Maternal Mental Disorder Research Articles

Earlier Contact with Child Protection Services Among Children of Parents With Criminal Convictions and Mental Disorders.

Parental history of offending and/or mental illness are risk factors for child maltreatment. However, limited research has directly contrasted the role of maternal versus paternal criminal offending or mental health problems in contributing to earlier contact with the child protection system. In this study we examined the relative contributions of these risk factors in relation to the time to the offspring's first report to child protection services, or first placement in out of home care (OOHC), using administrative records for a population sample of 71,661 children. Prior paternal offending had a greater independent effect on time to the offspring's first contact with child protection services (HR = 2.27 [95% CI = 2.14-2.40]) than maternal offending (HR = 1.75 [95% CI = 1.63 -1.87]) or maternal mental disorder diagnosis (HR = 1.66 [95% CI = 1.57 -1.77]). By contrast, prior maternal offending (HR = 2.58 [95% CI = 2.26-2.95]) and mental disorder diagnosis (HR = 2.33 [95% CI = 2.05-2.63]) had a greater effect on earlier placement in OOHC, relative to prior paternal offending (HR = 1.59 [95% CI = 1.35 -1.88]) and mental disorder diagnosis (HR = 1.06 [95% CI = 0.94 -1.19]). These findings demonstrate the potential benefits of coordinated government responses across multiple agencies to identify vulnerable children and families who might benefit from early interventions or support services.

Maternal common mental disorder over time and asthma control: The role of social support.

Despite therapeutic advances, asthma prevalence remains high. Psychosocial factors, including maternal mental disorders, may be involved. This study aims to evaluate the association of maternal common mental disorders (CMDs) and their change over time with asthma morbidity in the child and to observe the effect of social support on this association. This prospective study involved 189 dyads of mothers and their asthmatic children aged between 2 and 14years, assisted in specialized outpatient clinics. We measured the association of maternal CMD evolution (absent, maintained, or improved over time) with asthma control and visits to the emergency department (ED) due to asthma attacks through Poisson regression analysis. We further stratified the sample according to social support levels to identify a possible effect of this variable on the association of maternal psychological symptoms with asthma morbidity. Compared with mothers who maintained CMD over time, maternal CMD absence had a protective effect on the occurrence of visits to the ED (RR: 0.45; 95% CI: 0.26-0.79) and maternal CMD improvement was associated with lower risk of uncontrolled asthma in the child (RR: 0.60; 95% CI: 0.37-0.97). There was a stronger association of maternal CMD improvement with asthma control in the child only for the stratum of mothers with high social support in its three dimensions (affective-social interaction, emotional-informational, and material dimensions). Maternal CMD absence and improvement over the study period were protective factors for uncontrolled asthma in the child, mainly in the presence of high social support.

Perinatal Determinants of Child Maltreatment in Japan.

Background: Child maltreatment induces significant health problems, both during childhood and into adulthood. To prevent child maltreatment, it is important to detect perinatal risk factors for earlier intervention. The aim of this study was to evaluate the perinatal risk factors associated with child maltreatment during pregnancy.Methods: A case-control study was conducted to compare perinatal data from the Maternal and Child Health Handbook between the case and control groups. Cases were collected from children registered in two Child Guidance Centers in Japan. The control group consisted of 3.5-year-old children in a city in Osaka Prefecture whose mothers responded to questionnaires containing information from the Maternal and Child Health Handbook. The association between perinatal factors and child maltreatment was assessed using multiple logistic regression analysis.Results: The data of 70 cases and 345 controls were collected. The following were found to be perinatal factors related to child maltreatment: teenage pregnancy (OR: 257.3, 95% CI: 17.3–3832.7), a mother aged 20–24 years (OR: 22.8, 95% CI: 4.4–117.8), a father who is older than the mother by 10 years or more (OR: 14.1, 95% CI: 2.1–94.8), an unmarried mother (OR: 15.7, 95% CI: 2.6–93.6), maternal mental disorder (OR: 48.9, 95% CI: 9.3–258.3), the first maternal prenatal visit being later than 20 weeks (OR: 132, 95% CI: 12.7–1384.7), little prenatal care (<10 visits) (OR: 21.4, 95% CI: 2.9–157.1), a low-birth-weight baby (OR: 5.1, 95% CI: 1.1–24.1), and congenital disease (OR: 7.9, 95% CI: 1.1–56.4).Conclusions: This study revealed that young mothers, fathers much older than mothers, unmarried mothers, and maternal mental disorder, mothers with late first visit or little perinatal care, and low-birth-weight babies and babies with congenital disease were associated with child maltreatment. These findings can be used to detect high-risk families for child maltreatment during or after pregnancy.

