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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.

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