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Badon SE, Oberman N, Ramsey M, Quesenberry CP, Kurtovich E, Gomez Chavez L, Brown SD, Albright CL, Bhalala M, Avalos LA. Effect of a Tailored eHealth Physical Activity Intervention on Physical Activity and Depression During Postpartum: Randomized Controlled Trial (The Postpartum Wellness Study). JMIR Ment Health 2025; 12:e64507. [PMID: 40403143 PMCID: PMC12121695 DOI: 10.2196/64507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 03/20/2025] [Accepted: 03/25/2025] [Indexed: 05/24/2025] Open
Abstract
Background Strong evidence suggests physical activity (PA) can ameliorate postpartum depression (PPD) symptoms; however, many postpartum individuals do not meet PA guidelines. Electronic health (eHealth) interventions are a promising approach to address common barriers to PA during postpartum. Objective To test the effectiveness of a tailored eHealth PA intervention for increasing PA and decreasing depressive symptoms in individuals at high risk for PPD. Methods We conducted a randomized controlled trial within the Kaiser Permanente Northern California integrated health care delivery system. From November 2020 to September 2022, individuals 2-6 months postpartum at high risk for PPD were randomized to an eHealth PA intervention (n=50) or usual care (n=49). The eHealth PA intervention group received access to an online library of 98 ten-minute workout videos developed for postpartum individuals, including interaction with their infants. At baseline, 3 months, and 6 months postrandomization, surveys were used to assess depressive symptoms, PA, sleep quality, anxiety symptoms, perceived stress, and mother-infant bonding. PA was also measured using a wrist-worn accelerometer for 7 days at each timepoint. Primary outcomes were depressive symptoms and device-measured moderate-to-vigorous intensity PA (dm-MVPA) at 3 months postrandomization. Secondary outcomes were self-reported MVPA (sr-MVPA) at 3 and 6 months postrandomization and depressive symptoms and dm-MVPA at 6 months postrandomization. Intent-to-treat and modified intent-to-treat (excluding participants in the intervention group who did not watch at least 1 video) analyses were conducted using linear regression adjusted for variables used in the randomization procedure and using multiple imputation to account for missing data. Results Participants were 4 months postpartum at baseline with moderately severe depressive symptoms (mean PHQ-8 [Patient Health Questionnaire-8] score=12.6), on average. Intent-to-treat analyses indicated no association between the intervention and change in depressive symptoms (mean difference=-0.9; 95% CI -3.3 to 1.5), dm-MVPA per day (mean difference=-4.5 minutes; 95% CI -23.5 to 14.5), or sr-MVPA per week (mean difference=3.8; 95% CI -1.9 to 9.5) at 3 months postrandomization or 6 months postrandomization (depressive symptoms: mean difference=-1.3; 95% CI -3.7 to 1.1; dm-MVPA: mean difference=1.3 minutes; 95% CI -18.9 to 21.5; sr-MVPA: mean difference=-1.8 MET-hours; 95% CI -7.7 to 4.2). Engagement with the intervention was suboptimal; although 52% (n=26) of participants allocated to the intervention group logged on to the intervention website and watched at least 1 video, the median minutes watched per week peaked at 10 minutes 2 weeks postrandomization, then fell to zero for the rest of the follow-up period. Results from modified intent-to-treat analyses were similar to those from intent-to-treat analyses. Conclusions An eHealth PA intervention tailored to postpartum individuals did not affect depressive symptoms or PA among those at high risk for PPD. Additional research to develop effective and engaging PA interventions is needed to help alleviate PPD symptoms and decrease PPD risk.
