Poor Maternal Mental Health Mediates the Relationship Between Household Food Insecurity and Early Child Development in Brazil

Abstract

Abstract Objectives The aim of the study was to evaluate whether maternal mental health and infant's diet mediate the association between Household Food Insecurity (HFI) and Early Child Development (ECD) using Structural Equation Modeling (SEM). We hypothesized a priori that both maternal mental health and infant's diet would mediate the association between HFI and ECD. Methods A cross-sectional study was carried out with 474 mother-infant dyads at Primary Health Centers in the Federal District, Brazil. Mothers answered a questionnaire that evaluated variables through validated instruments. SEM analyses were conducted including the following observed variables: HFI, ECD, consumption of a healthy and diverse diet, presence of a partner in the household, wanted pregnancy and current breastfeeding. Latent variables were included to evaluate mental health (created from maternal depression, trait anxiety and state anxiety), poverty (created from maternal educational level, household per capita income and participation in the Brazilian cash transfer program) and infant health (created from preterm birth, hospitalization after birth and Neonatal Intensive Care Unit needed after birth). Results Poor maternal mental health mediated the relationship between HFI and ECD (β = –0.05), but a healthy and diverse diet was not a mediator in this relationship. Poverty was related to lower ECD scores directly (β = 0.21) and indirectly (β = 0.02). Not having a partner (β = 0.05) and having an unwanted pregnancy (β = 0.02) predicted indirectly lower ECD scores. Conclusions Poor maternal mental health mediates the relationship between HFI and ECD, and ECD is influenced by poverty, single motherhood and unwanted pregnancy through different pathways. Therefore, it is necessary that public policies and interventions that aim to promote an optimal ECD also approach these aspects. Longitudinal cohort studies are needed to determine causality and identify promising approaches to improve parenting skills and ECD outcomes in the context of HFI. Funding Sources This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) (Finance Code 001, CAPES scholarship Programa Doutorado Sanduíche no Exterior Process number 88,881.189710/2018–01).