Abstract
Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. We identified 21 trials with 28 284 mother-child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13-1.71, ten trials, N = 4749 mother-child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02-0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.
Highlights
Mental health is critical to public health and contributes substantially to the global burden of disease (Whiteford et al, 2015)
There are a number of compelling reasons to integrate mental health services into routine maternal and child health care in low- and middle-income countries (LMICs)
Randomised controlled trials (RCTs) were eligible for our systematic review if the study: (1) described interventions delivered during the perinatal period, defined as pregnancy through 1-year post-partum; (2) incorporated an maternal mental health (MMH) intervention component; (3) included a MMH outcome; (4) was conducted in an LMIC and (5) included a child health, nutrition or development outcome
Summary
Mental health is critical to public health and contributes substantially to the global burden of disease (Whiteford et al, 2015). In low- and middle-income countries (LMICs), there are few resources to address this burden, resulting in large numbers of people with mental health concerns not receiving treatment (Demyttenaere et al, 2004). Calls have been made to make evidence-based treatments for mental disorders more accessible by integrating them into nonspecialised health settings, such as primary, maternal and child care systems (Lancet Global Mental Health Group et al, 2007). There are a number of compelling reasons to integrate mental health services into routine maternal and child health care in LMICs. First, mental disorders in the perinatal period are common and disabling (Baron et al, 2016). Treatments for maternal mental disorders have been evaluated as effective in multiple LMICs and existing treatment guidelines for non-specialised providers include specific recommendations for pregnant women (Rahman et al, 2013)
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