Maternal psychopathology and offspring mental health service utilization in adolescents without mental disorders: a national representative survey.

We investigated whether maternal psychopathology predicts offspring mental health service utilization in adolescents without mental disorders. We used weighted data (N = 2317) from NCS-A participants (age: 13-18years) who did not meet DSM-IV criteria for any lifetime mental disorder. Adolescent mental disorders were assessed with the WHO CIDI. Maternal psychopathology was obtained by self-report. Adolescent mental health service use was assessed with the Service Assessment for Children and Adolescents. Substantial associations between maternal psychopathology and mental health service use in offspring without mental disorders were found between affective disorders and the mental health/medical specialty (hazard ratio (HR) = 2.49, 95% confidence interval (CI) = 1.60-3.90) and any service sector (HR = 2.14, CI = 1.45-3.16), anxiety disorders and any service sector (HR = 1.63, CI = 1.13-2.35), behavior disorders and the school (HR = 3.69, CI = 1.39-9.77) and any service sector (HR = 2.81, CI = 1.12-7.07), substance use disorders and the mental health/medical specialty (HR = 3.75, CI = 1.75-8.03), the school (HR = 3.17, CI = 1.43-7.02), and any service sector (HR = 3.66, CI = 2.00-6.70), and any mental disorder and the mental health/medical specialty (HR = 2.10, CI = 1.34-3.30) and any service sector (HR = 2.03, CI = 1.40-2.92). Results were comparable when restricting analyses to offspring with no indication of suicidality and no more than three life events during the past 12months. The likelihood of service use was higher among offspring of mothers with mental disorders, compared to mothers without mental disorders. Considering maternal mental disorder status may help to identify subjects at risk of overtreatment.

Prevalence of self-reported mental disorders in pregnancy and associations with adverse neonatal outcomes: a population-based cross-sectional study

BackgroundMental disorders in pregnancy are common causes of morbidity and mortality with associated risks of adverse neonatal outcomes. Our aims were to evaluate the prevalence of self-reported mental disorders in women presenting to maternity services and to determine the association between history of self-reported maternal mental disorder and adverse neonatal outcomes.MethodsData on all singleton pregnancies known to maternity services in Northern Ireland over the period 2010 to 2015 were extracted from the Northern Ireland Maternity System (NIMATS), including frequency data for number of pregnancies where the mother reported a history of mental disorder. Odds ratios were derived from logistic regression analyses to determine the associations between self-reported maternal mental disorder and preterm birth, low infant birth weight and APGAR scores.ResultsIn total, 140,569 singleton pregnancies were registered using NIMATS over this period. In 18.9% of these pregnancies, the mother reported a history of at least one mental disorder. After adjustment for potential confounding factors, significant associations were demonstrated between self-reported maternal mental disorder and preterm birth (odds ratio [OR] 1.31, 95% confidence interval [CI] 1.25–1.37), low infant birth weight (OR 1.29, 95% CI 1.21–1.38) and APGAR score < 7 at 1 min (OR 1.14, 95% CI 1.10–1.19) and 5 min (OR 1.23, 95% CI 1.12 to 1.34).ConclusionsThese findings emphasise the critical importance of routine enquiry regarding psychiatric history when women present to maternity services and the impact of maternal mental illnesses upon outcomes for their infants.

