Maternal depression in Latinas and child socioemotional development: A systematic review

Prenatal inflammation and trauma symptoms in Latina mothers: The role of discrimination and growing up in an ethnic minoritized context

Background

The race-based traumatic stress model proposes that discrimination elicits trauma-related symptoms. Cumulative discriminatory experiences and subsequent trauma symptoms may lead to prenatal inflammation, with far reaching consequences for the health of a mother and her child.

Methods

Latina mothers, primarily of Mexican and Central American heritage (n = 150), completed the Everyday Discrimination Scale and the Traumatic Avoidance subscale of the Inventory of Depression and Anxiety Symptoms-II during pregnancy (24-32 weeks). Plasma levels of cytokines were measured with multiplex assays, which were aggregated into a pro-inflammatory cytokine profile (IL-1β, TNF-α, IFN-γ, and IL-8) after a Confirmatory Factor Analysis supported this approach.

Results

Latina mothers who grew up in the US reported more discrimination, more traumatic avoidance symptoms, and had a more elevated cytokine profile than those who immigrated after childhood. Based on a two-mediator sequential model, discrimination and traumatic avoidance symptoms sequentially provided mechanistic support for the higher levels of cytokines observed in mothers who grew up in the US. Additionally, mothers who experienced trauma symptoms in response to discrimination had an elevated cytokine profile, whereas those who did not had a suppressed cytokine profile.

Conclusion

This is among the first studies to examine the association between trauma symptoms, discrimination, and inflammation during pregnancy. In so doing, it elucidates critical pathways by which discrimination may be differentially biologically embedded across immigrant generations. Emotional responses to and chronicity of discrimination may be critical factors for understanding how experiences of discrimination may influence the maternal inflammatory milieu.

I am Lifted Above the World: utilizing VR for stress reduction among perinatal women of color

Background

Perinatal mental health conditions affect 800,000 individuals annually in the United States and are a leading cause of complications in pregnancy and childbirth. However, the impact of these conditions varies across racial and ethnic groups. Portable digital solutions, such as mobile apps, have been developed for maternal mental health, but they often do not adequately cater to the needs of women of color. To ensure the effectiveness and equity of these interventions, it is crucial to consider the unique experiences of perinatal women from diverse racial backgrounds. This qualitative study aims to explore the complex aspects of motherhood, maternal mental well-being, and resilience among perinatal women of color. It also investigates the factors that either hinder or facilitate the use of Virtual Reality (VR) for stress management in this specific demographic.

Methods

This research involves two focus groups comprising perinatal women, primarily identifying as Black or Latina, enrolled in the ongoing Nurturing Moms study at the University of Miami Miller School of Medicine. Additionally, feedback is collected from five different participants. The study assesses Nurture VR™, a VR-based program integrating mindfulness techniques, relaxation exercises, and guided imagery for pregnancy and postpartum.

Results

Qualitative analysis uncovers five primary themes and 19 sub-themes, addressing the complexities of motherhood, maternal mental health, attitudes towards VR therapy, postpartum care, and the perception of resilience. Participants share challenges related to household management, caregiving, financial stress, breastfeeding, relaxation, sleep, and the significance of social support. Their preferences and reservations regarding VR therapy are also expressed.

Conclusion

This study sheds light on the diverse struggles and obstacles faced by women of color during and after pregnancy, with potential repercussions for their mental and sleep health. It underscores the need for mental health screening and analysis of maternal stress-related sleep issues, in addition to the facilitation of social support in maternal health programs. Additionally, it highlights the promise of culturally responsive behavioral treatments, including VR interventions, in offering timely and tailored mental health support to perinatal women, taking into account their intersectional identities.