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Affiliation(s)
- Sylvia E Badon
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
| | - Nina Oberman
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
| | - Maya Ramsey
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
| | - Charles P Quesenberry
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
| | - Elaine Kurtovich
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
| | - Lizeth Gomez Chavez
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
| | - Susan D Brown
- School of Medicine, University of California Davis, Davis, CA, United States
| | | | - Mibhali Bhalala
- Redwood City Medical Center, Kaiser Permanente Northern California, Redwood City, CA, United States
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, 4480 Hacienda Dr, Pleasanton, CA, 94588, United States, 1 4152646944
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Kurbatfinski S, Ntanda H, Mullin J, Dewey D, Leung BMY, Letourneau N. Are Children's Externalizing and Internalizing Behaviours at 5 Years Predicted by Maternal Perinatal Depression Trajectory Profiles? CHILDREN (BASEL, SWITZERLAND) 2025; 12:535. [PMID: 40426714 PMCID: PMC12110483 DOI: 10.3390/children12050535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2025] [Revised: 04/15/2025] [Accepted: 04/17/2025] [Indexed: 05/29/2025]
Abstract
Background/Objectives: Mothers' depressive symptoms are associated with their children's internalizing and externalizing behavioural problems. Because mothers' depressive symptoms can vary across the prenatal and postnatal periods, considering their trajectories is important when predicting children's behavioural problems. The purposes of this study were to: (1) identify profiles of mothers characterized by their prenatal and postnatal (up to 3 years postpartum) depressive symptom trajectories and (2) examine the associations between maternal depressive symptom profile trajectories and preschool children's internalizing and externalizing behavioural problems at 5 years of age. Methods: This study used data derived from the APrON Study. The Edinburgh Postnatal Depression Scale measured mothers' depressive symptoms in early (<27 weeks) and late (≥27 weeks) pregnancy and at 3, 6, 12, 24, and 36 months postpartum. The Behavioural Assessment Scales for Children, 2nd Edition, quantified children's internalizing and externalizing problems at approximately 60 months of age. Non-growth latent profile analysis determined the most suitable and parsimonious number of maternal depressive symptom profiles, and linear regression analysis quantified their associations with their 5-year-old-children's behavioural problems. Results: A three-profile structure characterized maternal depressive symptom trajectories: minimal, subclinical, and high. Unadjusted (n = 704) and adjusted (n = 621) analyses showed that: 1) mothers' subclinical and high depressive symptom profiles (p < 0.01) predicted children's internalizing problems and 2) mothers' subclinical depressive symptom profiles (p < 0.01) predicted externalizing problems. Conclusions: Maternal subclinical depressive symptoms were equally, if not more, important compared to high depressive symptoms in predicting children's behavioural problems. Overlooking mothers with subclinical depressive symptoms could have implications for their children's behavioural/mental health.
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Affiliation(s)
- Stefan Kurbatfinski
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (H.N.); (J.M.); (D.D.)
| | - Henry Ntanda
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (H.N.); (J.M.); (D.D.)
| | - Jackson Mullin
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (H.N.); (J.M.); (D.D.)
| | - Deborah Dewey
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (H.N.); (J.M.); (D.D.)
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Brenda M. Y. Leung
- Faculty of Health Sciences, University of Lethbridge, Lethbridge, AB T1K 3M4, Canada;
| | - Nicole Letourneau
- Alberta Children’s Hospital Research Institute, Owerko Centre, Calgary, AB T2N 1N4, Canada; (H.N.); (J.M.); (D.D.)
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB T2N 1N4, Canada
- Departments of Pediatrics, Psychiatry and Community Health Sciences, Faculty of Nursing, Cumming School of Medicine, Alberta Children’s Hospital Research Institute, Owerko Centre, University of Calgary, Calgary, AB T2N 1N4, Canada
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Braddon A, Alati R, Betts KS. Examining the association between maternal prenatal psychiatric disorders and behavioural problems among offspring in early childhood: population-based study. BJPsych Open 2025; 11:e18. [PMID: 39819471 PMCID: PMC11795177 DOI: 10.1192/bjo.2024.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 11/13/2024] [Accepted: 11/16/2024] [Indexed: 01/19/2025] Open
Abstract
BACKGROUND Exposure to maternal mental illness during foetal development may lead to altered development, resulting in permanent changes in offspring functioning. AIMS To assess whether there is an association between prenatal maternal psychiatric disorders and offspring behavioural problems in early childhood, using linked health administrative data and the Australian Early Development Census from New South Wales, Australia. METHOD The sample included all mother-child pairs of children who commenced full-time school in 2009 in New South Wales, and met the inclusion criteria (N = 69 165). Univariable logistic regression analysis assessed unadjusted associations between categories of maternal prenatal psychiatric disorders with indicators of offspring behavioural problems. Multivariable logistic regression adjusted the associations of interest for psychiatric categories and a priori selected covariates. Sensitivity analyses included adjusting the final model for primary psychiatric diagnoses and assessing association of interest for effect modification by child's biological gender. RESULTS Children exposed in the prenatal period to maternal psychiatric disorders had greater odds of being developmentally vulnerable in their first year of school. Children exposed to maternal anxiety disorders prenatally had the greatest odds for behavioural problems (adjusted odds ratio 1.98; 95% CI 1.43-2.69). A statistically significant interaction was found between child biological gender and prenatal hospital admissions for substance use disorders, for emotional subdomains, aggression and hyperactivity/inattention. CONCLUSIONS Children exposed to prenatal maternal mental illness had greater odds for behavioural problems, independent of postnatal exposure. Those exposed to prenatal maternal anxiety were at greatest risk, highlighting the need for targeted interventions for, and support of, families with mental illness.
