72% women (95% CI = 56.3%-84.7%). The overall compliance rate to the intervention was 85.63%, which was higher for responders than nonresponders (92.9% vs. 69.8%; P < 0.001). MCPI resulted in statistically significant improvement in the mean score of depression (P = 0.001, d = 0.95) and anxiety (P = 0.001, d = 1.30). On secondary outcome variables, significant improvement was obtained in the overall present social support (P = 0.001; d = 4.65), present social support from partner (P = 0.027; d = 0.45) and parents (P = 0.001; d = 0.74), future social support from parents (P = 0.001; d = 0.81), the performance of household responsibility (P = 0.001; d = 0.97), lifestyle in the last two weeks (P = 0.001; d = 3.57), parental stress (P = 0.001; d = 1.04), and marital satisfaction (P = 0.014; d = 0.52).

CONCLUSION

This pilot study shows that MCPI has a promising role in relieving depression and anxiety. It also improved the perception of social support from partner and parents, functionality, marital satisfaction, and reduced parental stress.

Toward early screening for early management of postnatal depression? Relationships between clinical signs present in the infant and underlying maternal postnatal depression

OBJECTIVE

The objective was to screen for maternal postnatal depression (MPD) by administering the Edinburgh Postnatal Depression Scale (EPDS) during the first "peak" of incidence of MPD (i. e., between the 6th and the 10th week of the infant's life) and to therefore explore the relationship between mothers' EPDS scores and early clinical signs in the infant. We wanted to evaluate the relevance of a diagnostic tool that combines the EPDS with questions focused on clinical signs displayed by the infant.

PARTICIPANTS

Seven hundred and sixty seven mothers aged 18-46 (M = 30.5, SD = 4.9) participated in the study, representing 49.2% of all women who delivered in the study area during the research inclusion period. Main outcome measures: Sociodemographic data were collected. MPD was measured by EPDS (score ≥ 12). The presence of clinical signs in the infant was investigated by closed (i.e., yes or no) questions inquiring into whether the infant has or has had difficulty sleeping, feeding difficulties, crying difficult to calm, or other difficulties.

RESULTS

The prevalence of MPD in our sample was 22.16%. The relationships between MPD and early clinical signs present in the infant, i.e., sleep difficulties, feeding problems, crying difficult to calm (p < 0.001), and other problems (p = 0.004), were very significant, as confirmed by a chi-square test of independence. In particular, sleep difficulties (OR = 2.05, CI 1.41-2.99) and feeding difficulties (OR = 1.59, CI 1.10-2.30) seemed to predict MPD.

CONCLUSIONS

Early clinical signs in the infant can alert the medical team to potential psychological suffering on the part of the mother, at which time the EPDS can be proposed. The use of this method has the potential to improve screening for, and therefore early management of, MPD.

Maternal mental health and child nutritional status in an urban slum in Bangladesh: A cross-sectional study

Poor mental health may diminish a mother's capacity to adequately care for her child, resulting in a negative impact on the child's nutrition. This study aims to determine the association between maternal mental health and child nutritional status in a poor urban population in Bangladesh. We carried out a cross-sectional study among 264 mother-child pairs in an urban slum area of Bangladesh. The Self-Reporting Questionnaire-20 (SRQ-20) was used to assess maternal mental health. An SRQ-20 score ≥7 was considered a common mental disorder (CMD). Anthropometric measurements were performed to assess nutritional status of the children. The prevalence of maternal CMD was 46.2%. Maternal CMD was associated with poorer child feeding practice (p<0.001), poorer hygiene practice (p<0.001), poorer preventive care service use (p = 0.016), and suffering from diarrheal diseases (p = 0.049). The prevalence of stunting, wasting and underweight in children was 44.3%, 18.2% and 33.7%, respectively. A poorer child feeding practice was associated with wasting (p = 0.004) and underweight (p<0.001) but not with stunting. Poorer hygiene practices and suffering from diarrheal diseases were associated with stunting and underweight, but not with wasting. In multivariable analysis, maternal CMD was associated with child wasting (adjusted odds ratio, aOR = 2.25, 95% CI = 1.15-4.43). The association between maternal CMD and child underweight found in the bivariate analysis was attenuated and no longer statistically significant after multivariable analysis (aOR = 1.77, 95% CI = 0.94-3.33). No statistically significant association was observed between maternal CMD and stunting in this study (aOR = 1.46, 95% CI = 0.84-2.54). Maternal mental health affects nutritional status of the children where child feeding practice, hygiene practice and preventive care use might play a role. Interventions to address maternal mental health in child nutrition programs might improve child nutritional status.

Postnatal Mental Health, Hand Washing Practices, and Infant Illness in Rural China

Background: Maternal mental health problems play an important role in infant well-being. Although western countries have extensively studied the associations between maternal mental disorders, hygiene practices and infant health, little is known in developing settings. This study investigates the correlations between postnatal mental health problems, hand washing practices and infant illness in rural western China.

Methods: A total of 720 mothers of infants aged 0–6 months from four poor counties in rural western China were included in the survey. Mental health symptoms were assessed using the Depression, Anxiety, and Stress Scale-21 (DASS-21). Questions about infant illness and hand washing practices followed evaluative surveys from prior studies. Adjusted ordinary least squares regressions were used to examine correlations between postnatal mental health (depression, anxiety, and stress) symptoms, hand washing practices, and infant illness outcomes.

Results: Maternal depression, anxiety and stress symptoms were significantly associated with reduced hand washing overall and less frequent hand washing after cleaning the infant's bottom. Mental health symptoms were also associated with a higher probability of infants showing two or more illness symptoms and visiting a doctor for illness symptoms. Individual hand washing practices were not significantly associated with infant illness; however, a composite measure of hand washing practices was significantly associated with reduced probability of infant illness.

Conclusion: Postnatal mental health problems are prevalent in rural China and significantly associated with infant illness. Policy makers and practitioners should investigate possible interventions to improve maternal and infant well-being.

The Impact of Maternal Depression and Parent-Child Interactions on Risk of Parasitic Infections in Early Childhood: A Prospective Cohort in Benin

Objectives

Maternal depression occurs in 13–20% of women from low-income countries, which is associated with negative child health outcomes, including diarrheal disease. However, few studies have investigated its impact on child risk of infectious disease. We studied the impacts of maternal depressive symptoms and parent–child interactions, independently, on the risk of Plasmodium falciparum malaria and soil-transmitted helminth infection in Beninese children.

Methods

Our population included mothers and children enrolled in a clinical trial during pregnancy (MiPPAD) in Benin. The Edinburgh Postnatal Depression Scale (EPDS) assessed maternal depressive symptoms and the home observation measurement of the environment (HOME) assessed parent–child interactions. Blood and stool sample analyses diagnosed child malaria and helminth infection at 12, 18, and 24 months. Negative binomial and Poisson regression models with robust variance tested associations.

Results

Of the 302 mother–child pairs, 39 (12.9%) mothers had depressive symptoms. Median number of malaria episodes per child was 3 (0–14) and 29.1% children had at least one helminth infection. Higher EPDS scores were associated with lower HOME scores; relative risk (RR) 0.97 (95% confidence interval (CI) 0.95, 0.99), particularly with lower acceptance, involvement, and variety subscales; RR 0.92 (95% CI 0.85, 0.99), RR 0.82 (95% CI 0.77, 0.88), RR 0.93 (95% CI 0.88, 0.99), respectively. However, neither exposure was associated with risk of parasitic infection in children.

Conclusions for Practice

Maternal depressive symptoms are associated with poor parent–child interactions, particularly acceptance of behavior, involvement with children, and variety of interactions, but these exposures do not independently impact risk of parasitic infection in children.

Evaluating the impact of a common elements-based intervention to improve maternal psychological well-being and mother-infant interaction in rural Pakistan: study protocol for a randomised controlled trial

INTRODUCTION

Millions of children in low resource settings are at high risk of poor development due to factors such as under nutrition, inadequate stimulation and maternal depression. Evidence-based interventions to address these risk factors exist, but often as a separate and overlapping package. The current study aims to evaluate the effectiveness of a common elements-based intervention to improve mother-infant interaction at 12 months post-partum.