Developmental trajectories of internalizing distress among ethnic minoritized mothers following childbirth: Associations with early child psychological adjustment

A substantial body of work has established that mothers' internalizing distress can negatively affect children's socioemotional development. Yet few studies have examined how distinct patterns of mothers' distress over time differentially impact child behaviors across early childhood. To address this gap, the current study explored developmental trajectories of mothers' internalizing distress and examined the associations of these patterns with child adjustment outcomes. Mexican immigrant, Dominican immigrant, and African American mothers (N = 272) were annually assessed for internalizing distress over the first 6 years following childbirth. Children's psychological adjustment (internalizing, externalizing, and hyperactivity behaviors) was measured at the last yearly assessment in first grade. A growth mixture model revealed two distinct classes of distress where mothers were classified as having low stable distress (82.4%) or moderate distress that began as stable then declined when their children were 64 months old (17.6%). Children of mothers in the moderate, late decline class showed greater internalizing, externalizing, and hyperactivity behaviors in the first grade compared to children of mothers in the low stable class. Findings highlight the necessity of supporting the mental health of ethnic minoritized mothers following childbirth and further expand our knowledge of family psychopathology to promote healthy psychological adjustment in children.

Household Social Needs, Emotional Functioning, and Stress in Low-Income Latinx Children and their Mothers

Latinx families may be particularly vulnerable to emotional dysfunction, due to higher rates of economic hardship and complex social influences in this population. Little is known about the impact of environmental stressors such as unmet social needs and maternal stress on the emotional health of Latinx children from low-income families. We conducted secondary analyses using survey and biomarker data from 432 Latinx children and mothers collected in a separate study. We used binomial and multinomial logistic regression to test if household social needs, or maternal perceived stress or hair cortisol concentration (HCC), predicted child measures of emotional functioning or child HCC, independent of relevant sociodemographic factors. Approximately 40% of children in the sample had symptoms consistent with emotional dysfunction, and over 37% of households reported five or more social needs. High perceived maternal stress predicted higher odds of child emotional dysfunction (OR = 2.15; 95% CI [1.14, 4.04]; p = 0.01), and high maternal HCC was positively associated with high child HCC (OR = 10.60; 95% CI [4.20, 26.74]; p < 0.01). Most individual household social needs, as well as the level of household social need, were not independently associated with child emotional dysfunction or child HCC. Our findings begin to define a framework for understanding emotional health, stress, and resilience when caring for Latinx children and mothers living with high levels of social need, and the need for integrated mental health and social needs screening and interventions in settings that serve this population.

The effect of the COVID-19 pandemic on infant development and maternal mental health in the first 2 years of life

We investigated how exogenous variation in exposure to the COVID-19 pandemic during the first year of life is related to infant development, maternal mental health, and perceived stress. Ninety-three socioeconomically diverse pregnant women were recruited before the pandemic to participate in a longitudinal study. Infants ranged in age at the beginning of lockdown (0-9.5 months old), thus experiencing different durations of pandemic exposure across the first year of life. The duration of pandemic exposure was not associated with family demographic characteristics, suggesting it captured exogenous variability. We tested associations between this exogenous variation in pandemic exposure and child and family outcomes. We also examined whether mother-reported disruptive life events were correlated with child and family outcomes. We found no association between duration of pandemic exposure in the first year of life and infant socioemotional problems, infant language development, or maternal mental health and perceived stress symptoms, at 12 or 24 months. However, we found that self-reported exposure to pandemic-related disruptive life events predicted greater maternal depression, anxiety, and perceived stress at 12 months, and greater depression and anxiety at 24 months. Socioeconomic status did not moderate these associations. These findings suggest cautious optimism for infants raised during this period.

Association of Exposure to Intimate Partner Violence With Maternal Depressive Symptoms and Early Childhood Socioemotional Development Among Mothers and Children in Rural Tanzania

IMPORTANCE

Approximately 1 in 4 women experience intimate partner violence (IPV) or nonpartner sexual violence during their lifetime. Mothers exposed to IPV are more likely to experience depressive symptoms and to discipline their children harshly, which may affect their children's socioemotional development; however, there is limited evidence on these outcomes.