Public interest through web search trends of neuromodulation treatments in the United States

Maternal antenatal depression may alter offspring neurodevelopment, but long follow-up studies are lacking. We studied the risks for mood disorders and schizophrenia in adult offspring of antenatally depressed mothers, taking account parental severe mental disorders.In the general population-based Northern Finland 1966 Birth Cohort with 12,058 children, 13.9% of the mothers reported themselves depressed at mid-gestation. The offspring were followed 43 years. Severe mood disorders and schizophrenia in the offspring and severe mental disorders in the parents were detected using the Care Register for Healthcare. Maternal smoking during pregnancy, perinatal complications, fathers´ social class, family type at birth, and grand multiparity were considered as confounding variables.The offspring of antenatally depressed mothers had an elevated risk for depression (adjusted OR 1.5; 95% CI 1.03–2.2), compared to cohort members without maternal antenatal depressed mood. The offspring with maternal antenatal depressed mood and parental severe mental disorder had markedly elevated risks for depression (3.3; 1.8–6.2), and schizophrenia (3.9; 2.0–7.5), compared to the offspring without one or both of these risk factors.Maternal antenatal depressed mood was determined by one question and did not necessarily signify a clinical condition. Data on maternal postnatal mood was not available.The offspring with maternal antenatal depressed mood and parental severe mental disorder had high risk for depression and schizophrenia. Early interventions in parental severe mental disorder might present an opportunity for decreasing the risk for mood disorders and schizophrenia in the offspring.

Maternal Common Mental Disorder as Predictors of Stunting among Children Aged 6-59 Months in Western Ethiopia: A Case-Control Study.

Background Child malnutrition in low- and middle-income countries still continues to be an alarming. Africa and Asia bear the greatest share of all forms of malnutrition. The association between maternal common mental disorder and stunting has not been studied well even in developed countries; much less in developing countries and even the findings are conflicting. Thus, the purpose of the present research was to investigate the relationship of maternal common mental disorder and child stunting. Methods Institution based unmatched case-control study design was employed from March to April 2017. Two hundred thirty-four sampled children (78 cases and 156 controls) were randomly selected. Anthropometric measurements (height/length and weight) were taken by calibrated instruments. Maternal common mental disorder (CMD) was measured by using the locally validated Self-Reporting Questionnaire (SRQ-20). Data entry was done by Epi data version 3.1 and analysis was done by SPSS 21.0 statistical software. Result Finding of this study found out about three-fourths of cases (71.8%) and three-fourths of controls (69.9%) were residing in rural and urban areas, respectively. Regarding maternal common mental disorder, more than half of cases mother (53.8%) and more than one-tenth of controls mother (13.5%) were found to have common mental disorder. The study showed that children of mothers who had common mental disorder were found to be three times more likelihood of developing stunting than children whose mothers had not common mental disorder. Conclusion and Recommendation The study indicated that maternal common mental disorder was significantly associated with stunting. Therefore, emphasis should be given in preventing, managing, and maintaining maternal mental health in order to prevent stunting.

Severe mood disorders and schizophrenia in the adult offspring of antenatally depressed mothers in the Northern Finland 1966 Birth Cohort: Relationship to parental severe mental disorder