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Affiliation(s)
- Amy Braddon
- School of Population Health, Curtin University, Australia
| | - Rosa Alati
- School of Population Health, Curtin University, Australia
| | - Kim S. Betts
- School of Population Health, Curtin University, Australia
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Raouna A, Girard LC, MacBeth A. Modelling the associations between parental depressive symptoms, hypomanic traits, and infant socio-emotional development: The mediating role of parental reflective functioning. J Affect Disord 2025; 369:995-1003. [PMID: 39447976 DOI: 10.1016/j.jad.2024.10.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/27/2024] [Accepted: 10/20/2024] [Indexed: 10/26/2024]
Abstract
BACKGROUND Although understanding of maternal hypomania in the postpartum period is gradually improving, the intergenerational pathways of risk associated with hypomania in the context of postpartum depression remain unknown. It is also unclear whether distinct or shared pathways of risk exist for infants exposed to different parental mood characteristics and whether these pathways are mediated by parental reflective functioning. METHODS An online survey was administered to 1788 parents (89 % mothers, 50 % White) who were primary caregivers of a child under 2. Structural equation modelling techniques were employed to model direct and indirect associations between parental depressive symptoms, hypomanic traits and infant socio-emotional development, investigating the mediating role of parental reflective functioning. RESULTS Elevated levels of parental depressive symptoms, in the presence of hypomanic personality traits, were directly associated with infant socio-emotional challenges, without affecting parental reflective functioning. However, higher levels of parental hypomanic traits in the postnatal period displayed a fully mediated pathway of risk transmission to infants' socio-emotional development via their negative association with parental reflective functioning. LIMITATIONS Results should be interpreted with caution as the reliance on self-and-parent-reported scales may have introduced biases influenced by individual perceptions and situational factors. Additionally, the cross-sectional design of this study inhibits establishing cause-and-effect relationships. CONCLUSIONS Overall, these results highlight the critical role of both parental depressive symptoms and hypomanic traits on infant socio-emotional development, suggesting that supporting parental mood regulation and mentalizing abilities in the postnatal period could reduce the risk of early maladaptive socio-emotional trajectories in children.
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Affiliation(s)
- Aigli Raouna
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Teviot Place, EH8 9AG Edinburgh, United Kingdom.
| | - Lisa-Christine Girard
- Department of Special Needs Education, University of Oslo, Sem Særlands vei Helga Engshus, 0371 Oslo, Norway
| | - Angus MacBeth
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Medical School (Doorway 6), Teviot Place, EH8 9AG Edinburgh, United Kingdom
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Vitte L, Nakić Radoš S, Lambregtse-van den Berg M, Devouche E, Apter G. Peripartum Depression: What's New? Curr Psychiatry Rep 2025; 27:31-40. [PMID: 39625603 DOI: 10.1007/s11920-024-01573-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/25/2024] [Indexed: 01/12/2025]
Abstract
PURPOSE OF THE REVIEW Peripartum depression (PPD), including both depression during pregnancy and postpartum, is the most frequent health disorder during the perinatal period. It is a significant public health issue in many countries due to its prevalence and its impact on women, as well as on their partners and offspring. Here, we will attempt to untangle the most recent studies and publications, considering what it is essential to know in 2024 about PPD as a specific perinatal issue. RECENT FINDINGS PPD appears to be a very heterogeneous disorder in which a complex interplay between different factors contributes to its pathophysiology. Thus, the need to enhance diagnosis and referral through a better understanding of its severity and co-morbidities has emerged as a major public health issue. Indeed, research has consistently shown that PPD negatively impacts parent-infant interactions and infants' cognitive, social, and emotional development. Evidence underlining its global risk has accumulated over the past three decades, but many questions remain, including how these vulnerable offspring developmental trajectories unfold.