METHOD AND ANALYSIS

A two-arm, single-blinded, individual randomised controlled trial is being carried out in the community settings of the rural subdistrict of Gujar Khan in Rawalpindi, Pakistan. 250 pregnant women in third trimester with distress (Self-Reporting Questionnaire, cut-off score >9) have been randomised on 1:1 allocation ratio into intervention (n=125) and treatment-as-usual arms (n=125). The participants in the intervention arm will receive 15 individual sessions of intervention on a monthly basis by non-specialist facilitators. The intervention involves components of early stimulation, learning through play, responsive feeding, guided discovery using pictures, behavioural activation and problem solving. The primary outcome is caregiver-infant interaction at 12 months postpartum. The secondary outcomes include maternal psychological well-being, quality of life, social support and empowerment. Infant secondary outcomes include growth, nutrition and development. The data will be collected at baseline, 6 and 12 months postpartum. A qualitative process evaluation will be conducted to inform the feasibility of intervention delivery.

ETHICS

Ethics approval for the present study was obtained from the Human Development Research Foundation Institutional Review Board, Islamabad Pakistan.

DISSEMINATION

If proven effective, the study will contribute to scale-up care for maternal and child mental health in low resource settings, globally. The findings of the present study will be published in peer-reviewed journals and presented at conferences and community forums.

TRIAL REGISTRATION NUMBER

NCT04252807.

Postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia: a systematic review and meta-analysis

BACKGROUNDS

Despite remarkable progress in the reduction of maternal mortality, postpartum depression remains a major public health problem among vulnerable populations. In Ethiopia, study findings regarding postpartum depression and its association with intimate partner violence and social support have been inconsistent. Therefore, this systematic review and meta-analysis estimate the pooled prevalence of postpartum depression and its association with intimate partner violence and inadequate social support in Ethiopia.

METHODS

We systematically searched international databases like PubMed, Web of Science, SCOPUS, CINAHL, PsycINFO, Google Scholar, Science Direct, and the Cochrane Library. All identified observational studies reporting the postpartum depression and or its predictors in Ethiopia were included. Two authors independently extracted all necessary data using a standardized data extraction format. The I² statistics were used to assess the heterogeneity of the studies. A random-effects model was computed to estimate the pooled prevalence of postpartum depression and its associations with the selected predictors.

RESULTS

The random effect meta-analysis of thirteen studies showed a pooled prevalence of postpartum depression was 21.55% (95% CI: 17.89, 25.94). The highest prevalence of postpartum depression occurred in Addis Ababa, 23.3% and the lowest was in Harar, 13.11%. Our meta-analysis indicated a 5.46 folds increased risk of postpartum depression among women exposed to intimate partner violence (POR = 5.46 (95%CI: 3.94, 7.56, I²=38.8%) and 6.27 folds increased risk postpartum depression among women who had inadequate social support (POR = 6.27 (95%CI: 4.83, 8.13, I2=0) relative to those who had adequate social support. The meta-analysis further revealed that marital dissatisfaction (POR = 2.6%; 95%CI: 1.48-4.65), previous postpartum depression (POR = 2.03%; 95%CI: 1.72-2.4), and substance abuse (POR = 2.03%; 95%CI: 1.72-2.4) were associated with postpartum depression.

CONCLUSIONS

Our study indicates that two in every ten postpartum women in Ethiopia are suffering from postpartum depression. Intimate partner violence and social support should be a major focus to improve women's mental health during postpartum period with the reduction of substance abuse. There is an urgent need for concerted efforts in the reduction of postpartum depression through prevention efforts of intimate partner violence and substance abuse.

Perinatal mental health: a review of progress and challenges

Perinatal mental health has become a significant focus of interest in recent years, with investment in new specialist mental health services in some high-income countries, and inpatient psychiatric mother and baby units in diverse settings. In this paper, we summarize and critically examine the epidemiology and impact of perinatal mental disorders, including emerging evidence of an increase of their prevalence in young pregnant women. Perinatal mental disorders are among the commonest morbidities of pregnancy, and make an important contribution to maternal mortality, as well as to adverse neonatal, infant and child outcomes. We then review the current evidence base on interventions, including individual level and public health ones, as well as service delivery models. Randomized controlled trials provide evidence on the effectiveness of psychological and psychosocial interventions at the individual level, though it is not yet clear which women with perinatal mental disorders also need additional support for parenting. The evidence base on psychotropic use in pregnancy is almost exclusively observational. There is little research on the full range of perinatal mental disorders, on how to improve access to treatment for women with psychosocial difficulties, and on the effectiveness of different service delivery models. We conclude with research and clinical implications, which, we argue, highlight the need for an extension of generic psychiatric services to include preconception care, and further investment into public health interventions, in addition to perinatal mental health services, potentially for women and men, to reduce maternal and child morbidity and mortality.

Multidimensional predictors of common mental disorders among Indian mothers of 6- to 24-month-old children living in disadvantaged rural villages with women's self-help groups: A cross-sectional analysis

Common mental disorders (CMD) among mothers cause disability, negatively affect child development, and have high long-term economic costs. Little is known about how factors across multiple life dimensions, modeled together, are differentially related to maternal mental health in high poverty contexts. Further, there is limited evidence on determinants of CMD in areas where self-help groups (SHGs) exist to promote women's wellbeing. Filling this evidence gap is important given the high prevalence of CMD and the rapid expansion of SHGs in rural India. Cross-sectional data were collected from 1644 mother-infant pairs living in disadvantaged rural villages across five Indian states-Jharkhand, Madhya Pradesh, West Bengal, Odisha, and Chhattisgarh-surveyed in the Women Improving Nutrition through Group-based Strategies study. CMD were assessed using the 20-item Self Reporting Questionnaire (SRQ). We examined 31 factors across four life dimensions: work (work type, time spent in labor, domestic and caretaking activities), agency (SHG membership, decision-making, gender attitudes), health/nutrition (underweight, fertility, diet diversity, child illness), and household/environment (dependency ratio, wealth, food security, shocks, water, sanitation). Survey-adjusted multivariate logistic and ordinary least squares regression models were fit to examine predictors of CMD or SRQ score. On average, mothers were 26 (range 18-46) years old and their children were 15 (range 6-24) months old. CMD defined as ≥ 8 positive SRQ responses were reported by 262 women (16%). Protective factors included being engaged in agricultural labor as a main occupation relative to being a housewife (AOR 0.18, 95% CI 0.10-0.32), more time working (0.85, 0.77-0.93), higher decision-making (0.33, 0.16-0.69), SHG membership (0.73, 0.56-0.96), and having an improved toilet (0.49, 0.33-0.72). Risk factors included food insecurity (1.13, 1.07-1.20) and shocks to non-farm livelihoods (2.04, 1.10-3.78). Practitioners and policymakers should aim to improve food security, economic wellbeing and social capital, such as that created through SHG membership, to improve maternal mental health. Future research should aim to understand why working outside the home, albeit in agricultural work, appears to protect maternal mental health in this context.

Consequences of maternal postpartum depression: A systematic review of maternal and infant outcomes

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.

Healthy Options: study protocol and baseline characteristics for a cluster randomized controlled trial of group psychotherapy for perinatal women living with HIV and depression in Tanzania

BACKGROUND

Perinatal women accessing prevention of mother-to-child transmission of HIV (PMTCT) services are at an increased risk of depression; however, in Tanzania there is limited access to services provided by mental health professionals. This paper presents a protocol and baseline characteristics for a study evaluating a psychosocial support group intervention facilitated by lay community-based health workers (CBHWs) for perinatal women living with HIV and depression in Dar es Salaam.

METHODS

A cluster randomized controlled trial (RCT) is conducted comparing: 1) a psychosocial support group intervention; and 2) improved standard of mental health care. The study is implemented in reproductive and child health (RCH) centers providing PMTCT services. Baseline characteristics are presented by comparing sociodemographic characteristics and primary as well as secondary outcomes for the trial for intervention and control groups. The trial is registered under clinicaltrials.gov (NCT02039973).