BackgroundMaternal antenatal depression may alter offspring neurodevelopment, but long follow-up studies are lacking. We studied the risks for mood disorders and schizophrenia in adult offspring of antenatally depressed mothers, taking account parental severe mental disorders. MethodsIn the general population-based Northern Finland 1966 Birth Cohort with 12,058 children, 13.9% of the mothers reported themselves depressed at mid-gestation. The offspring were followed 43 years. Severe mood disorders and schizophrenia in the offspring and severe mental disorders in the parents were detected using the Care Register for Healthcare. Maternal smoking during pregnancy, perinatal complications, fathers´ social class, family type at birth, and grand multiparity were considered as confounding variables. ResultsThe offspring of antenatally depressed mothers had an elevated risk for depression (adjusted OR 1.5; 95% CI 1.03–2.2), compared to cohort members without maternal antenatal depressed mood. The offspring with maternal antenatal depressed mood and parental severe mental disorder had markedly elevated risks for depression (3.3; 1.8–6.2), and schizophrenia (3.9; 2.0–7.5), compared to the offspring without one or both of these risk factors. LimitationsMaternal antenatal depressed mood was determined by one question and did not necessarily signify a clinical condition. Data on maternal postnatal mood was not available. ConclusionThe offspring with maternal antenatal depressed mood and parental severe mental disorder had high risk for depression and schizophrenia. Early interventions in parental severe mental disorder might present an opportunity for decreasing the risk for mood disorders and schizophrenia in the offspring.

La parentalité des mères psychotiques et sa prise en charge en psychiatrie vue par les professionnels de santé

ObjectivesParenthood of mothers with a psychotic disorder has become a growing social reality that requires specific care. This study was carried out to shed light on an understudied topic that raises a number of ethical questions. The purpose of this study was to explore the point of view of healthcare professionals working in psychiatry services about parenthood of psychotic mothers and what they are offered in terms of support and care. MethodsSixteen health professionals working in psychiatry services responded to a semi-directive interview. They were recruited on a voluntary basis. Anonymity was ensured and all professionals gave their written informed consent to participate in the study. Interview's content was transcribed verbatim then examined through a qualitative thematic analysis. ResultsThe interviews highlighted contrasting representations of these mothers’ parenthood. Whilst the weaknesses and difficulties in parenting and education were predominantly mentioned, mothers’ resources and skills were hardly acknowledged. Although attachment to the child was one of the few resources noticed, the professionals named 25 items relating to parenting problems. The main ones related to the impact on the child of the symptoms of the maternal mental disorder, and to difficulties in coping with daily tasks. A lack of empathy was also observed in these mothers. The parent's difficulties appeared to be more significant depending on the child's developmental stage. Family support was described as essential in helping these mothers with parenting. However, parenting issues seem to be very seldom taken into account by adult psychiatric services, as most health professionals believe these questions do not fall within their field of activity. A lack of training and information on this issue is seen as one of the main barriers regarding this topic. Besides, the organization of psychiatric services in France, with its child and adult sectors, appears to be a barrier to a joint work of child psychiatry and adult psychiatry. However, for these professionals, psychiatry in general remained the place where the issue of parenthood should be addressed. Children of psychotic mothers were perceived as suffering from the parent's difficulties, yet reporting situations where the children were in danger remained an unusual practice in adult psychiatry. This was considered as belonging to the realm of other institutions, or of child psychiatry. Lack of knowledge about existing procedures and partners appeared to limit assessments of situations of concern that should be reported. These results invite to discuss on models of support, for instance based on empowerment and recovery approaches. These models build on the strengths and resources of people who are seen as stakeholders in their own care journey. Given the impact of parenting on the mental health of these mothers, implementing recovery programs that focus on sexuality and parenthood could be effective. Providing health professionals with information might raise their awareness of their role in taking charge of the patients in a comprehensive perspective that includes parenthood issues. Professionals’ practices seemed to be more focused on the patient and his symptoms rather than on all aspects of their personal life (family, children, work). Finally, some ethical issues are discussed. Parenthood of psychotic mothers deserves a global approach, including work in partnership. Although the law lays down the principle of shared secrecy, some professionals still remain reserved about sharing relevant information, given the medical confidentiality principle. These issues also appear to be an argument for refusing to report a child as requiring a child protection intervention. ConclusionAlthough its limitations, in particular the low number of professionals who agreed to participate, this study sheds new light on a scarcely studied issue that deserves more attention given the increasing number of patients with children who are cared in psychiatric services.