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Affiliation(s)
- Lisa Vitte
- Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, University Rouen Normandy, Le Havre, France
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Paris, France
| | - Sandra Nakić Radoš
- University Department of Psychology, Catholic University of Croatia, Ilica 244, 10000, Zagreb, Croatia
| | - Mijke Lambregtse-van den Berg
- Departments of Psychiatry and Child & Adolescent Psychiatry, Erasmus University Medical Center, 3015 GD, Rotterdam, The Netherlands
| | - Emmanuel Devouche
- Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, University Rouen Normandy, Le Havre, France.
- Laboratoire de Psychopathologie et Processus de Santé (LPPS UR 4057), Université Paris Cité, Paris, France.
| | - Gisèle Apter
- Service Universitaire de Pédopsychiatrie, Hospital Group Du Havre, University Rouen Normandy, Le Havre, France
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Suffel AM, Carreira H, Walker J, Grint D, Osborn D, McDonald HI, Warren-Gash C. The association of maternal mental health with vaccination coverage and timeliness in early childhood - A historical cohort study in England using electronic health records. Vaccine 2025; 43:126529. [PMID: 39566366 DOI: 10.1016/j.vaccine.2024.126529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 11/08/2024] [Accepted: 11/08/2024] [Indexed: 11/22/2024]
Abstract
BACKGROUND Maternal mental illness (MMI) affects almost a quarter of mothers and may impact a child's development and physical health. It remains unclear whether MMI is associated with altered utilization of vaccination services. Understanding this association could help to identify families in need of additional support. METHODS Using primary care data from England, we conducted a historical cohort study of 397,519 children born in England between 2006 and 2014 with linked maternal records. Associations between different types of MMI (common mental disorders, severe mental illness and alcohol and substance use disorder) with childhood immunisation were explored using logistic regression for differences in coverage and accelerated failure time models for differences in timeliness before the child's fifth birthday. RESULTS While there were no differences in vaccination coverage at the age of one, children of mothers with common mental disorders had lower odds of being vaccinated at the ages of two (OR 0.95, 95 %CI: 0.93-0.98) and five (OR 0.86, 95 % CI 0.84-0.89) in comparison to children of mothers with no record of MMI. Vaccination coverage was even lower for children of mothers with comorbid substance disorder and common mental disorder (OR 0.70, 95 % CI: 0.62-0.78 at the age of five). There were no significant differences in timeliness of vaccine receipt by MMI. CONCLUSIONS Inequalities in vaccination coverage associated with MMI grow with increasing age of the child. Extending support services for women with MMI beyond the child's first year of life could offer potential to improve vaccination uptake and reduce childhood infections.
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Affiliation(s)
- Anne M Suffel
- NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine, London, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
| | - Helena Carreira
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jemma Walker
- NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Daniel Grint
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - David Osborn
- Department of Psychiatry, University College London, United Kingdom; Camden and Islington NHS Foundation Trust, United Kingdom
| | - Helen I McDonald
- NIHR Health Protection Research Unit in Immunisation at the London School of Hygiene and Tropical Medicine, London, United Kingdom; Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom; Department of Life Science, University of Bath, United Kingdom
| | - Charlotte Warren-Gash
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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MacBeth A, Christie H, Golds L, Morales F, Raouna A, Sawrikar V, Gillespie-Smith K. Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health. Psychol Psychother 2024; 97 Suppl 1:1-15. [PMID: 37534856 DOI: 10.1111/papt.12483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the 'First 1000 Days' from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches. AIMS AND METHODS In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health. RESULTS We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health. DISCUSSION Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.