RESULTS

Among 742 women enrolled, baseline characteristics were comparable for intervention and control groups, although more women in the control group had completed secondary school (25.2% versus 18.2%). Overall, findings suggest that the population is highly vulnerable with over 45% demonstrating food insecurity and 17% reporting intimate partner violence in the past 6 months.

CONCLUSIONS

Baseline characteristics for the cluster RCT were comparable for intervention and control groups. The trial will examine the effectiveness of a psychosocial support group intervention for the treatment of depression among women living with HIV accessing PMTCT services. A reduction in the burden of depression in this vulnerable population has implications in the short-term for improved HIV-related outcomes and for potential long-term effects on child growth and development.

TRIAL REGISTRATION

The trial is registered under clinicaltrials.gov (NCT02039973). Retrospectively registered on January 20, 2014.

Effectiveness of a group intervention led by lay health workers in reducing the incidence of postpartum depression in South India

BACKGROUND

Postnatal depression is a highly prevalent disorder with serious implications on maternal and child outcomes. There are few studies examining feasible interventions in low-middle-income community settings.

AIMS

To assess the effectiveness of a low intensity group intervention led by lay workers during the antenatal period in reducing postnatal depression at 6-2 weeks postpartum.

METHODS

A parallel group design with both positive and negative controls was employed. 1 community site was allocated to each of the 3 arms. The active intervention consisted of problem based sessions with cognitive behavioural components. The primary outcome was the presence of depression on CIS-R and secondary outcome measures where Global Assessment of Functioning (GAF) scores, EPNDS scores and participant perceptions.

RESULTS

69, 75 and 70 women received active, positive control and negative control interventions respectively. Post partum depression diagnosed with the CIS-R was present in 14.06% (C.I.- 5.55%-22.57%) and 22.62% (C.I.15.62%-29.63%) in the active arm and two control (combined) arms respectively. There was a 1/3 lower proportion of postpartum depression and impaired functioning in the intervention group, though statistical significance was not reached (p = 0.30). There were high levels of satisfaction reported for the active intervention.

CONCLUSION

There were trends for the possible effectiveness for this low intensity intervention and conclusions regarding its effectiveness can't be made as the sample size was small. There is a need to explore and develop locally relevant, innovative and feasible strategies for prevention of postnatal depression in resource constrained enviroments.

Impact of maternal adverse childhood experiences on child socioemotional function in rural Kenya: Mediating role of maternal mental health

Mothers in low- and middle-income countries (LMIC) suffer heightened vulnerability for adverse childhood experiences (ACEs), which is exacerbated by the multitude of risk factors associated with poverty and may lead to increased risk of psychiatric disorder. The constellation of complex, co-occurring biological, environmental, social, economic and psychological risk factors are in turn transmitted to her child, conferring vulnerability for adverse development. This study examines the association between maternal intra- and extra-familial ACEs, maternal education and the mental health of her child, mediated by maternal mental health. Mother-child dyads (n = 121) in Machakos, Kenya were examined cross-sectionally using self-report measures of ACEs, maternal mental health and child internalizing and externalizing mental health problems. The four models proposed to examine the relationship between intra- and extra-familial maternal ACEs and child internalizing and externalizing problems demonstrated indirect pathways through maternal mental health. These effects were found to be conditional on levels of maternal education, which served as a protective factor at lower levels of maternal ACEs. These models demonstrate how the impact of ACEs persists across the lifespan resulting in a negative impact on maternal mental health and conferring further risk to subsequent generations. Elucidating the association between ACEs and subsequent intergenerational sequelae, especially in LMIC where risk is heightened, may improve targeted caregiver mental health programs for prevention and intervention.

Effectiveness of applying problem-solving training on depression in Iranian pregnant women: Randomized clinical trial

BACKGROUND

Depression during pregnancy is one of the major concerns in mental health, hence using interventional methods for the treatment or reducing the rate of depression is considered a priority for maternal and fetal health. The present study aimed to examine the effectiveness of problem-solving training in reducing depression in pregnant women.

MATERIALS AND METHODS

This randomized clinical trial was conducted on seventy pregnant women referring to Prenatal Care Clinics, Najmiyeh hospital in Tehran, Iran. The participants were randomly allocated divided into experimental and control groups. The experimental group was given routine prenatal care training at the clinic along with problem-solving skills training based on the Identify, Define, Explore, Act, Look back model in five sessions, but the control group only received routine prenatal care training. Data were collected using the Beck's Depression Inventory at the beginning of the study and at the immediately and 1 month after two groups. Data were analyzed using descriptive and analytical statistical tests.

RESULTS

In the experimental group, the mean depression score significantly reduced from 16.06 ± 4.73 before intervention to 12.83 ± 4.10 and 13 ± 4.24 after intervention and at follow-up (P < 0.05). While in the control group, the mean depression from 15.34 ± 2.94 before intervention to 14.80 ± 2.76 and 14.86 ± 2.924 after intervention and at follow-up. It was not statistically significant in the control group (P > 0.05).

CONCLUSIONS

Problem-solving training can be used as an optional method of reducing depression in pregnant women, and it is recommended that should be implemented by the health-care team.

Maternal Common Mental Disorder as Predictors of Stunting among Children Aged 6-59 Months in Western Ethiopia: A Case-Control Study

Background

Child malnutrition in low- and middle-income countries still continues to be an alarming. Africa and Asia bear the greatest share of all forms of malnutrition. The association between maternal common mental disorder and stunting has not been studied well even in developed countries; much less in developing countries and even the findings are conflicting. Thus, the purpose of the present research was to investigate the relationship of maternal common mental disorder and child stunting.

Methods

Institution based unmatched case-control study design was employed from March to April 2017. Two hundred thirty-four sampled children (78 cases and 156 controls) were randomly selected. Anthropometric measurements (height/length and weight) were taken by calibrated instruments. Maternal common mental disorder (CMD) was measured by using the locally validated Self-Reporting Questionnaire (SRQ-20). Data entry was done by Epi data version 3.1 and analysis was done by SPSS 21.0 statistical software.

Result

Finding of this study found out about three-fourths of cases (71.8%) and three-fourths of controls (69.9%) were residing in rural and urban areas, respectively. Regarding maternal common mental disorder, more than half of cases mother (53.8%) and more than one-tenth of controls mother (13.5%) were found to have common mental disorder. The study showed that children of mothers who had common mental disorder were found to be three times more likelihood of developing stunting than children whose mothers had not common mental disorder.

Conclusion and Recommendation

The study indicated that maternal common mental disorder was significantly associated with stunting. Therefore, emphasis should be given in preventing, managing, and maintaining maternal mental health in order to prevent stunting.

Military spouses with deployed partners are at greater risk of poor perinatal mental health: a scoping review

BACKGROUND

Poor mental health in the perinatal period is associated with a number of adverse outcomes for the individual and the wider family. The unique circumstances in which military spouses/partners live may leave them particularly vulnerable to developing perinatal mental health (PMH) problems.

METHODS

A scoping review was carried out to review the literature pertaining to PMH in military spouses/partners using the methodology outlined by Arksey and O'Malley (2005). Databases searched included EBSCO, Gale Cengage Academic OneFile, ProQuest and SAGE.

RESULTS

Thirteen papers fulfilled the inclusion criteria, all from the USA, which looked a PMH or well-being in military spouses. There was a strong focus on spousal deployment as a risk factor for depressive symptoms and psychological stress during the perinatal period. Other risk factors included a lack of social/emotional support and increased family-related stressors. Interventions for pregnant military spouses included those that help them develop internal coping strategies and external social support.

CONCLUSIONS

US literature suggests that military spouses are particularly at risk of PMH problems during deployment of their serving partner and highlights the protective nature of social support during this time. Further consideration needs to be made to apply the findings to UK military spouses/partners due to differences in the structure and nature of the UK and US military and healthcare models. Further UK research is needed, which would provide military and healthcare providers with an understanding of the needs of this population allowing effective planning and strategies to be commissioned and implemented.

Using technology to scale-up training and supervision of community health workers in the psychosocial management of perinatal depression: a non-inferiority, randomized controlled trial

BACKGROUND

The Thinking Healthy Programme (THP) is an evidence-based psychological intervention endorsed by the World Health Organization, tailored for non-specialist health workers in low- and middle-income countries. However, training and supervision of large numbers of health workers is a major challenge for the scale-up of THP. We developed a 'Technology-Assisted Cascaded Training and Supervision system' (TACTS) for THP consisting of a training application and cascaded supervision delivered from a distance.