Inter-partner violence during pregnancy, maternal mental health and birth outcomes in Vietnam: A systematic review

IntroductionIntimate partner violence (IPV) is common worldwide and associated with maternal mental disorders and adverse child health outcomes. Research in this field in Vietnam is still nascent, although some substantial studies have emerged in recent years. The objective of this review was to estimate the prevalence of IPV during pregnancy in Vietnam and examine its impact upon women and children at an early age. MethodsWe searched seven bibliographic databases (from 1970 to 2018), browsed grey literature sources, and consulted experts. Two review authors independently extracted data and assessed risk of bias with using the Newcastle – Ottawa Quality Assessment Tool for non-randomized studies. A meta-analysis was conducted using the Mantel-Haenszel fixed-effect approach to estimate pooled effect (odds ratio) of Prenatal IPV (P-IPV) on maternal Common Mental Disorder (CMD). ResultsThe selection process produced eight eligible studies of 4598 participants. Six studies were pooled. The estimated proportions of IPV during pregnancy ranged from 5.9% to 32.5% depending on the form of IPV. P-IPV is strongly associated with greater risk of both mental disorders and adverse birth outcomes (preterm labor and low-birth-weight). The meta-analysis revealed that women exposed to P-IPV have a 4-fold increased risk for prenatal CMD compared to non-abused peers (OR = 3.69, 95% CI (2.51–5.42), I2 = 36%). Women exposed to physical P-IPV had five-fold increased odds of premature labour, OR = 5.5, 95% CI (2.1–14.1) and almost six-fold increased odds of having low-birth-weight neonates, OR = 5.7, 95% CI (2.2–14.9). DiscussionTo improve mother and child well-being in Vietnam, multifaceted health policies should include routine screening for IPV and mental disorders in the antenatal care system. Taken together, the evidence supports calls for national programs in Vietnam to eliminate gender inequality and promote awareness of the serious harms caused by IPV.

Out-of-home placement to age 18 years in children exposed to a postpartum mental disorder.

Little is known about risk of custody loss or out-of-home placement among children whose mothers experience postpartum mental disorders, and whether this risk differs from that of children whose mothers had earlier onset of their mental disorder. National Danish registers comprising 1 868 467 births (1982-2012) were used to determine how the timing of maternal illness onset influences out-of-home placement risk up to age 18 years among children exposed to a maternal mental disorder. Compared to children unexposed to maternal mental illness, risk was higher for children exposed to a maternal mental disorder whose mothers had a first contact for a mental disorder in the 0-12 months of predelivery (8.17/1000 person-years; aIRR 4.56, 95% CI 4.08-5.09), the first 3 months postpartum (4.60/1000 person-years; 3.55, 2.95-4.26) and 4-12 months postpartum (6.49/1000 person-years; 3.93, 3.50-4.41). Risk was even higher for children exposed to a maternal mental disorder when illness onset was more than 1-year predelivery (9.11/1000 person-years; 5.48, 5.32-5.66). Risk of out-home placement in children exposed to mothers with a new-onset postpartum mental disorder is almost as high as in children whose mothers have long-standing illness. A better understanding of the trajectories of these mothers and children is warranted.

Substance use disorder in the offspring of antenatally depressed mothers in the Northern Finland 1966 birth cohort: Relationship to parental history of severe mental disorder

IntroductionMaternal depression during pregnancy is common. However, reports of the adult offspring with maternal antenatal depression are scarce.ObjectivesOur aim was to study whether offspring of antenatally depressed mothers have increased risk for substance use disorder when taking account parental mental disorder.MethodsIn the Northern Finland 1966 Birth Cohort, the mothers of 12,058 children were asked at the antenatal clinic if they felt depressed. The offspring were followed for over 40 years. Substance use disorders were detected using the Finnish Care Register for Health Care, which was also used for identifying severe mental disorders in the parents till 1984.ResultsOf the mothers, 14% had rated themselves as depressed during pregnancy. Of the parents, 10% had had a hospital-treated mental disorder. The risk for substance use disorder was slightly increased in the offspring of antenatally depressed mothers (crude OR 1.6; 95% CI 1.2–2.1), when compared with the cohort members without maternal antenatal depression. The risk for substance use disorder was higher in the offspring with both maternal antenatal depression and parental mental disorder (2.8; 1.7–4.7) than in those with maternal depression but without parental mental disorder (1.4; 1.1–2.0) or those without maternal depression and with parental mental disorder (1.5; 1.1–2.2). The reference group was cohort members without maternal antenatal depression and without parental mental disorder. The association remained significant after adjustment [1].ConclusionsOffspring with both maternal depression during pregnancy and parental severe mental disorder have elevated risk for substance use disorder.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Early origins of mental disorder - risk factors in the perinatal and infant period.