OBJECTIVE

To examine the association between IPV, maternal depressive symptoms, harsh child discipline, and child stimulation with child socioemotional development.

DESIGN, SETTING, AND PARTICIPANTS

This study used cross-sectional follow-up data collected from February 19 to October 10, 2014, from a birth cohort of children aged 18 to 36 months who were enrolled in a randomized, double-blind, placebo-controlled trial of neonatal vitamin A supplementation in the Morogoro region of Tanzania. Data analysis occurred between September 10, 2019, and January 20, 2020.

EXPOSURES

Lifetime experience of IPV was assessed using an abbreviated module of the Tanzania Demographic and Health Survey, maternal depressive symptoms were assessed with the Patient Health Questionnaire, and data on harsh child discipline and maternal stimulation of their children were collected using modules of the United Nations Children's Fund Multiple Indicator Cluster Survey.

MAIN OUTCOMES AND MEASURES

Child socioemotional development was measured by the Caregiver-Reported Early Childhood Development Instruments.

RESULTS

A total of 981 mother-child dyads were included in the analytic sample; 388 children (39.6%) were between ages 18 and 24 (mean [SD] age, 27.06 [6.08]) months, and 515 (52.5%) were male children. A negative association was observed between maternal report of physical IPV only (mean difference, -0.022; 95% CI, -0.045 to -0.006) and physical and sexual IPV (mean difference, -0.045; 95% CI, -0.077 to -0.013) with child socioemotional scores, but neither was statistically significant after including depressive symptoms in the model, which is consistent with mediation. Furthermore, a negative association was observed between maternal mild to severe depressive symptoms and child socioemotional development, including adjustment for IPV (mean difference, -0.073; 95% CI, -0.103 to -0.043). Harsh disciplinary practices and stimulation were not associated with child socioemotional development after adjusting for IPV, maternal depressive symptoms, and other factors.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that maternal depressive symptoms may explain the negative association between IPV and child socioemotional development.

Family environment characteristics and sleep duration in children: Maternal mental health as a mediator

BACKGROUND

Family environment is a key factor affecting children's health. However, little is known about whether and how the family environment affects sleep duration in children. This study investigated the effects of both physical and social characteristics of the family environment on sleep duration in children and determined whether these associations were mediated by maternal mental health.

METHODS

Data were obtained from the Taiwan Birth Cohort Study. A total of 19,400 children who completed 6-month, 18-month, 3-year, 5.5-year, and 8-year surveys were analyzed. The physical family environment characteristics were household crowding and housing quality. Family functioning was used as an indicator of family social environment. Multiple linear regression and path analysis were performed to test the hypotheses.

RESULTS

The children living in crowded households had shorter sleep durations (β = -0.03, p < .001). Superior housing quality and family functioning were associated with longer sleep durations (β = 0.04 and 0.02, respectively, ps < .01). The effects of housing quality and family functioning on sleep duration were mediated by maternal mental health.

CONCLUSIONS

Both physical and social characteristics of the family environment are critical to sleep duration in children. The effects of family environment characteristics on sleep duration in children are in part mediated by maternal mental health. Interventions to improve sleep during childhood by targeting the family environment may be more effective when maternal mental health is considered.

A storyboarding approach to train school mental health providers and paraprofessionals in the delivery of a strengths-based program for Latinx families affected by maternal depression

Mental health professionals in schools and the community are often overburdened and underfunded in high-need areas, limiting their capacity to deliver needed family-based mental health interventions. To address this issue, paraprofessional school personnel (e.g., family engagement liaisons) can facilitate these family-based mental health interventions alongside licensed mental health professionals, thereby increasing access to mental health services for families with mental health needs. To train professional and paraprofessional school personnel in maternal depression and interventions, we used storyboarding, a narrative storytelling method traditionally used to create films. Latinx families who had previously participated in a family-focused program for maternal depression shared real life stories focused on themes of (a) maternal depression, (b) impact on children, (c) cultural views and role of immigration, (d) self-harm and suicide, and (e) what families need. In this conceptual paper, we describe our engagement of families in a multistep process of storyboarding that resulted in video modules of family stories for a training website and in-person workshop for school professionals and paraprofessionals. We conclude with how community-engaged tools such as storyboarding can be used to increase awareness and reduce stigma of maternal depression among staff training to deliver family-focused mental health programs in schools.