METHODS

A single-blind, non-inferiority, randomized controlled trial was conducted in District Swat, a post-conflict area of North Pakistan. Eighty community health workers (called Lady Health Workers or LHWs) were randomly assigned to either TACTS or conventional face-to-face training and supervision by a specialist. Competence of LHWs in delivering THP post-training was assessed by independent observers rating a therapeutic session using a standardized measure, the 'Enhancing Assessment of Common Therapeutic factors' (ENACT), immediately post-training and after 3 months. ENACT uses a Likert scale to score an observed interaction on 18 dimensions, with a total score of 54, and a higher score indicating greater competence.

RESULTS

Results indicated no significant differences between health workers trained using TACTS and supervised from distance v. those trained and supervised by a specialist face-to-face (mean ENACT score M  =  24.97, s.d.  =  5.95 v. M =  27.27, s.d.  =  5.60, p  =  0.079, 95% CI 4.87-0.27) and at 3 months follow-up assessment (M  =  44.48, s.d.  =  3.97 v. M =  43.63, s.d.  =  6.34, p  =  0.53, CI -1.88 to 3.59).

CONCLUSIONS

TACTS can provide a promising tool for training and supervision of front-line workers in areas where there is a shortage of specialist trainers and supervisors.

Maternal depression and primary healthcare use for children: a population-based cohort study in Denmark

BACKGROUND

Depression is a common mental illness worldwide. The offspring of a mother with depression has higher risk of developing mental and physical illness.

AIM

This study aimed to investigate the association between the timing of maternal depression and the use of primary health care for the offspring.

DESIGN AND SETTING

A population-based birth cohort study in Danish primary care using Danish national registers.

METHOD

All Danish children born between 1 January 2000 and 31 December 2013 (n = 869 140 children) were included in the study. The primary outcome was number and type of annual contacts with the GP. The secondary outcome was specific services used by the GP to assess inflammatory and infectious disease in the children. Exposure was maternal depression of four categories: non-depressed, recent, previous, and past depression. The association was expressed as adjusted incidence rate ratios (IRR) with 95% confidence intervals (CI).

RESULTS

Maternal depression was associated with a higher use of primary health care for all three categories of depression. The strongest association was found for children of a mother with recent depression; they had 16% more contacts than children of a non-depressed mother (adjusted IRR = 1.16, 95% CI = 1.15 to 1.17), and 19-24% more positive infectious-related tests were found in this group.

CONCLUSION

Exposure to maternal depression was associated with a significantly higher use of primary health care for the offspring for all exposure categories. These findings reveal that healthcare use is higher for the offspring exposed to maternal depression, even several years after expected remission. The higher ratio of positive tests indicates that exposed children are ill with infectious disease more often.

Prevalence and determinants of antenatal depression among pregnant women in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Antenatal depression is more prevalent in low and middle income countries as compared to high income countries. It has now been documented as a global public health problem owing to its severity, chronic nature and recurrence as well as its negative influence on the general health of women and development of children. However, in Ethiopia, there are few studies with highly variable and inconsistent findings. Therefore, the aim of this study was to determine the prevalence of antenatal depression and its determinants among pregnant women in Ethiopia.

METHODS

In this systematic review and meta-analysis, we exhaustively searched several databases including PubMed, Google Scholar, Science Direct and Cochrane Library. To estimate the pooled prevalence, studies reporting the prevalence of antenatal depression and its determinants were included. Data were extracted using a standardized data extraction format prepared in Microsoft Excel and transferred to STATA 14 statistical software for analysis. To assess heterogeneity, the Cochrane Q test statistics and I2 test were used. Since the included studies exhibit considerable heterogeneity, a random effect meta- analysis model was used to estimate the pooled prevalence of antenatal depression. Finally, the association between determinant factors and antenatal depression were assessed.

RESULTS

The overall pooled prevalence of antenatal depression, in Ethiopia, was 24.2% (95% CI: 19.8, 28.6). The subgroup analysis of this study indicated that the highest prevalence was reported from Addis Ababa region with a prevalence of 26.9% (21.9-32.1) whereas the lowest prevalence was reported from Amhara region, 17.25 (95% CI: 6.34, 28.17). Presence of previous history of abortion (OR: 3.0, 95% CI: 2.1, 4.4), presence of marital conflict (OR: 7.2; 95% CI: 2.7, 19.0), lack of social support from husband (OR: 3.2: 95% CI: 1.2, 8.9), and previous history of pregnancy complication (OR: 3.2: 95% CI: 1.8, 5.8) were found to be determinants of antenatal depression.

CONCLUSION

The pooled prevalence of antenatal depression, in Ethiopia, was relatively high. Presence of previous history of abortion, presence of marital conflict, lack of social support from husband, presence of previous history of pregnancy complications were the main determinants of antenatal depression in Ethiopia.

Factors influencing developmental delay among young children in poor rural China: a latent variable approach

OBJECTIVES

The aims of the study were to determine the prevalence of suspected developmental delay in children living in poor areas of rural China and to investigate factors influencing child developmental delay.

DESIGN

A community-based, cross-sectional survey was conducted.Eighty-three villages in Shanxi and Guizhou Provinces, China.

PARTICIPANTS

A total of 2514 children aged 6-35 months and their primary caregivers.

OUTCOME MEASURES

Suspected child developmental delay was evaluated using the Ages & Stages Questionnaires-Chinese version. Caregivers' education and age, wealth index, child feeding index, parent-child interaction, number of books and Zung Self-Rating Depression Scale were reported by the primary caregivers. Haemoglobin levels were measured using a calibrated, automated analyser. Birth weight was obtained from medical records.

RESULTS

Overall, 35.7% of the surveyed children aged 6-35 months demonstrated suspected developmental delay. The prevalence of suspected developmental delay was inversely associated with age, with the prevalence among young children aged 6-11 months being almost double that of children aged 30-35 months (48.0% and 22.8%, respectively). Using a structural equation model, it was demonstrated that caregiver's care and stimulus factors and child's haemoglobin level were directly correlated, while caregiver's sociodemographic factors were indirectly associated with suspected developmental delay.

CONCLUSIONS

The prevalence of suspected developmental delay is high in poor rural areas of China, and appropriate interventions to improve child development are needed.

Identifying the factors associated with depressive symptoms among postpartum mothers in Kathmandu, Nepal

Purpose

This study aimed to identify the factors associated with depressive symptoms among postpartum mothers in Kathmandu, Nepal.

Method

A hospital-based cross-sectional study that included 346 postpartum mothers at 4-14 weeks after delivery was carried out. Validated Nepalese version of Edinburgh Postnatal Depression Scale with cut-off value of ≥12 was used to screen depressive symptoms and structured questionnaires were used to identify the associated factors. Possible factors associated with depressive symptoms were identified by logistic regression analysis.

Result

The mean age of the mothers was 22.75 (SD = 4.51). The prevalence of depressive symptoms among postpartum mothers was 17.1% (95% CI = 15.07-19.12). No significant association existed between postpartum depressive symptoms and socio demographic and economic characteristics. In multivariate analysis, risk factors for postpartum depressive symptoms were identified as follows: women without adequate rest during pregnancy (aOR = 4.023, 95% CI = 1.294-12.501), abortion history (aOR = 3.25, 95% CI = 1.208-9.065), poor relationship with husband (aOR = 1.67, 95% CI = 1.073-8.384), marital dissatisfaction (aOR = 4.053, 95% CI = 2.281-12.819) and stressful life events (aOR = 3.89, 95% CI = 1.504-9.810).

Conclusions

This study aids to draw attention on the incorporation of routine screening for basic support and intervention for identified risk factors in postpartum period. Policies can be formulated to encourage postpartum women to obtain adequate rest during pregnancy, support women with poor partner relationship, reduce marital dissatisfaction, help women adjust with stressful life events, and prevent and manage abortion appropriately. These policies may reduce harmful consequences of postpartum depressive symptoms for women, newborn and their family.