BackgroundThere is increasing understanding of the significance of early neurodevelopment in establishing risk for the range of mental disorders. Models of the early aetiology of mental disorders are complex with a range of potential factors from genetic and epigenetic to environmental influencing neurological and psychological development. Whilst the mechanisms are not fully understood, this paper provides an overview of potential biological and neurobiological factors that might be involved.MethodAn aetiological model is presented and discussed. The discussion includes a range of risk factors for mental disorder. Maternal anxiety disorder is presented and reviewed as an example of the interaction of placental, epigenetic and early parenting factors elevating risk of poor neonatal outcome.ResultsAvailable evidence points to the importance of in-utero influences as well as the role of early attachment and emotional care. Transgenerational mechanisms such as the impact of maternal mental disorder on foetal development are important models for examination of early risk. Maternal anxiety, as an example, is a significant risk factor for compromised mental health.ConclusionsDevelopment of models for understanding the early origins of mental disorder is an important step in elaborating risk reduction strategies. Comprehensive early identification of risk raises the possibility of preventive interventions.

Predicting ADHD by Assessment of Rutter's Indicators of Adversity in Infancy.

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with early onset. ADHD is associated with significant morbidity and mortality, partly due to delayed diagnosis. Identification of children at high risk for developing ADHD could lead to earlier diagnosis and potentially change the negative trajectory of the illness for the better. Since early psychosocial adversity is considered to be a likely etiological risk factor for ADHD, markers of this construct may be useful for early identification of children at high risk. Therefore, we sought to investigate whether Rutter’s indicators of adversity (low social class, severe marital discord, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care) assessed in infancy could serve as early predictors for the development of ADHD.Methods and FindingsUsing data from the Danish nationwide population-based registers, we established a cohort consisting of all 994,407 children born in Denmark between January 1st 1993 and December 31st 2011 and extracted dichotomous values for the six Rutter’s indicators of adversity at age 0–12 months (infancy) for each cohort member. The cohort members were followed from their second birthday and the association between the sum of Rutter’s indicators of adversity (RIA-score) in infancy and subsequent development of ADHD was estimated by means of Cox regression. Also, the number needed to screen (NNS) to detect one case of ADHD based on the RIA-scores in infancy was calculated. During follow-up (9.6 million person-years), 15,857 males and 5,663 females from the cohort developed ADHD. For both males and females, there was a marked dose-response relationship between RIA-scores assessed in infancy and the risk for developing ADHD. The hazard ratios for ADHD were 11.0 (95%CI: 8.2–14.7) and 11.4 (95%CI: 7.1–18.3) respectively, for males and females with RIA-scores of 5–6, compared to males and females with RIA-scores of 0. Among males with RIA-scores of 5–6, 37.6% (95%CI: 27.0–50.7) had been diagnosed with ADHD prior to the age of 20, corresponding to a NNS of 3.0 (95%CI: 2.2–4.0).ConclusionsRutter’s indicators of adversity assessed in infancy strongly predicted ADHD. This knowledge may be important for early identification of ADHD.

