Abstract

BackgroundPostpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children’s mental development on all sub-scales in a Pakistani population.MethodsA quasi-experimental study was conducted in two peri-urban communities of Karachi, a mega city of Pakistan, to assess the impact of postpartum anxiety and depression on children’s growth and mental development. A total of 420 women were enrolled, who had given consent out of 651 pregnant women identified, during February 2004 to December 2005. Data for socio-demographic, home environment and family relationship variables were collected between 36 weeks of pregnancy and within 10 days of childbirth. Mother’s levels of anxiety and depression were assessed at 1, 2, 6, 12, 18, 24, and 30 months of childbirth. An indigenous, validated screening instrument- Aga Khan University Anxiety and Depression scale was used and diagnostic confirmation was done through a psychologist’s interview, based on DSM IV criteria. Children’s growth and development was monitored in the same sequence using an Early Childhood Development tool that consists of five subscales; socio emotional, language, cognitive, gross motor and fine motor development. Physical growth was monitored by measuring height and weight of the child. Data was analyzed using SAS 9.2. Multivariable Generalized Estimating Equations (GEE) logistic regression was conducted to identify association of postpartum anxiety and depression with each early childhood development indicator, adjusting for parental and child factors.ResultsA significant association of postpartum anxiety and depression with delayed development on all five subscales of children’s mental development was found in our study. Interestingly, our study found that higher maternal age had adverse effects on child’s emotional whereas positive impact on child’s cognitive development. Children’s stunting had an adverse impact on all five subscales of children’s development. Male children were at higher risk for delayed language and gross motor development relative to female children.ConclusionsOur study found that postpartum anxiety and depression is associated with adverse outcomes regarding children’s mental development on all sub-scales. The impact was accentuated by low family income or child’s increasing age.

Highlights

  • Postpartum anxiety and depression has detrimental effects on the overall mental development of children

  • When children were stunted they were more likely to be delayed for gross motor development (ORadj= 1.7, 95% confidence odds ratio interval (CI): 0.9, 3.0)

  • At the 18th month of follow-up there is a significant impact of maternal depression on children’s delayed fine motor development; children of depressed mothers being at a 4folds risk (ORadj= 4.0, 95% CI: 1.4, 11.3)

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Summary

Introduction

Postpartum anxiety and depression has detrimental effects on the overall mental development of children. This study aims to assess the impact of postpartum anxiety and depression on children’s mental development on all sub-scales in a Pakistani population. A review conducted on 143 studies from 40 countries shows that the prevalence of PPD varies from 0.5 – 60% depending on the definitions used and influence of various cultural factors [2]. This wide range might be due to differences in socio-economic environments e.g. poverty and levels of social support and biological vulnerability factors. Infants of depressed mothers show impaired maternal-child interactions [9], lower cognitive development, more behavioral problems [10], and a higher risk of psychiatric disorders during adolescent years than those of non-depressed mothers [11]

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