Comparison of Urdu Versions of the Resilience Scale and the Resilience Scale for Adults

BACKGROUND AND PURPOSE

Several methodological challenges are associated with measuring resilience in women. This study compares the 14-item Resilience Scale (RS-14) and the Resilience Scale for Adults (RSA) in a community sample of women.

METHODS

Data were collected from 120 women residing in low socioeconomic areas of Karachi, Pakistan. Construct validity, internal consistency, and responsiveness were calculated.

RESULTS

Both scales demonstrated satisfactory psychometric characteristics. The total RS-14 score was significantly associated with all subscales of the RSA. However, two items of the RS-14 did not show any association with any of the subscales of the RSA. Medium effect size was noted on the "structured style"subscale of the RSA.

CONCLUSION

Differences between the scales concluded that the Urdu version the of RSA yielded improved results in this sample.

Maternal supplementation with small-quantity lipid-based nutrient supplements during pregnancy and lactation does not reduce depressive symptoms at 6 months postpartum in Ghanaian women: a randomized controlled trial

We examined the impact on depression at 6 months postpartum of maternal supplementation with small-quantity lipid-based nutrient supplement (SQ-LNS) compared to supplementation with iron and folic acid (IFA) or multiple micronutrients (MMN). In this partially double-blinded randomized controlled trial, pregnant women ≤20 weeks gestation (n = 1320) were recruited from antenatal clinics and randomly assigned to receive either (1) SQ-LNS during pregnancy and for 6 months postpartum, or (2) IFA during pregnancy only, or (3) MMN during pregnancy and for 6 months postpartum. Maternal depressive symptoms were measured at 6 months postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Women who scored 12 or more on the EPDS were considered to show symptoms of depression. One thousand one hundred fifty-one women were included in this analysis (LNS = 382, IFA = 387 and MMN = 382). Characteristics of the three groups were similar at baseline, and there were no significant differences between women who were included in the analysis (n = 1151) and those who were not (n = 169). At 6 months postpartum, 13% of the women overall showed symptoms of depression, and this did not differ by group (LNS = 13.1%, IFA = 11.2% and MMN = 14.7%. P = 0.36). The median (25, 75 percentile) EPDS score did not differ by group (LNS 4.0 (1.0, 8.0), IFA 4.0 (1.0, 8.0), MMN 5.0 (2.0, 9.0), P _transformed = 0.13). Adjustment for covariates did not alter these findings. Maternal supplementation with SQ-LNS compared to MMN or IFA did not affect postnatal depressive symptoms in this sample of Ghanaian women.

Maternal depressive symptoms and child nutritional status: A cross-sectional study in socially disadvantaged Pakistani community

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.

Understanding Peripartum Depression Through Neuroimaging: a Review of Structural and Functional Connectivity and Molecular Imaging Research

PURPOSE OF REVIEW

Imaging research has sought to uncover brain structure, function, and metabolism in women with postpartum depression (PPD) as little is known about its underlying pathophysiology. This review discusses the imaging modalities used to date to evaluate postpartum depression and highlights recent findings.

RECENT FINDINGS

Altered functional connectivity and activity changes in brain areas implicated in executive functioning and emotion and reward processing have been identified in PPD. Metabolism changes involving monoamine oxidase A, gamma-aminobutyric acid, glutamate, serotonin, and dopamine have additionally been reported. To date, no studies have evaluated gray matter morphometry, voxel-based morphometry, surface area, cortical thickness, or white matter tract integrity in PPD. Recent imaging studies report changes in functional connectivity and metabolism in women with PPD vs. healthy comparison women. Future research is needed to extend these findings as they have important implications for the prevention and treatment of postpartum mood disorders.

Poor early childhood outcomes attributable to maternal depression in Mexican women

We aimed to estimate the population fraction of poor early child health and developmental outcomes attributable to maternal depressive symptoms (DS) contrasting it between low- and middle/high-income households. We used a nationally representative probabilistic sample of 4240 children younger than 5 years old and their mothers, derived from the Mexican National Health and Nutrition Survey Data (ENSANUT 2012). Complex survey design, sampling, and analytic weights were taken into account in analyses. DS was measured by CESD-7. Child outcomes were as follows: breastfeeding, attending well-child check-ups, respiratory disease, diarrhea and general health problems, immunization, accidents, growth, obesity, and food insecurity. Prevalence of DS among mothers was 21.36%. In low-SES households, DS was associated with higher risk of never being breastfed (RR = 1.77; p < .05), health problems (RR = 1.37; p < .05), acute respiratory disease (RR = 1.51; p < .05), accidents requiring child hospitalization (RR = 2.16; p < .01), and moderate or severe food insecurity (RR = 1.58; p < .001). In medium- or high-SES households, DS was associated with higher risk of never attending a developmental check-up (RR = 2.14; p < .05) and moderate or severe food insecurity (RR = 1.75; p < .01). Population risks attributable to DS ranged from 2.30 to 17.45%. Prevention of DS could lead to reduction of problematic early childhood outcomes in both low and medium/high SES.

Maternal care mediates the effects of nutrition and responsive stimulation interventions on young children's growth

BACKGROUND

Undernutrition contributes to at least half the estimated six million annual childhood deaths worldwide. Furthermore, one in three children fails to meet their developmental potential because of risks including stunting, illness, under-stimulation, poor responsive interactions and maternal depressive symptoms. Our study investigates the role of caregiving processes on children's height-for-age at 2 and 4 years.

METHODS

The Pakistan Early Child Development Scale-up study assessed the longitudinal effectiveness of early nutrition and responsive stimulation interventions on growth and development at 4 years of age. In total, 1302 children were followed up from birth to 4 years. We leveraged path analyses to explore potential mediators of early intervention effects on children's height-for-age at 4 years, including maternal depressive symptoms, mother-child interaction quality, diarrhoeal illness and height-for-age at 2 years.

RESULTS

Our final model had excellent model fit (comparative fix index = 0.999, Tucker-Lewis index = 0.998, root mean square error of approximation = 0.008) and showed that mother-child interaction quality mediated the effects of both enhanced nutrition and responsive stimulation interventions on height-for-age at 4 years via its longitudinal stability from 2 years of age (β = 0.016, p = 0.005; β = 0.048, p < 0.001, respectively). Further, diarrhoeal illness mediated the effects of maternal depressive symptoms at 1 year post partum on children's height-for-age at 4 years via the longitudinal stability of height-for-age z-score from 2 years of age onwards (β = -0.007, p = 0.019).

CONCLUSIONS

The quality of early caregiving experience mediated the association between both interventions and height-for-age. The effect of maternal depressive symptoms on growth was mediated by diarrhoeal illness. Programmatic approaches to child nutrition and growth must address all these potentially modifiable factors.

Maternal Psychological Distress and Perceived Impact on Child Feeding Practices in South Kivu, DR Congo

BACKGROUND

Maternal mental health problems are associated with poor child growth and suboptimal child feeding practices, yet little qualitative research has been conducted to understand mothers' perceptions about how maternal mental ill health and child nutrition are related.

OBJECTIVE

The objective of the study was to understand maternal perceptions on sources of psychological distress, and how distress impacts functioning, especially related to childcare and feeding practices among mothers of young children in South Kivu, DR Congo.

METHODS

Mothers of young children who were participating in a larger study were eligible. Using purposive sampling, participants were selected if they had high or low levels of psychological distress, based on their mean item score on measures of symptoms of depression, anxiety, and post-traumatic stress. Twenty in-depth interviews and 2 focus group discussions were conducted, with a total of 35 mothers. Key informant interviews were conducted with 5 local health workers. Audio recordings were transcribed and coded, and the analysis was guided by Grounded Theory methodology.

RESULTS

Major themes to emerge were that women's husbands were a significant source of distress, with husbands' infidelity, abandonment, and lack of financial support mentioned by participants. Psychological distress resulted in appetite and weight loss, and poor nutritional status made it difficult to breastfeed. Participants perceived psychological distress caused milk insufficiency and difficulty breastfeeding.

CONCLUSION

Mothers experiencing psychological distress may need greater support for maternal nutrition and breastfeeding, and engaging fathers through responsible parenting interventions may reduce psychological distress and have a positive impact on child health.