Early Predictors of Eating Problems in Preadolescence—A Prospective Birth Cohort Study

PurposeThe epidemiology of childhood eating problems is far from being fully described. The present study aims to explore early predictors of eating behavior problems in preadolescence. MethodsThe study sample comprised 1,939 children from the birth cohort study, the Copenhagen Child Cohort (CCC2000). Logistic regression models were used to investigate associations among infancy health, developmental and relational factors, maternal mental health problems, socioeconomic factors, parental reported eating behavior patterns in preschool age and eating behavior problems in preadolescence. ResultsA number of factors expressing socioeconomic disadvantage across childhood were associated with an increased risk of eating behavior problems at age 11–12 years. In addition, overeating patterns at age 5–7 years predicted restrained eating in preadolescence (odds ratio [OR] = 2.77; 95% confidence interval [CI] = 1.13–6.77; p = .03), with overweight at age 11–12 years and low annual household income as strong explanatory factors (OR = 4.79; 95% CI = 2.81–8.17; p < .0001 and OR = 2.06; 95% CI = 1.19–3.58; p = .02, respectively). No significant associations between perinatal, early child- and relational factors, or maternal mental disorder and eating behavior problems in preadolescence were found. ConclusionsOur results suggest that overeating at age 5–7 years is prospectively associated with restrained eating in preadolescence, with contemporaneous socioeconomic disadvantages and overweight as strong explanatory factors. Our findings might reflect successful public health interventions toward childhood obesity or might reflect a developmental course of problematic eating fluctuating between over- and undereating. Future studies should focus on the possible pathways from overeating to restrained eating and more severe eating pathology, including possible negative side effects of otherwise successful interventions aimed at reducing childhood obesity.

Fatigue as a manifestation of psychosocial distress in a low-income country: a population-based panel study.

ObjectiveFatigue is a common complaint worldwide and associated with disability and high health service use costs. We tested the hypothesis that maternal fatigue would be associated independently with maternal common mental disorder (‘maternal CMD’) in a rural, low‐income country setting.MethodsThe analysis was conducted using data from a population‐based cohort located in the Butajira demographic surveillance site, Ethiopia. A total of 1065 women were recruited in pregnancy and followed up to 2.5 (n = 1009; 94.7%) and 3.5 years post‐partum (n = 989; 92.9%). Maternal CMD symptoms were measured using a locally validated version of the Self‐Reporting Questionnaire and fatigue was measured using a dichotomised item from the Patient Health Questionnaire‐15. Physical health indicators included haemoglobin level, body mass index and illness episodes. Generalised estimating equations were used to conduct hypothesis‐driven and exploratory multivariable analyses in the panel at 2.5 and 3.5 years.ResultsThe prevalence of maternal fatigue was 8.3% at 2.5 years and 5.5% at 3.5 years post‐partum. Psychological symptoms of maternal CMD were associated independently with complaints of fatigue after adjusting for anaemia, body mass index, physical ill health, poverty and other confounding variables: adjusted odds ratio (aOR), 1.46; 95% confidence interval (CI), 1.28–1.66 for each one point increase in SRQ score. In the multivariable model, only psychosocial factors (CMD and stressful life events) and self‐reported physical ill health were associated significantly with complaints of fatigue.ConclusionComplaints of fatigue are associated strongly with maternal CMD and other psychosocial risk factors in this rural, low‐income country setting with a high burden of undernutrition and infectious disease. Fatigue should be understood as a potential indicator of CMD in primary care to improve detection and treatment.

The role of natural disaster in individual and relational adjustment in Sri Lankan mothers following the 2004 tsunami.

The purpose of this study is to examine the associations between maternal mental health distress symptoms, including depression and post-traumatic stress disorder, the extent to which the presence of a child's disaster-related physical health problem(s) have interfered with daily functioning, and family cohesion over time among Sri Lankan mothers who survived the tsunami on 26 December 2004. Study variables were measured using a self-report questionnaire administered approximately four months after the event and three years later in summer 2008. Univariate, bivariate, and multivariate analyses were conducted. Path analysis was employed to assess the relationships between the key variables over time and the correlations in the study variables at each time point. Among other findings, the results of the path analysis indicated that post-traumatic stress symptom distress four months after the disaster significantly predicted variance in family cohesion three years later. Clinical and empirical research implications are presented and discussed.

