The positive impact of maternal depression intervention on children's emotional and behavioral symptoms in a low-resource setting

Abstract

Objectives: Children of depressed mothers are at risk of developing mental health problems. We sought to determine whether treatment for maternal depression by community-based health workers would decrease behavioral/emotional symptoms in their children. Interventions for maternal depressive symptoms in a low/middle-income country can have a high global impact. Methods: Community-based health workers were trained to deliver a psychosocial intervention for mothers with depression in a primary care setting. A total of 49 mothers and 60 children were assessed pre-intervention, post-intervention, and at 6 months follow-up. Child behavioral/emotional symptoms were evaluated according to type of change in maternal depressive symptoms: response or remission. Results: An overall decrease in maternal depressive symptoms from baseline to post-intervention and 6 months follow-up were found. Response or remission was associated with better outcomes in child behavioral/emotional symptoms at 6 months follow-up (p = 0.0247, Cohen’s d : 0.76; p = 0.0224, Cohen’s f : 0.44) but not at post-intervention (p = 0.1636, Cohen’s d : 0.48; p = 0.0720, Cohen’s f : 0.33). Conclusions: Improvement in maternal depression was related to decreased behavioral/emotional symptoms in their children. Our results suggest that providing interventions for maternal depression in primary care is a viable strategy to prevent behavioral/emotional symptoms in the next generation. Clinical Trial registration: Brazilian Clinical Trials, number RBR-5qhmb5.

Global “Maternal” Mental Health From a Non-Binary Life Course Perspective

“…aternal mental health has been acknowledged as a the single most modifiable risk factor to improve child behavioral, cognitive, and socio-emotional wellness, [1][2][3] yet remains unprioritized in the World Health Organization's (WHO) 2022 World Mental Health Report. 4 While infancy, childhood and adolescence are acknowledged as vulnerable moments of opportunity across the lifespan for strategic intervention, the (birthing person) "mother"-child dyad, and the critical need to protect this developmentally essential social unit, is an underexplored strategy towards achieving global psychological wellness.…”

“…12,14 Strong associations between maternal depression, child psychopathology, infant undernourishment, low birth weight, impaired cognitive and motor development, disrupted emotional regulation and child mortality exist in studies based within LMIC. 2 Similarly, well trained, community-based health workers (CHW's) and facility-based primary care workers effectively deliver and impact maternal mental health care in LMIC settings, and therefore provide critical, low-cost resources for impacting maternal child health, diverse trajectories of development, biological diversity and productivity within society. 1,2,4,5 Globally, the public sector spends less than 2% of budget on mental health resources, 70% of which, in middle income countries, is allocated to inpatient psychiatric facilities.…”

“…2 Similarly, well trained, community-based health workers (CHW's) and facility-based primary care workers effectively deliver and impact maternal mental health care in LMIC settings, and therefore provide critical, low-cost resources for impacting maternal child health, diverse trajectories of development, biological diversity and productivity within society. 1,2,4,5 Globally, the public sector spends less than 2% of budget on mental health resources, 70% of which, in middle income countries, is allocated to inpatient psychiatric facilities. 4 Vicious cycles of poverty and mental health exist due to lack of community-based infrastructures, and disparate accessibility which plague LMIC, where over 80% of those living with mental disorders reside.…”

“…1,4 Cost-effective screenings for perinatal depression, community and school-based social, emotional and regulatory interventions are accessible and affordable with public sector budgetary and institutional commitment. [2][3][4] The WHO Comprehensive Mental Health Action Plan 2013-2030 provides a blueprint for action that has elicited commitments from all member countries. 4 While very thorough, this blueprint has potential to expand strategies for mental wellness by protecting human beings across the life course, starting with the essential social dyad of "mother"-child and its critical and well-studied impact on infant, child and adolescent behavioral, cognitive and socio-emotional health, encouraging inclusivity, safety and biodiversity in the wide array of gendered and sexual human expressions.…”

“…4 While very thorough, this blueprint has potential to expand strategies for mental wellness by protecting human beings across the life course, starting with the essential social dyad of "mother"-child and its critical and well-studied impact on infant, child and adolescent behavioral, cognitive and socio-emotional health, encouraging inclusivity, safety and biodiversity in the wide array of gendered and sexual human expressions. [1][2][3]5 The commitments of WHO and UN member states require budgetary allocations, and scaled implementations that center around family, inclusivity, recovery and human rights-based care. 4,5 -Amanda Watson, DNP, CNM, APRN Assistant Professor School of Nursing, University of Delaware Newark, Delaware…”