Child mental health and maternal depression history in Pakistan
- 585 Downloads
We address the significant gaps in knowledge of prevalence and correlates of child mental health (CMH) problems outside of high income countries. We describe the prevalence of CMH problems and their correlates with a focus on the association with maternal depression in a sample of seven-year-old children in rural Pakistan.
This study was nested in a long-term follow-up of a perinatal depression intervention together with a reference group of non-depressed women, yielding a population representative sample. The Total Difficulties (TD) and component scores of the Strength and Difficulties Questionnaire (SDQ) were used to measure emotional and behavioral difficulties.
The mean SDQ TD score was 10.6 (standard deviation = 8.3), with 12.5 % of children categorized as “abnormal” using standard cutoffs. Boys had a roughly 1 point higher (worse) SDQ TD score than girls (p value = 0.04). Children of mothers who were depressed prenatally as well as currently had SDQ TD scores 2.87 points higher than children whose mothers were not depressed at either time point (p value < 0.01). This association was stronger for boys. There was no evidence of elevated SDQ TD score among children whose mothers were depressed only prenatally or only currently. Some deviations from this pattern were observed with specific components of the SDQ.
In this low resource, South Asian setting, we found evidence of elevated levels of emotional and behavioral problems, highlighting the need for effective interventions. Given the strong association of CMH with maternal depression, any intervention efforts should give strong consideration to maternal mental health.
KeywordsChild mental health Socio-emotional development Maternal depression Strengths and difficulties questionnaire Gender differences
This study was supported by Grand Challenges Canada (GCC#0058-03), Government of Canada, under the Saving Brains programme. We thank Jill Ahs for her contribution to the project-planning phase, writing of the proposal, and gathering and developing methods for data collection. We are especially grateful to the study participants who gave their and their children’s time to be interviewed.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
- 2.Kieling C, Baker-Henningham H, Belfer M, Conti G, Ertem I, Omigbodun O, Rohde LA, Srinath S, Ulkuer N, Rahman A (2011) Global Mental Health 2 Child and adolescent mental health worldwide: evidence for action. Lancet 378(9801):1515–1525. doi: 10.1016/s0140-6736(11)60827-1 CrossRefPubMedGoogle Scholar
- 7.UNICEF (2012) South Asia. http://www.unicef.org/infobycountry/southasia.html. Accessed September 19, 2014 2014
- 13.John PB, Russell S, Russell PS (2007) The prevalence of posttraumatic stress disorder among children and adolescents affected by tsunami disaster in Tamil Nadu. Disaster management & response: DMR: an official publication of the Emergency Nurses Association 5(1):3–7. doi: 10.1016/j.dmr.2006.11.001 Google Scholar
- 18.Walker SP, Wachs TD, Gardner JM, Lozoff B, Wasserman GA, Pollitt E, Carter JA, Int Child Dev Steering G (2007) Child development in developing countries 2—Child development: risk factors for adverse outcomes in developing countries. Lancet 369 (9556):145–157Google Scholar
- 19.Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal depression: a study of mothers in Goa, India. vol 159. First published. doi: 10.1176/appi.ajp.159.1.43
- 21.Hussain MFA, Nauman F Maternal mental distress: a risk factor for infant under nutrition in developing countries. J Pak Med Assoc 60 (4):329–329Google Scholar
- 24.Campbell SB, Morgan-Lopez AA, Cox MJ, McLoyd VC, Natl Inst Child Hlth Human Dev E (2009) A latent class analysis of maternal depressive symptoms over 12 years and offspring adjustment in adolescence. J Abnorm Psychol 118 (3):479–493. doi: 10.1037/a0015923
