KEY FINDINGS
Does the THPP+ intervention work?
The peer-delivered, psychosocial intervention, Thinking Healthy Program, Peer Delivered, Plus (THPP+) implemented in the Bachpan study is aimed at mitigating maternal depression symptoms and bolstering child social and emotional development in rural Pakistan, a setting that has a high prevalence of maternal depression and limited access to mental health care. Three years after the birth of the child, symptoms of depression had reduced by about the same amount in both in the group that received the intervention and the control group, that had received enhanced care. Two key lessons learned are that sustaining a program over three years is especially challenging, and a program with multiple models and levels might be needed to better target women with varying needs.
Read more in our article in The Lancet Psychiatry.
What effect do fathers have on early childhood development and maternal depression?
Fathers have an important role in a child's life and are uniquely positioned to influence early childhood development and maternal health and wellbeing. Most fathers of children in the Bachpan cohort reside with their children and are fairly involved in childcare, with 40 percent of mothers reporting that the resident father plays with the baby daily and 70 percent reporting that the father is able to help take care of the child. Father involvement positively predicts child developmental milestones, particularly for cognition and fine motor skills, and is associated with child social emotional development and improved maternal health.
Read more in our article in Social Science & Medicine.
What are the role of grandmothers in child growth and development?
Grandmothers are an important source of childcare, particularly in low-resource settings. In the Bachpan cohort, 68 percent of children reside with a grandmother and most are involved in caregiving. Greater involvement in childcare appears to be positively associated with early childhood cognitive development, socioemotional development, and the development of fine motor skills in the first two years of life.
Read more in our article in BMJ Global Health.
What are the effects of cultural practices in the post-natal period on post-partum depression?
Cultural post-partum practices are associated with increased social support for mothers; this support may be protective against post-partum depression. In Pakistan, post-partum practices are referred to as chilla (چله), which is typically a 40-day period of confinement for a woman after her first birth, where she returns to her mother's home and receives additional support. The majority of women in the Bachpan cohort participate in some chilla activities. We have found that chilla participation is associated with reduced likelihood of major depressive episodes for mothers who were not prenatally depressed and reduced symptom severity for mothers who were prenatally depressed. This indicates that cultural practices may be an important leverage point for interventions to prevent post-partum depression.
Read more in our article in BMC Public Health.
What is the relationship between socioeconomic status and prenatal depression?
There is increasing interest in the relationship between indicators of socioeconomic status, poverty, and mental health outcomes in lower- and middle-income countries; prenatal depression is a salient public health concern and contributes to negative outcomes for both the mother and child. Among the sample of pregnant women in the THPP+ program in rural Pakistan, we have found that fewer assets, increased food insecurity, and household debt were associated with worse symptoms of depression, with no evidence of a threshold effect.
Read more in our article in SSM - Population Health.
Are there biomarkers for maternal depression and early childhood adversity?
Maternal depression and childhood adversity is associated with increased risk for stress-related disease and other adverse social and developmental outcomes. This chronic stress becomes biologically embedded along the hypothalamic-pituitary-adrenal (HPA) axis, affecting the production of stress hormones, notably cortisol and dehydroepiandrosterone (DHEA). Hair samples from infants in the Bachpan cohort demonstrate that exposure to maternal depression during pregnancy and having a mother who experienced intimate-partner violence were associated with lower levels of DHEA, while higher socioeconomic status is associated with higher levels of DHEA. Our research did not find a significant association between measures of childhood adversity and maternal depression.
Read more in our article in the Journal of Affective Disorders.
What effect does responsive caregiving have on children?
Responsive caregiving is defined as caregivers responding appropriately to child behavior and is linked to various child health outcomes. Evidence from the Bachpan cohort demonstrates that higher maternal educational attainment, socioeconomic status, fewer children, and a lack of maternal depression are all associated with increased use of responsive caregiving behaviors. Additionally, responsive caregiving was found to be associated with improved socioemotional outcomes, although there was no association identified with child growth.
Read more in our article in BMC Public Health.
What influence do adverse childhood experiences have on maternal depression?
Adverse childhood experiences (ACEs) are a common precursor to depression in adults and encompass a wide variety of traumatic experiences, including emotional neglect, physical neglect, household substance abuse, incarceration of a household member, household mental illness, physical abuse, emotional abuse, household violence, bullying, community violence, and collective violence. In the Bachpan cohort, 58 percent of women reported having at least one ACE, with household violence and neglect being the most common. Number of ACEs was positively associated with likelihood of depression and severity of depression.
Read more in our article in BMC Public Health.
Does perinatal social support reduce the risk of maternal depression?
Maternal depression occurring during pregnancy or within 1 year of childbirth imposes a high burden on women, with the potential to create long-lasting adverse consequences for herself and her child. Perinatal social support can play an instrumental role in protecting women against maternal depression. In the Bachpan cohort, women who reported greater levels of social support at 3, 6, and/or 12 months postpartum had a decreased risk of depression at 12 months postpartum.
Read more in our article in Journal of Epidemiology and Community Health.
What factors contribute to an increase in suicidal ideation during pregnancy and postpartum?
Suicidal ideation (SI) is an important concern during pregnancy and postpartum. In this paper, we studied the prevalence and predictors of SI over time in our sample of mothers. We found that about 12% of our sample experienced SI during pregnancy and around 5% experienced SI at 3,6, and 24 months postpartum. Interpersonal conflict, family conflict, isolation, and intimate partner violence were identified as key contributors to suicidal ideation during pregnancy and in postpartum. Preventative coping strategies such as perceived social support (i.e. the feeling of “belonging” or connection to one’s social environment) was identified as a robust protective factor of SI.
Read more in our article in Archives of Suicide Research.
What is the impact on maternal mental health when infant caregiving is shared between the mother and other household members?
Our team designed Day-in-the-Life (DIL) method as a new way to measure caregiving and maternal support. This measure is a semi-structured interview in which the mother describes her child’s day from their perspective. Mothers report on who participates in regular caregiving activities, including daily feedings, bathing; social caregiving such as comforting or playing with the child; and support activities such as performing care in the absence of the mother. We found that the DIL measure has excellent interrater agreement and was easy to administer. Through this measure, we found that mothers mostly performed regular caregiving tasks alone. Social caregiving activities were mostly shared by paternal grandmother because the daughter-in-law lives in the husband’s house. There was also more support from others when the mother was less able to provide care (e.g., when ill). In this study, we did not find strong evidence that receiving less support for regular and social caregiving tasks resulted in depressive symptoms for the mother. However, mothers were more likely to have depressive symptoms if they did not have support when they were unable to provide care.
Read more in our article in Family Relations.
What are the impacts of intimate partner violence and stressful life events on perceived stress in the postpartum period?
In this study, we were interested in learning about the associations between intimate partner violence (IPV) exposure (including the type and severity of IPV), stressful life events, and perceived stress in women. We found that psychological IPV was the most common form of IPV followed by sexual IPV and physical IPV. Experiencing IPV in the last year was associated with increases in levels of perceived stress. Also, the more severe IPV participants reported, the higher their perceived stress scores were. Stressful life events like financial, health, and conflict concerns also increase the risk of IPV. These events, specifically reported at 12 months postpartum, increased the risk of physical, psychological, and sexual IPV at 24 months by an average of 15%. A novel finding of this study due to its longitudinal design and nuanced measures of IPV is that physical IPV is associated with the largest increase in stress.
Read more in our article in Social Psychiatry and Psychiatric Epidemiology.