Association between maternal depression and emotion and behavior regulation in Peruvian children: a population-based study

Depression is more frequent in women, affecting the early stages of child development. This study aimed to determine the association between maternal depression and self-regulation of emotions and behaviors in Peruvian children under five years. A cross-sectional analytical study of data collected by the 2019 Demographic and Family Health Survey (ENDES) was conducted. The outcome variable was emotion and behavior regulation in children aged 24 to 59 months, and exposure was the presence of depression in women aged 15 to 49 years during the 14 days prior to the survey using the Patient Health Questionnaire (PHQ-9). A generalized linear model of the binomial family was used for reporting crude prevalence ratios and adjusted. The overall prevalence of children who did not self-regulate their emotions and behaviors was 68.8%, while 3.8% of the mothers had moderate depressive symptoms and 2.2% severe symptoms. Regarding the association of interest, moderate and severe depressive symptoms of mothers decreased the probability of children regulating emotions and behaviors in the first model, whereas in the second model, an association was only found with severe depressive symptoms. In conclusion, children of mothers with moderate and severe depressive symptoms had a lower probability of self-regulating their emotions and behaviors. Therefore, it is necessary to develop maternal education, nutritional and social support programs and mental health strategies from the first level of care aimed at reducing social, economic and child factors to reduce the risk of depression in mothers and low early childhood development, which could reduce the risk of developing mental health disorders in adolescence and adulthood.

Systemic inequities and depressive symptomology in Hispanic mothers: A path analysis model

BACKGROUND

Hispanic mothers are one of the largest groups to give birth. They also experience high rates of morbidity and mortality; however, there is limited data related to their health inequities.

PURPOSE

The purpose of this study was to evaluate systemic inequities associated with discrimination using the Reproductive Justice Framework to observe factors that influenced depressive symptomology in Hispanic women.

METHODS

A path analysis was conducted to evaluate systemic inequities that influenced postpartum depression using the public database, Listening to Mothers III (LMIII). The sub-sample consisted of n = 406 Hispanic mothers. Data was initially collected between the years 2011 and 2013.

RESULTS

Hispanic mothers were more likely to experience occurrences of perceived discrimination while seeking perinatal healthcare. These occurrences of discrimination led to lower trust in their healthcare providers, lower satisfaction with care, more instances of unwanted medical procedures, the need to feel to hold back comments about their health which ultimately resulted in higher rates of self-reported postpartum depression. The model fit indices supported the model's plausibility (χ² /df ratio = 3.16, Comparative Fit Index = 0.91, Root Mean Square Error of Approximation = 0.06).

CONCLUSIONS

This data supported our hypothesis that the pathway of discriminatory barriers Hispanic mothers experience during pregnancy influence postpartum depression.

The Health of Hispanic Children from Birth to Emerging Adulthood

This article summarizes frameworks for understanding Hispanic children's health, sources of national data available to evaluate their health, and variations in health among Hispanic children. Following ecological and life-course perspectives, we organize our review of the literature on Hispanic children's health and development according to three key stages of child development (zero to three, early to middle childhood, and adolescence to emerging adulthood) with attention to how each stage influences the next. Within each stage, we consider how social position (i.e. skin color, social class, gender, and nativity), social contexts (i.e. family, school, and neighborhood), and political and legal contexts influence Hispanic children's health and development. To improve the health and development of Hispanic children, federal, state, and local policies must address social and economic injustices that lead to declines in health across immigrant generations and persistent racial/ethnic health disparities.

