TRAJECTORIES OF MATERNAL DEPRESSION AND THE IMPACT ON CHILD COGNITIVE DEVELOPMENT: LONGITUDINAL DATA ANALYSIS WITH INTERNATIONAL PARTICIPANTS FROM THE MAL-ED STUDY

Abstract

Depression is recognized as a disabling and impairing condition, impacting mood, cognitions, and daily functioning (APA, 2013; WHO, 2017). Women are more likely to develop depression than men (Gutierrez-Lobos et al., 2002; Noble, 2005). The perinatal period is a sensitive time when mothers are vulnerable to developing depression (Noble, 2005; Schiller et al., 2015). Further, postpartum depression is a risk factor for negative outcomes for both mother and child (Goodman & Gotlib, 1999), including child cognitive development (Grace et al., 2003). The onset and course of depression involves a variety of biopsychosocial components that are often accounted for in research on maternal depression (Billings & Moos, 1993; Cummings & Davies, 1994; Nobel, 2005). Examining the severity, chronicity, and time of onset of maternal depression reveals specific patterns or trajectories for the mother’s experience; these trajectories can provide better understanding of maternal depression and its impact on child development (Brennan et al., 2000). Maternal depression is prevalent yet under-studied and under-identified in low-middle income countries (LMICs), with most research of postpartum depression centering Western and English-speaking families (Gelaye et al.,2016; Halbreich &Karkun, 2006). To better understand and treat maternal depression across cultures, research is needed in diverse locations with culturally sensitive methods. The purpose of the present study is to identify trajectories of maternal depression in diverse, international locations including LMICs. The MAL-ED Study involves eight study sites (Dhaka, Bangladesh (BGD); Fortaleza, Brazil (BRF); Vellore, India; (INV), Bhaktapur, Nepal (NEB); Loreto, Peru (PEL); Naushahro Feroze, Pakistan (PKN); Venda, South Africa (Dzimauli Community, SAV); and Haydom, Tanzania (TZH)) and incorporates several health-related factors pertaining to mothers and children (Murray-Kolb et al., 2014). The present study included five of the eight international sites. Maternal depression, as measured by the Self-Report Questionnaire (SRQ; Beusenberg & Orley, 1994), was assessed across the first two years postpartum, allowing for longitudinal analysis of trajectory using latent class growth analysis (LCGA). Maternal depression trajectories differed across the five sites, but demonstrated a general pattern of high, moderate, and low symptoms for the total sample. Path models were used to determine if there was a relationship between maternal depression trajectories and child cognitive development as measured by the Bayley Scales for Infant and Toddler Development, 3rd Edition (BSID-III, Bayley, 2009) for the total sample. To address the influence of contextual factors, the Home Observation for the Measurement of the Environment (HOME; Caldwell & Bradley, 1984, 2003) was incorporated in analysis as a mediator. However, the mediation analysis was not statistically significant and maternal depression trajectory was not a strong predictor of child cognitive development with the total sample. The results indicated that better home environment predicted improved cognitive scores, regardless of maternal depression trajectories. The present study provided evidence that maternal depression trajectories varied based on cultural group. Although maternal depression trajectories did not predict child cognitive development with the total sample, future research can explore trajectories in each location and relationships with other variables. Additionally, further investigation of how the home environment impacts child cognitive development in the five different locations can be informative for providing services to children and their families.