Maternal mental health and social support: effect on childhood atopic and non-atopic asthma symptoms

BackgroundAtopic and non-atopic asthma have distinct risk factors and immunological mechanisms, and few studies differentiate between the impacts of psychosocial factors on the prevalence of these disease phenotypes. The authors...

Are family variables associated with ADHD, inattentive type? A case–control study in schools

Attention-deficit/hyperactivity disorder (ADHD) seems to be associated with significant psychosocial adversity. However, few studies assessed the role of environmental, social and interpersonal factors specifically in ADHD, inattentive type (ADHD-I). Thus, this study aims to investigate whether family environment risk factors are associated with ADHD-I. In a case-control study, we assessed a non-referred sample of 100 children and adolescents with ADHD-I and 100 non-ADHD controls (6-18years old). They were systematically evaluated through structured diagnostic interviews. The following family adversity measures were used: Rutter's family adversity index (marital discord, low social class, large family size, paternal criminality, maternal mental disorder), Family Environment Scale (FES) (subscores of cohesion, expressiveness and conflict) and Family Relationship Index (FRI) (based on the subscores above). After adjusting for confounding factors (social phobia and maternal history of ADHD), the odds ratio (OR) for ADHD-I increased as the number of Rutter's indicators increased. Families of children with lower FES cohesion subscores presented higher OR for ADHD-I (OR 1.24; 95% confidence interval 1.05-1.45). Lower levels of FRI, a general index of family relationship, were also related to higher risk of ADHD-I (OR 1.11; 95% confidence interval 1.03-1.21). Our findings suggest that family adversity (in general), low family cohesion and low FRI (in particular) are associated with an increase in the risk for ADHD-I. However, the cross-sectional nature of the study limits our ability to infer causality.

Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort

BackgroundChronicity and severity of early exposure to maternal common mental disorders (CMD) has been associated with poorer infant development in high-income countries. In low- and middle-income countries (LAMICs), perinatal CMD is inconsistently associated with infant development, but the impact of severity and persistence has not been examined.MethodsA nested population-based cohort of 258 pregnant women was identified from the Perinatal Maternal Mental Disorder in Ethiopia (P-MaMiE) study, and 194 (75.2%) were successfully followed up until the infants were 12 months of age. Maternal CMD was measured in pregnancy and at two and 12 months postnatal using the WHO Self-Reporting Questionnaire, validated for use in this setting. Infant outcomes were evaluated using the Bayley Scales of Infant Development.ResultsAntenatal maternal CMD symptoms were associated with poorer infant motor development ( -0.20; 95% CI: -0.37 to -0.03), but this became non-significant after adjusting for confounders. Postnatal CMD symptoms were not associated with any domain of infant development. There was evidence of a dose-response relationship between the number of time-points at which the mother had high levels of CMD symptoms (SRQ ≥ 6) and impaired infant motor development ( = -0.80; 95%CI -2.24, 0.65 for ante- or postnatal CMD only, = -4.19; 95%CI -8.60, 0.21 for ante- and postnatal CMD, compared to no CMD; test-for-trend χ213.08(1), p < 0.001). Although this association became non-significant in the fully adjusted model, the coefficients were unchanged indicating that the relationship was not confounded. In multivariable analyses, lower socio-economic status and lower infant weight-for-age were associated with significantly lower scores on both motor and cognitive developmental scales. Maternal experience of physical violence was significantly associated with impaired cognitive development.ConclusionsThe study supports the hypothesis that it is the accumulation of risk exposures across time rather than early exposure to maternal CMD per se that is more likely to affect child development. Further investigation of the impact of chronicity of maternal CMD upon child development in LAMICs is indicated. In the Ethiopian setting, poverty, interpersonal violence and infant undernutrition should be targets for interventions to reduce the loss of child developmental potential.