Maternal post-traumatic stress and depression symptoms and outcomes after NICU discharge in a low-income sample: a cross-sectional study

Background

Having a preterm newborn and the experience of staying in the neonatal intensive care unit (NICU) has the potential to impact a mother’s mental health and overall quality of life. However, currently there are few studies that have examined the association of acute post-traumatic stress (PTS) and depression symptoms and infant and maternal outcomes in low-income populations.

Design/ methods

In a cross-sectional study, we examined adjusted associations between positive screens for PTS and depression using the Perinatal Post-traumatic stress Questionnaire (PPQ) and the Patient Health-Questionnaire 2 (PHQ-2) with outcomes using unconditional logistic and linear regression models.

Results

One hundred sixty-nine parents answered the questionnaire with 150 complete responses. The majority of our sample was Hispanic (68%), non-English speaking (67%) and reported an annual income of <$20,000 (58%). 33% of the participants had a positive PPQ screen and 34% a positive PHQ-2 screen. After adjusting for confounders, we identified that a positive PHQ-2 depression score was associated with a negative unit (95% CI) change on the infant’s Vineland Adaptive Behavior Scales, second edition of − 9.08 (− 15.6, − 2.6) (p < 0.01). There were no significant associations between maternal stress and depression scores and infant Bayley Scales of Infant Development III scores or re-hospitalizations or emergency room visits. However, positive PPQ and screening score were associated with a negative unit (95% CI) unit change on the maternal Multicultural Quality of Life Index score of − 8.1 (− 12, − 3.9)(p < 0.01) and − 7.7 (− 12, − 3) (p = 0.01) respectively.

Conclusions

More than one-third of the mothers in this sample screened positively for PTS and depression symptoms. Screening scores positive for stress and depression symptoms were associated with a negative change in some infant development scores and maternal quality of life scores. Thoughtful screening programs for maternal stress and depression symptoms should be instituted.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-020-03536-0.

Pregnancy associated epigenetic markers of inflammation predict depression and anxiety symptoms in response to discrimination

Latina mothers, who have one of the highest fertility rates among ethnic groups in the United States (US), often experience discrimination. Psychosocial influences during pregnancy, such as discrimination stress, promotes inflammation. However, the role of epigenetic markers of inflammation as a mediator between, and predictor of, maternal discrimination stress and neuropsychiatric outcomes has not been extensively studied. The current study investigates the role of DNA methylation at FOXP3 Treg-cell-specific demethylated region (TSDR), as a marker of regulatory T (Treg) cells that are important negative regulators of inflammation, and the promoter of tumour necrosis factor-alpha (TNF-α) gene, an important pro-inflammatory cytokine, in relation to discrimination stress during pregnancy and depression and anxiety symptomatology.

A sample of 148 Latina women residing in the US (mean age 27.6 years) were assessed prenatally at 24–32 weeks’ gestation and 4–6 weeks postnatally for perceived discrimination exposure (Everyday Discrimination Scale, EDS), emotional distress (depression, anxiety, perinatal-specific depression), acculturation, and acculturative stress. DNA methylation levels at the FOXP3 and TNFα promoter regions from blood samples collected at the prenatal stage were assessed by bisulphite pyrosequencing.

Regression analyses showed that prenatal EDS associated with postnatal emotional distress, depression and anxiety symptoms only in those individuals with higher than mean levels of FOXP3 TSDR and TNFα promoter methylation; no such significant associations were found in those with lower than mean levels of methylation for either. We further found that these relationships were mediated by TNFα only in those with high FOXP3 TSDR methylation, implying that immunosuppression via TNFα promoter methylation buffers the impact of discrimination stress on postpartum symptomatology. These results indicate that epigenetic markers of immunosuppression and inflammation play an important role in resilience or sensitivity, respectively, to prenatal stress.