- 30.Samarakkody D, Fernando D, McClure R, Perera H, De Silva H (2012) Prevalence of externalizing behavior problems in Sri Lankan preschool children: birth, childhood, and sociodemographic risk factors. Soc Psychiatry Psychiatr Epidemiol 47(5):757–762. doi: 10.1007/s00127-011-0377-5 CrossRefPubMedGoogle Scholar
- 36.Lassi ZS, Mahmud S, Syed EU, Janjua NZ (2011) Behavioral problems among children living in orphanage facilities of Karachi, Pakistan: comparison of children in an SOS Village with those in conventional orphanages. Soc Psychiatry Psychiatr Epidemiol 46(8):787–796. doi: 10.1007/s00127-010-0248-5 CrossRefPubMedGoogle Scholar
- 37.Imran N, Sattar A, Amjad N, Bhatti MR (2009) Psychological problems in children of parents with mental illness: a comparative study from Lahore, Pakistan. Pak J Med Sci 25(6):895–900Google Scholar
- 38.Rahman A, Malik A, Sikander S, Roberts C, Creed F (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372(9642):902–909PubMedCentralCrossRefPubMedGoogle Scholar
- 39.Maselko J, Sikander S, Bhalotra S, Bangash O, Ganga N, Mukherjee S, Egger H, Franz L, Bibi A, Liaqat R, Kanwal M, Abbasi T, Noor M, Ameen N, Rahman A (2015) Impact of an early perinatal depression intervention on longer-term child development outcomes. Lancet Psychiatry (in press)Google Scholar
- 43.Syed EU (2007) Comparing the urdu version of strengths and difficulties questionnaire (SDQ) and the child behavior checklist (CBCL) in a sample of 5–11 year old school children in Karachi, Pakistan. J Pak Psychiatric Soc 4(1):15–18Google Scholar
- 45.First MB, Spitzer RL, Gibbon M, Williams JB (2002) Structured clinical interview for DSM-IV-TR Axis I disorders, research version, non-patient edition. (SCID-I/NP) Biometrics Research, New York Psychiatric Institute, New YorkGoogle Scholar
- 46.Gorman LL, O’Hara MW, Figueiredo B, Hayes S, Jacquemain F, Kammerer MH, Klier CM, Rosi S, Seneviratne G, Sutter-Dallay AL, Grp T-P (2004) Adaptation of the structured clinical interview for DSM-IV disorders for assessing depression in women during pregnancy and post-partum across countries and cultures. Br J Psychiatry 184:S17–S23. doi: 10.1192/bjp.184.46.s17 CrossRefGoogle Scholar
- 49.Goodman A, Heiervang E, Fleitlich-Bilyk B, Alyahri A, Patel V, Mullick MSI, Slobodskaya H, dos Santos DN, Goodman R (2012) Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence. Soc Psychiatry Psychiatr Epidemiol 47(8):1321–1331. doi: 10.1007/s00127-011-0440-2 PubMedCentralCrossRefPubMedGoogle Scholar
- 50.Niclasen J, Teasdale TW, Andersen AMN, Skovgaard AM, Elberling H, Obel C (2012) Psychometric properties of the danish strength and difficulties questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS One. doi: 10.1371/journal.pone.0032025 PubMedCentralPubMedGoogle Scholar
- 58.Cents RAM, Diamantopoulou S, Hudziak JJ, Jaddoe VWV, Hofman A, Verhulst FC, Lambregtse-van den Berg MP, Tiemeier H (2013) Trajectories of maternal depressive symptoms predict child problem behaviour: the generation R study. Psychol Med 43(1):13–25. doi: 10.1017/s0033291712000657 CrossRefPubMedGoogle Scholar
- 61.Usami M, Iwadare Y, Watanabe K, Kodaira M, Ushijima H, Tanaka T, Harada M, Tanaka H, Sasaki Y, Okamoto S, Sekine K, Saito K (2014) Prosocial behaviors during school activities among child survivors after the 2011 earthquake and tsunami in Japan: a retrospective observational study. PLoS One. doi: 10.1371/journal.pone.0113709 Google Scholar
- 72.Goodman A, Heiervang E, Fleitlich-Bilyk B, Alyahri A, Patel V, Mullick MS, Slobodskaya H, Dos Santos DN, Goodman R (2012) Cross-national differences in questionnaires do not necessarily reflect comparable differences in disorder prevalence. Soc Psychiatry Psychiatr Epidemiol 47(8):1321–1331. doi: 10.1007/s00127-011-0440-2 PubMedCentralCrossRefPubMedGoogle Scholar
- 73.Maoz H, Goldstein T, Goldstein BI, Axelson DA, Fan JY, Hickey MB, Monk K, Sakolsky D, Diler RS, Brent D, Kupfer DJ, Birmaher B (2014) The effects of parental mood on reports of their children’s psychopathology. J Am Acad Child Adolesc Psychiatry 53(10):1111–1122. doi: 10.1016/j.jaac.2014.07.005 PubMedCentralCrossRefPubMedGoogle Scholar