The impact of maternal diet fortification with lipid-based nutrient supplements on postpartum depression in rural Malawi: a randomised-controlled trial

Perinatal depression is highly prevalent in low-and-middle-income countries and has been linked to poor child health. Suboptimal maternal nutrition may be a risk factor for perinatal depression. In this randomised-controlled trial conducted in rural Malawi, we set out to test the hypothesis that women taking a fatty acid-rich lipid-based nutrient supplement (LNS) would have fewer depressive symptoms postpartum than those taking iron-folate (IFA) or multiple-micronutrient (MMN) capsules. Women were recruited from antenatal clinics and randomised to receive LNS or MMN during pregnancy and for 6 months postpartum, or IFA during pregnancy only. Maternal depressive symptoms were measured using validated translations of the Self Reporting Questionnaire (SRQ) and Edinburgh Postnatal Depression Scale (EPDS), antenatally (SRQ only) and at 6 months postpartum (SRQ and EPDS). Analysis was by modified intention to treat. One thousand three hundred and ninety one women were randomised (LNS = 462, MMN = 466, IFA = 463). The groups were similar across a range of baseline variables. At 6 months postpartum, 1078 (77.5%) had SRQ completed; mean (SD) scores were LNS 1.76(2.73), MMN 1.92(2.75), IFA 1.71(2.66), P = 0.541. One thousand and fifty seven (76.0%) had EPDS completed; mean (SD) scores were LNS 5.77(5.53), MMN 5.43(4.97), IFA 5.52(5.18), P = 0.676. There were no statistically significant differences between the groups on SRQ or EPDS scores (continuous or dichotomised) in unadjusted or adjusted models. In conclusion, fortification of maternal diet with LNS compared with MMN or IFA did not reduce postnatal depressive symptoms in this study.

Maternal common mental disorders and associated factors: a cross-sectional study in an urban slum area of Dhaka, Bangladesh

Background

Poor maternal mental health has a negative impact on child growth and development. The objective of the study was to find out the associated factors of maternal common mental disorders (CMD) in an urban slum area of Bangladesh.

Methods

This cross-sectional study was carried out from September to November 2013 among conveniently selected 264 mothers having under-five children at Kamrangirchar area of Dhaka. A structured questionnaire based on Self-Reporting Questionnaire-20 (SRQ-20) was used for data collection where a cut-off of 7 was considered to ascertain CMD.

Results

Majority of the mothers were housewives (89.8%), educated up to primary level (40.9%) and lived in nuclear families (83.0%) with low socioeconomic status (64.4%) and moderate household food insecurity (57.5%). The prevalence of maternal CMD was 46.2%. In bivariate analysis, the associated factors of CMD were higher maternal age (p = 0.043), lower educational qualification (p = 0.015), low socioeconomic status (p = 0.004), household food insecurity (p < 0.001), maternal undernutrition (p = 0.001), child wasting (p = 0.005) and child underweight (p < 0.001). Household food insecurity (p < 0.001) and maternal undernutrition (p = 0.004) were identified as associated factors of maternal CMD after controlling for socio-demographic variables. There were about 5 times and 12 times increased odds of having maternal CMD in moderately (adjusted OR = 4.8, 95% CI 2.0–11.7) and severely food insecure household (adjusted OR = 11.6, 95% CI 3.5–38.1), respectively, than food secure one. Underweight mothers had 2.5 times increased odds of experiencing CMD as compared with mothers who were not underweight (adjusted OR = 2.6, 95% CI 1.4–5.0).

Conclusion

The prevalence of maternal CMD was relatively higher than other developing countries studied so far. Household food insecurity and maternal under-nutrition were the associated factors of maternal CMD. Therefore, interventions to improve household food security and maternal nutrition can improve maternal CMD and thus make useful contributions to child growth and development.

Mother-to-mother therapy in India and Pakistan: adaptation and feasibility evaluation of the peer-delivered Thinking Healthy Programme

BACKGROUND

Perinatal depression is highly prevalent in South Asia. Although effective and culturally feasible interventions exist, a key bottleneck for scaled-up delivery is lack of trained human resource. The aim of this study was to adapt an evidence-based intervention so that local women from the community (peers) could be trained to deliver it, and to test the adapted intervention for feasibility in India and Pakistan.

METHODS

The study was conducted in Rawalpindi, Pakistan and Goa, India. To inform the adaptation process, qualitative data was collected through 7 focus groups (four in Pakistan and three in India) and 61 in-depth interviews (India only). Following adaptation, the intervention was delivered to depressed mothers (20 in Pakistan and 24 in India) for six months through 8 peers in Pakistan and nine in India. Post intervention data was collected from depressed mothers and peers through 41 in-depth interviews (29 in Pakistan and 12 in India) and eight focus groups (one in Pakistan and seven in India). Data was analysed using Framework Analysis approach.

RESULTS

Most mothers perceived the intervention to be acceptable, useful, and viewed the peers as effective delivery-agents. The simple format using vignettes, pictures and everyday terms to describe distress made the intervention easy to understand and deliver. The peers were able to use techniques for behavioural activation with relative ease. Both the mothers and peers found that shared life-experiences and personal characteristics greatly facilitated the intervention-delivery. A minority of mothers had concerns about confidentiality and stigma related to their condition, and some peers felt the role was emotionally challenging.

CONCLUSIONS

The study demonstrates the feasibility of using peers to provide interventions for perinatal depression in two South Asian settings. Peers can be a potential resource to deliver evidence-based psychosocial interventions.

TRIAL REGISTRATION

Pakistan Trial: ClinicalTrials.gov Identifier: NCT02111915 (9 April 2014), India Trial: ClinicalTrials.gov Identifier: NCT02104232 (1 April 2014).

Postpartum depression and infant feeding practices in a low income urban settlement in Nairobi-Kenya

Background

Postpartum depression can compromise caregiving activities, including infant feeding practices, resulting in child malnutrition. The purpose of this study was to examine the effects of postpartum depression on infant feeding practices and malnutrition among women in an urban low income settlement in Nairobi-Kenya. We conducted a cross-sectional study based in Kariobangi North Health Centre in Nairobi County. The study sample included 200 mother-infant pairs visiting the Maternal and Child Health clinics for infant immunization at 6–14 weeks postpartum. We assessed postpartum depression using the Edinburgh Postpartum Depression Scale. Infant feeding practices were assessed based on World Health Organization infant and young child feeding guidelines. Nutritional status (weight for age) was ascertained using infants’ growth monitoring card (percentiles and z-score). We conducted logistic regression analyses to determine the relative odds of non-exclusive breast feeding and infant underweight among mothers with postpartum depression.

Results

The prevalence of PPD was 13.0% (95% CI 8.3–17.7%). Taking into account differences in socioeconomic status of depressed and non-depressed mothers, non-depressed mothers had a 6.14 (95% CI 2.45–13.36) times higher odds of practicing exclusive breastfeeding than mothers who were depressed. Mothers with PPD had a 4.40 (95% CI 1.91–11.93) time higher odds of having an underweight infant than mothers without depression.

Conclusions

This study contributes towards filling the knowledge gap regarding the adverse effects of postpartum depression on infant health in sub-Saharan Africa. We recommend more research on PPD using longitudinal designs to establish temporal ordering of these important public health problems and development of community-based interventions to address post-partum depression.

Electronic supplementary material

The online version of this article (doi:10.1186/s13104-016-2307-9) contains supplementary material, which is available to authorized users.

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries

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.

Prevalence and Associated Factors of Antenatal Depression among Women Attending Antenatal Care Service at Gondar University Hospital, Northwest Ethiopia

BACKGROUND

Depression is the most prevalent psychiatric disorder during pregnancy and is associated with psychosocial and clinical obstetric factors. Depressive disorders are not only common and chronic among women throughout the world but also principal sources of disability. The scarce information and limited attention to the problem might aggravate the consequence of the problem and can limit the intervention to be taken. Therefore, the current study was conducted to determine the prevalence and identify associated factors for antenatal depression.

