Abstract
The disability associated with maternal common mental disorders (CMDs) is among the possible explanations for the association between chronic childhood malnutrition and CMDs. CMDs may impair the mother's ability to perform her role, particularly in deprived environments. The present study aimed to evaluate whether disability relating to CMDs could be part of the pathway of the association between childhood malnutrition and maternal CMDs. Cross-sectional study conducted in two institutions: one for malnourished children and another for eutrophic children living in a low-income community in the state of Alagoas, Brazil. The cases consisted of 55 malnourished children aged from 12 to 60 months who were attending a nutritional rehabilitation center, with height-for-age z-scores < 2. The controls were 70 eutrophic children of the same age who were attending a day care center in the same area as the cases. The Self-Report Questionnaire made it possible to identify likely cases of maternal CMD. The Sheehan Disability Scale enabled evaluation of the associated disability. Chronic childhood malnutrition was significantly associated with maternal disability relating to CMDs (OR = 2.28; 95% CI: 1.02-5.1). The best logistic regression model using chronic childhood malnutrition as the dependent variable included the following independent variables: higher number of people living in the household; absence of the biological father from the household; and maternal disability relating to CMDs. If confirmed, the association between chronic childhood malnutrition and maternal disability relating to CMDs may be useful in helping to identify the causal chain between childhood malnutrition and maternal CMDs and to indicate environmental risk factors associated with chronic childhood malnutrition.
Highlights
Prospective studies have investigated the direction of associations of maternal common mental disorders (CMDs) and depression with chronic childhood malnutrition
To investigate the variables associated with child nutritional status and to model potential interactions, a sequence of bivariate analyses were performed on each variable, with controlling for potential confounders by all other variables (“maternal disability relating to CMDs”,“number of people living in the household”, “absence of biological father from the household” and “husband/partner in the labor market”)
The final and most parsimonious model identified three independent correlates (Table 2): (1) children with malnutrition were more than twice as likely to have a mother presenting disability associated with maternal CMDs (OR = 2.446; 95% CI = 1.059-5.649; P = 0.036); (2) children whose biological father was absent from the household were twice as likely to have a mother with disability associated with childhood malnutrition (OR = 2.097; 95% CI = 0.958-4.589; P = 0.064); and (3) smaller numbers of people living in the household had a protective effect (OR = 0.778; 95% CI = 0.631-0.959; P = 0.018)
Summary
Prospective studies have investigated the direction of associations of maternal common mental disorders (CMDs) and depression with chronic childhood malnutrition. In 2011, Surkan et al.[1] conducted a meta-analysis to investigate the association of childhood malnutrition with maternal CMDs and maternal depression worldwide They analyzed 17 studies that included case-control, cross-sectional and cohort designs. The results showed that maternal CMDs including depression were associated with early childhood underweight and stunting.[4,5] These studies reported that the association remained positive after adjustment for several possible confounders such as paternal and maternal education, maternal age, birth weight, infant physical health, breastfeeding practices, number of children and socioeconomic status.[1,2,6,7,8] On the basis of the results from the meta-analysis, it was unlikely that the results were a chance finding. The evidence for a positive association was strong.[1,2]
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