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Open Access Research article

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

Chiara Servili1, Girmay Medhin2, Charlotte Hanlon34*, Mark Tomlinson5, Bogale Worku6, Yonas Baheretibeb3, Michael Dewey4, Atalay Alem3 and Martin Prince4

Author Affiliations

1 Department of Psychiatry, University of Modena and Reggio Emilia, Italy

2 Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Addis Ababa, Ethiopia

3 Department of Psychiatry, Faculty of Medicine, Addis Ababa University, Addis Ababa, Ethiopia

4 King's College London (Institute of Psychiatry), Health Service and Population Research Department, De Crespigny Park, London, UK

5 Department of Psychology, Stellenbosch University, Matieland, South Africa

6 Department of Paediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia

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BMC Public Health 2010, 10:693  doi:10.1186/1471-2458-10-693

Published: 12 November 2010

Abstract

Background

Chronicity 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.

Methods

A 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.

Results

Antenatal maternal CMD symptoms were associated with poorer infant motor development (<a onClick="popup('http://www.biomedcentral.com/1471-2458/10/693/mathml/M1','MathML',630,470);return false;" target="_blank" href="http://www.biomedcentral.com/1471-2458/10/693/mathml/M1">View MathML</a> -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 (<a onClick="popup('http://www.biomedcentral.com/1471-2458/10/693/mathml/M1','MathML',630,470);return false;" target="_blank" href="http://www.biomedcentral.com/1471-2458/10/693/mathml/M1">View MathML</a> = -0.80; 95%CI -2.24, 0.65 for ante- or postnatal CMD only, <a onClick="popup('http://www.biomedcentral.com/1471-2458/10/693/mathml/M1','MathML',630,470);return false;" target="_blank" href="http://www.biomedcentral.com/1471-2458/10/693/mathml/M1">View MathML</a> = -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 <a onClick="popup('http://www.biomedcentral.com/1471-2458/10/693/mathml/M1','MathML',630,470);return false;" target="_blank" href="http://www.biomedcentral.com/1471-2458/10/693/mathml/M1">View MathML</a> 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.

Conclusions

The 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.