METHODS

Institutional based cross-sectional study was conducted by taking a sample of 388 pregnant women coming for ANC service at Gondar University Hospital. Systematic random sampling technique was employed to recruit the study participants. Structured, pretested and interview administered questionnaire was used to collect related information while Beck Depression Inventory (BDI) was used to assess individuals`depression condition. A cut off point with high sensitivity and specificity was determined and internal consistency of the tool was checked (Cronbach alpha = 0.82). Ep Info V. 2002 and STATA 12 were used for data entry and analyses, respectively. Adjusted Odds Ratio with its 95% CI was used to declare the statistical significance of the factors.

RESULTS

Depression among pregnant women was found to be 23% (95%CI: 18.48%, 26.86%). Factors significantly associated with depression were: woman`s age (20 to 29, AOR = 0.18,95% CI:0.07,0.49), occupation (housewife, AOR = 2.57,95%CI:1.21,5.46, merchant and daily laborers, AOR = 3.44 (1.38,8.58), previous pregnancy (No, AOR = 4.74,95% CI:1.58,14.17) and previous ANC follow up pattern (irregular, AOR = 11.43,95% CI:3.68,35.49), no follow up, AOR = 11.98, 95% CI:4.73,30.33).

CONCLUSION

Depression symptoms are common in pregnant mothers in the study area and interventions that would address the aforementioned factors would benefit to tackle further complications.

Economic Benefits of Investing in Women's Health: A Systematic Review

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.

Barefoot therapists: barriers and facilitators to delivering maternal mental health care through peer volunteers in Pakistan: a qualitative study

BACKGROUND

Perinatal depression is a public health problem in low and middle income countries. Although effective psychosocial interventions exist, a major limitation to their scale up is the scarcity of mental health professionals. The aim of this study was to explore the facilitators and barriers to the acceptability of peer volunteers (PVs)-volunteer lay women from the community with shared socio-demographic and life experiences with the target population-as delivery agents of a psychosocial intervention for perinatal depression in a rural area of Pakistan.

METHODS

This qualitative study was embedded in the pilot phase of a larger peer-delivered mental health programme. Forty nine participants were included: depressed mothers (n = 21), PVs (n = 8), primary health care staff (n = 5), husbands (n = 5) and mothers-in-law (n = 10). Data were collected through in-depth interviews and focus groups and analysed using the Framework Analysis approach.

RESULTS

The PVs were accepted as delivery agents by all key stakeholders. Facilitators included the PVs' personal attributes such as being local, trustworthy, empathetic, and having similar experiences of motherhood. The perceived usefulness and cultural appropriateness of the intervention and linkages with the primary health care (PHC) system was vital to their legitimacy and credibility. The PVs' motivation was important, and factors influencing this were: appropriate selection; effective training and supervision; community endorsement of their role, and appropriate incentivisation. Barriers included women's lack of autonomy, certain cultural beliefs, stigma associated with depression, lack of some mothers' engagement and resistance from some families.

CONCLUSION

PVs are a potential human resource for the delivery of a psychosocial intervention for perinatal depression in this rural area of Pakistan. The use of such delivery agents could be considered for other under-resourced settings globally.

Community health workers can improve child growth of antenatally-depressed, South African mothers: a cluster randomized controlled trial

BACKGROUND

Maternal antenatal depression has long-term consequences for children's health. We examined if home visits by community health workers (CHW) can improve growth outcomes for children of mothers who are antenatally depressed.

METHODS

A cluster randomized controlled trial of all pregnant, neighbourhood women in Cape Town, South Africa. Almost all pregnant women (98 %, N = 1238) were recruited and assessed during pregnancy, two weeks post-birth (92 %) and 6 months post-birth (88 %). Pregnant women were randomized to either: 1) Standard Care (SC), which provided routine antenatal care; or 2) an intervention, The Philani Intervention Program (PIP), which included SC and home visits by CHW trained as generalists (M = 11 visits). Child standardized weight, length, and weight by length over 6 months based on maternal antenatal depression and intervention condition.

RESULTS

Depressed mood was similar across the PIP and SC conditions both antenatally (16.5 % rate) and at 6 months (16.7 %). The infants of depressed pregnant women in the PIP group were similar in height (height-for-age Z scores) to the children of non-depressed mothers in both the PIP and the SC conditions, but significantly taller at 6 months of age than the infants of pregnant depressed mothers in the SC condition. The intervention did not moderate children's growth. Depressed SC mothers tended to have infants less than two standard deviations in height on the World Health Organization's norms at two weeks post-birth compared to infants of depressed PIP mothers and non-depressed mothers in both conditions.

CONCLUSIONS

A generalist, CHW-delivered home visiting program improved infant growth, even when mothers' depression was not reduced. Focusing on maternal caretaking of infants, even when mothers are depressed, is critical in future interventions.

TRIAL REGISTRATION

ClinicalTrials.gov registration # NCT00996528 . October 15, 2009.

Maternal mental health, and child growth and development, in four low-income and middle-income countries

OBJECTIVE

Extend analyses of maternal mental health and infant growth in low- and middle-income countries (LMICs) to children through age eight years, and broaden analyses to cognitive and psychosocial outcomes.

DESIGN

Community-based longitudinal cohort study in four LMICs (Ethiopia, India, Peru and Vietnam). Surveys and anthropometric assessments were carried out when the children were approximately ages 1, 5 and 8 years. Risk of maternal common mental disorders (rCMDs) was assessed with the Self-Reporting Questionnaire (SRQ)-20 (score ≥8).

SETTING

Rural and urban as well as low- and middle-income communities.

PARTICIPANTS

7722 mothers and their children.

MAIN OUTCOME MEASURES

Child stunting and underweight (Z score ≤2 of height and weight for age), and <20th centile for: cognitive development (Peabody Picture Vocabulary Test), and the psychosocial outcomes self pride and life satisfaction.

RESULTS

A high rate of rCMD, stunting and underweight was seen in the cohorts. After adjusting for confounders, significant associations were found between maternal rCMDs and growth variables in the first year of life, with persistence to age 8 years in India and Vietnam, but not in the other countries. India and Vietnam also showed significant associations between rCMDs and lower cognitive development. After adjustment, rCMD was associated with low life satisfaction in Ethiopia but not in the other cohorts.

CONCLUSIONS

Associations of maternal rCMD in the first year of life with child outcomes varied across the study cohorts and, in some cases, persisted across the first 8 years of life of the child, and included growth, cognitive development and psychosocial domains.

Antenatal depression is associated with pregnancy-related anxiety, partner relations, and wealth in women in Northern Tanzania: a cross-sectional study

Background

Psychosocial health problems, specifically depression during pregnancy, can have negative impact on birth outcomes, postnatal mental health of the mother, and infant health. Antenatal depression is more prevalent among women in low- and middle-income countries than among women in high-income countries. Risk factors for antenatal depression reported in the literature relate to pregnant women in South Asia. Consequently, this study assessed depression in pregnancy and related psychosocial risk factors among select pregnant women residing in Mwanza region, Northern Tanzania.

Methods

We analysed data from 397 pregnant women recruited from three antenatal clinics for the period June—August 2013 for this cross-sectional study. Women provided data at one time point during their pregnancy by completing the Edinburgh Postnatal Depression Scale and a structured questionnaire assessing psychosocial, demographic, and behavioural risk factors related to antenatal depression. Multiple logistic regression analysis was performed to determine the relationship between risk factors examined and antenatal depression.

Results

Overall, 33.8 % (n = 134) of pregnant women had antenatal depression. Pregnancy-related anxiety was associated with antenatal depression (odds ratio (OR) 1.36, 95 % confidence interval (CI) 1.23 to 1.5). Pregnant women with poor relationship with partner and low/moderate socio-economic status had the highest OR for antenatal depression (82.34, 95 % CI 4.47, 1516.60) after adjusting for other covariates. Pregnant women with poor relationship with partner and high socio-economic status had an OR of 13.48 (95 % CI 1.71, 106.31) for antenatal depression. “Reference” pregnant women were those with very good relationship with partner and high socio-economic status.