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Affiliation(s)
- Angus MacBeth
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Hope Christie
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lisa Golds
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Francisca Morales
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Aigli Raouna
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Vilas Sawrikar
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Bliznashka L, Nwabuikwu O, Ahun M, Becker K, Nnensa T, Roschnik N, Kachinjika M, Mvula P, Munthali A, Ndolo V, Katundu M, Maleta K, Quisumbing A, Gladstone M, Gelli A. Understanding modifiable caregiver factors contributing to child development among young children in rural Malawi. MATERNAL & CHILD NUTRITION 2024; 20:e13698. [PMID: 38960410 PMCID: PMC11574655 DOI: 10.1111/mcn.13698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/23/2024] [Accepted: 06/23/2024] [Indexed: 07/05/2024]
Abstract
This study examined modifiable caregiver factors influencing child development in Malawi using baseline data from 1,021 mothers and their children <2 years of age participating in a cluster-randomized controlled trial implemented in rural Malawi (2022-2025). We fit an evidence-based theoretical model using structural equation modelling examining four caregiver factors: (1) diet diversity (sum of food groups consumed in the past 24 h), (2) empowerment (assessed using the project-level Women's Empowerment in Agriculture Index), (3) mental health (assessed using the Self-Reported Questionnaire, SRQ-20), and (4) stimulation (number of stimulation activities the mother engaged in the past 3 days). Child development was assessed using the Malawi Development Assessment Tool (norm-referenced aggregate Z-score). The model controlled for child, caregiver, and household socioeconomic characteristics. Results showed that caregiver dietary diversity was directly associated with higher child development scores (standardized coefficient 0.091 [95% CI 0.027, 0.153]) and lower SRQ-20 scores -0.058 (-0.111, -0.006). Empowerment was directly associated with higher child development scores (0.071 [0.007, 0.133]), higher stimulation score (0.074 [0.013, 0.140]), higher dietary diversity (0.085 [0.016, 0.145]), and lower SRQ-20 scores (-0.068 [-0.137, -0.002]). Further, higher empowerment was indirectly associated with improved child development through enhancement of caregiver dietary diversity, with an indirect effect of 0.008 (0.002, 0.018). These findings highlight the important role that caregiver diet and empowerment play in directly influencing child development and other aspects of caregiver well-being. Interventions aimed at enhancing child development should consider these factors as potential targets to improve outcomes for children and caregivers.
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Affiliation(s)
- Lilia Bliznashka
- International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
- Global Academy of Agriculture and Food SystemsUniversity of EdinburghEdinburghScotland
| | - Odiche Nwabuikwu
- International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Marilyn Ahun
- Department of MedicineMcGill UniversityMontréalCanada
| | - Karoline Becker
- Department of International DevelopmentUniversity of OxfordOxfordUK
| | - Theresa Nnensa
- Department of Nutrition and DieteticsKamuzu University of Health SciencesBlantyreMalawi
| | | | | | | | | | - Victoria Ndolo
- Department of Human EcologyUniversity of MalawiZombaMalawi
| | | | - Kenneth Maleta
- Department of Nutrition and DieteticsKamuzu University of Health SciencesBlantyreMalawi
| | - Agnes Quisumbing
- International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
| | - Melissa Gladstone
- Department of Women and Children's Health, Institute of Translational MedicineUniversity of LiverpoolLiverpoolUK
| | - Aulo Gelli
- International Food Policy Research InstituteWashingtonDistrict of ColumbiaUSA
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Abdullah MA, Shaikh BT, Sattar NY, Sarwar B, Ahmed AS, Fatima SS. Are social determinants associated with depression among married women of reproductive age? A mixed methods study from urban slums of Islamabad, Pakistan. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0003463. [PMID: 39042607 PMCID: PMC11265670 DOI: 10.1371/journal.pgph.0003463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 07/02/2024] [Indexed: 07/25/2024]
Abstract
Depression among married women of reproductive age is on the rise in Pakistan, owing to post-COVID-19 phase, super-inflation, increasing poverty, deteriorating law and order situation and perpetuating the uncertain political situation in the country. This study aimed to investigate the factors associated with depression among married women of reproductive age in Pakistan, using a mixed methods approach. The quantitative phase utilized the Urdu version of the Patient Health Questionnaire-9 (PHQ-9) to assess depression among 340 married women. Twelve women with higher scores on the PHQ-9 were selected for in-depth interviews in the qualitative phase. The quantitative analysis revealed a higher prevalence of depression among women with poor socioeconomic status, lower educational levels, larger family sizes, and recent deaths in the family. In the qualitative phase, the main themes identified were the impact of social conditions, such as societal expectations and gender roles, the influence of medical conditions on mental health, financial difficulties, the stress associated with caring for a larger number of children, and the emotional burden of recent deaths in the family. This study highlights the importance of addressing depression among married women of reproductive age in Pakistan. It is crucial to focus on early diagnosis and prompt treatment to mitigate the adverse effects of depression on the affected individuals and their families. Targeted interventions should consider the social determinants of depression, including improving socioeconomic conditions through safety nets, providing mental health support at the primary health care level, and addressing the specific health issues and needs of women in the reproductive age group. A multi-pronged approach and health system's thinking can reduce the burden of depression among women, ultimately enhancing their overall well-being, productivity and quality of life.
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Affiliation(s)
| | | | | | - Balaj Sarwar
- Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan
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