Conclusions

High proportion of self-reported depression among select pregnant women attending antenatal clinics in Mwanza, Tanzania merit integrating depression assessment into existing antenatal care services. Health care providers need to assess pregnancy-related risk factors (pregnancy-related anxiety), socio-demographic factors (socio-economic status), and interpersonal risk factors (relationship with partner). Future research should appraise effectiveness of interventions that enhance partner relationships in reducing antenatal depression across all wealth distributions.

Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana

OBJECTIVES

To assess the impact of probable depression in the immediate postnatal period on subsequent infant mortality and morbidity.

DESIGN

Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths.

SETTING

Rural/periurban communities within the Kintampo Health Research Centre study area of the Brong-Ahafo Region of Ghana.

PARTICIPANTS

16,560 mothers who had a live singleton birth reported between 24 March 2008 and 11 July 2009, who were screened for probable postnatal depression (pPND) between 4 and 12 weeks post partum (some of whom had also had depression assessed at pregnancy), and whose infants survived to this point.

PRIMARY/SECONDARY OUTCOME MEASURES

All-cause early infant mortality expressed per 1000 infant-months of follow-up from the time of postnatal assessment to 6 months of age. The secondary outcomes were (1) all-cause infant mortality from the time of postnatal assessment to 12 months of age and (2) reported infant morbidity from the time of the postnatal assessment to 12 months of age.

RESULTS

130 infant deaths were recorded and singletons were followed for 67,457.4 infant-months from the time of their mothers' postnatal depression assessment. pPND was associated with an almost threefold increased risk of mortality up to 6 months (adjusted rate ratio (RR), 2.86 (1.58 to 5.19); p=0.001). The RR up to 12 months was 1.88 (1.09 to 3.24; p=0.023). pPND was also associated with increased risk of infant morbidity.

CONCLUSIONS

There is new evidence for the association between maternal pPND and infant mortality in low-income and middle-income countries. Implementation of the WHO's Mental Health Gap Action Programme (mhGAP) to scale up packages of care integrated with maternal health is encouraged as an important adjunct to child survival efforts.

Perinatal distress in women in low- and middle-income countries: allostatic load as a framework to examine the effect of perinatal distress on preterm birth and infant health

In low- and middle-income countries (LMIC), determinants of women’s and children’s health are complex and differential vulnerability may exist to risk factors of perinatal distress and preterm birth. We examined the contribution of maternal perinatal distress on preterm birth and infant health in terms of infant survival and mother–infant interaction. A critical narrative and interpretive literature review was conducted. Peer-reviewed electronic databases (MEDLINE, Embase, Global Health, CINHAL), grey literature, and reference lists were searched, followed by a consultation exercise. The literature was predominantly from high-income countries. We identify determinants of perinatal distress and explicate changes in the hypothalamic–pituitary–adrenal axis, sympathetic, immune and cardiovascular systems, and behavioral responses resulting in pathophysiological effects. We suggest cultural–neutral composite measures of allostatic mediators (i.e., several biomarkers) of maternal perinatal distress as objective indicators of dysregulation in body systems in pregnant women in LMIC. Understanding causal links of maternal perinatal distress to preterm birth in women in LMIC should be a priority. The roles of allostasis and allostatic load are considered within the context of the health of pregnant women and fetuses/newborns in LMIC with emphasis on identifying objective indicators of the level of perinatal distress and protective factors or processes contributing to resilience while facing toxic stress. We propose a prospective study design with multiple measures across pregnancy and postpartum requiring complex statistical modeling. Building research capacity through partnering researchers in high-income countries and LMIC and reflecting on unique ethical challenges will be important to generating new knowledge in LMIC.

Maternal mental health: The missing "m" in the global maternal and child health agenda

While the physical health of women and children is emphasized, the mental aspects of their health are often ignored by maternal and child health programs, especially in low- and middle-income countries. We review the evidence of the magnitude, impact, and interventions for common maternal mental health problems with a focus on depression, the condition with the greatest public health impact. The mean prevalence of maternal depression ranges between 15.6% in the prenatal and 19.8% in the postnatal period. It is associated with preterm birth, low birth weight, and poor infant growth and cognitive development. There is emerging evidence for the effectiveness of interventions, especially those that can be delivered by non-specialists, including community health workers, in low-income settings. Strategies for integrating maternal mental health in the maternal and child health agenda are suggested.

The expression of perinatal depression in rural Ghana

In low- and middle-income countries, perinatal depression (PND) has been associated with poor infant health outcomes, including frequency of infant diarrheal episodes, preterm delivery and low birth weight, and discontinuation or problems breastfeeding. Yet little is known about the awareness or expression of PND depression in Ghana. A total of 12 in-depth key-informant interviews were conducted with women who had experienced PND within the previous two-and-a-half years. Three focus-group discussions were conducted with new mothers (n = 11), grandmothers (n = 8), and fathers (n = 9) for contextual and supporting information. 'Thinking too much' was the term most commonly used to describe PND. The women saw their distress as caused largely by poverty, lack of social support, and domestic problems. Women sought help through family and religious organizations, rather than through medical services. Problems producing breast milk or breastfeeding were nearly universal complaints and suggest significant effects on infant health in the study area. These results present evidence to support the increasing consensus that depression presents in similar and disabling ways across cultures and contexts. This formative qualitative data is required to tailor depression prevention or treatment interventions to this particular socio-cultural context.

Parenting Skills and Emotional Availability: An RCT

OBJECTIVE

To investigate whether a responsive stimulation intervention delivered to caregivers of young children either alone or integrated with nutrition interventions would benefit parenting skills and emotional availability to promote children's development and growth compared with either a nutrition intervention alone or the usual standard of care.

METHODS

A cluster randomized factorial effectiveness trial was implemented in an impoverished community in Pakistan. The 4 trial arms were control (usual standard of care), responsive stimulation (responsive care and stimulation), enhanced nutrition (education and multiple micronutrients), and a combination of both enriched interventions. The 4 intervention packages were delivered by community health workers to 1489 mother-infant dyads in the first 2 years of life. Parenting skills and emotional availability indexed by mother-child interaction, caregiving environment, knowledge and practices pertaining to early childhood care and feeding, and maternal depressive symptoms were assessed at multiple intervals. An intention-to-treat factorial analysis was conducted.

RESULTS

Intervention groups were comparable at baseline. Responsive stimulation significantly benefitted parenting skills with large effect sizes on mother-child interaction (Cohen's d 0.8), caregiving environment (Cohen's d 0.9-1.0), and knowledge and practices (Cohen's d 0.7-1.1) compared with small-modest significant effects as a result of nutrition intervention on mother-child interaction and caregiving environment only (Cohen's d 0.4 and 0.2, respectively). The combined intervention had a small significant effect on decreasing maternal depressive symptoms over time (Cohen's d 0-0.2).

CONCLUSIONS

A responsive stimulation intervention can promote positive caregiving behaviors among impoverished families. Additional research is needed on interventions to reduce maternal depressive symptoms.

Are symptom features of depression during pregnancy, the postpartum period and outside the peripartum period distinct? Results from a nationally representative sample using item response theory (IRT)

BACKGROUND

Whether there are systematic differences in depression symptom expression during pregnancy, the postpartum period and outside these periods (i.e., outside the peripartum period) remains debated. The aim of this study was to use methods based on item response theory (IRT) to examine, after equating for depression severity, differences in the likelihood of reporting DSM-IV symptoms of major depressive episode (MDE) in women of childbearing age (i.e., aged 18-50) during pregnancy, the postpartum period and outside the peripartum period.

METHODS

We conducted these analyses using a large, nationally representative sample of women of childbearing age from the United States (n = 11,256) who participated in the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).

RESULTS

The overall 12-month prevalence of all depressive criteria (except for worthlessness/guilt) was significantly lower in pregnant women than in women of childbearing age outside the peripartum period, whereas the prevalence of all symptoms (except for "psychomotor symptoms") was not significantly different between the postpartum and the nonperipartum group. There were no clinically significant differences in the endorsement rates of symptoms of MDE by pregnancy status when equating for levels of depression severity.

CONCLUSIONS

This study suggests that the clinical presentation of depressive symptoms in women of childbearing age does not differ during pregnancy, the postpartum period and outside the peripartum period. These findings do not provide psychometric support for the inclusion of the peripartum onset specifier for major depressive disorder in the DSM-5.