Maternal mental illness, infant growth and infant psychomotor functioning in rural Masaka district, Uganda : a longitudinal cohort study
Year: 2020
Type: dissertation
Study design: Observational Study
Abstract: Background: Maternal mental illness (postpartum depression, generalised anxiety disorder [GAD] or Acute Adjustment Disorder with Anxiety (AADA), and comorbidity of maternal postpartum depression and GAD) occur during a critical stage in the infant's life.It is a stage in life when the infant psychomotor functioning and growth is likely to be affected by maternal mental illness.The purpose of the study was to investigate the association between maternal mental illness at six weeks and six months postpartum, infant growth and infant psychomotor functioning in rural Masaka district.Methods: A longitudinal cohort study design was used and quantitative methods used for data collection and analysis.Mother-infant dyads were assessed at six weeks postpartum (baseline) and followed up when the infants were six months old (follow-up).A total of 167 and 149 mother-infant dyads were investigated at baseline and follow-up, respectively.Postpartum depression, GAD, and comorbidity of maternal postpartum depression and GAD) was measured using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis I Disorders-Research Version-Non-Patient Edition (SCID-I-RV/NP), The Edinburgh Postnatal Depression Scale (EPDS) and The Self-ReportingQuestionnaire (SRQ-20).Relationship discord was measured using the Relationship Dynamics Scale (RDS) while Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS).Poverty was measured using an asset register Infant growth was measured using a portable digital weighing scale and with a tape measure.Psychomotor development was measured using the Kilifi Developmental Inventory (KDI) and the Developmental Milestones Checklist (DMC).Data was analysed using the IBM Statistical Package for the Social Sciences (IBM SPSS Version 23) computer program.The WHO's ANTHRO software (World Health Organization, 2011) was used for the anthropometric calculations.In the bivariate analysis, in weight for height Z-score (WHZ) for infants whose mothers were depressed (M= .60,SD=1.53) and those whose mothers were not depressed (M= 1.28, SD=1.28), t (147) = 2.17, p = 0.032).There was a significant difference in WAZ for infants at six months postpartum whose mothers were exclusively breastfeeding at six weeks postpartum(M= -.18, SD=1.25) and those whose mothers were not (M= -.84, SD=1.00), t (147) = 2.43, p = 0.016).There was a significant difference in WHZ for infants at six months postpartum whose mothers were exclusively breastfeeding at six weeks postpartum(M= 1.28, SD=1.36) and those whose mothers were not (M= .68,SD=1.12), t (147) = 2.03, p = 0.044).There was a significant difference in language development of Infants whose mothers were depressed at six weeks postpartum (M= 3.88, SD=1.06) and those whose mothers were not depressed (M= 4.32, SD=1.23), t (147) = 2.17, p = 0.031).There was a significant difference in language development of Infants whose mothers were psychologically distressed at six weeks postpartum (M= 3.83, SD=1.14) and those whose mothers were not (M=4.40,SD=1.17), t (147) = 2.91, p = 0.004).Maternal depression at six weeks postpartum was associated with maternal depression at six months postpartum X 2 (1, N = 149) 3.89, p = .049.Maternal AADA at six weeks postpartum was associated with maternal depression at six months postpartum X 2 (1, N = 149) 4.90, p = .027.Maternal psychological distress at six weeks postpartum was associated with maternal depression at six months postpartum X 2 (1, N = 149) 18.16, p = < .001.Maternal psychological distress at six weeks postpartum was associated with maternal GAD at six months postpartum X 2 (1, N = 149) 11.02, p = < .001.Maternal psychological distress at six weeks postpartum was associated with maternal psychological distress at six months postpartum X 2 (1, N = 149) 7.61, p = < 006.Maternal psychological distress at six weeks postpartum was associated with comorbidity at six months postpartum X 2 (3, N = 149) 23.20, p = < .001.There was a significant association between poverty and maternal psychological distress X 2 (4, N = 149) 11.73, p = .019.There was a v significant association between relationship discord at six months postpartum and depression X 2 (2, N = 149) 24.50, p = <.001.Furthermore, there was a significant association between relationship discord at six months and maternal psychological distress X 2 (2, N = 149) 18.84, p = <.001.There was also a significant association between relationship discord at six months and comorbidity of maternal depression and maternal GAD X 2 (2, N = 149) 30.45, p = <.001.Results from the DMC showed that a strong positive correlation between psychomotor functioning and social support r(147)=.189 p=.021.KDI results showed no significant relationship between psychomotor functioning and relationship discord or social support r(147)=.273 p=.001.Relationship discord at six weeks postpartum was negatively related with locomotor functioning on the KDI at six months postpartum r(147)=-.194p=.018.On the DMC, relationship discord at six weeks postpartum was negatively correlated with language development at six months postpartum r(147)=.-.179p=.029As far as effectiveness of Screening Tools for Depression was concerned, the ROC analysis was run for the EPDS and SRQ-20 using the SCID as a gold standard for diagnosis.The results of ROC analysis for the EPDS and the SCID show that the EPDS at the baseline had an AUC of 0.92 (95% CI: 0.88-0.97)with a standard error of 0.22 while the results of ROC analysis for the SRQ-20 at the baseline had an AUC of 0.78 (95% CI: 0.69-0.86)with a standard error of 0.042, indicating fair accuracy.The results of ROC analysis show that the EPDS with an ROC area of 0.92 performed significantly better as a screening tool for depression than the SRQ-20, which had an ROC area of 0.87 Multiple logistic regression was performed to find out which predictor variables were strongest in predicting maternal mental illness.For maternal depression at six weeks postpartum three independent variables -SSE, relationship discord and social supportwere included in the analysis.The strongest predictor of maternal depression was relationship vi discord with an odds ratio of 1.17.For maternal psychological distress at six weeks postpartum, relationship discord and social support were assessed as predictors for maternal psychological distress.Relationship discord significantly contributed to the model and was the strongest predictor of maternal psychological distress with an odds ratio of 1.4.Relationship discord at six months, relationship discord at six weeks, maternal psychological distress at six weeks, maternal AADA at six weeks and maternal depression at six weeks were included in the analysis as independent variables for maternal depression at six months.The strongest predictor of maternal depression at six months was relationship discord at six months, recording an odds ratio of 1.18.Poverty, maternal psychological distress at six weeks postpartum and relationship discord were included in the analysis as predictors for psychological distress.The strongest predictor of maternal psychological distress was poverty, recording an odds ratio of 9.23.Conclusion: This study shows that maternal mental illness is a significant predictor of infant growth and psychomotor development in rural Uganda.The research provides useful information regarding the factors that impact maternal mental health provision of system interventions within the communities, that is critical for averting adverse impacts of maternal mental illness on the infant's growth and infant psychomotor functioning.A high level of prevalence for maternal mental illness in rural areas was observed as compared to urban settings in other studies.This study informs and improves our understanding of infant growth and infant psychomotor functioning, providing evidence for interventions at the psychological, social and public health levels that focus not only on the participants but also on the infants. in the Department of Psychology, Stellenbosch University, for his support.I would like to take this oppourntiy to thank Prof Nadio Tony for his support, encouragement and believing in me.I am particularly thankful to my wife Samallie for her support, prayers, love and encouragement throughout my PhD study, and for looking after our children while I was away.Thanks to my lovely children Elisy, Erica and Evana
Author: Simon Kizito
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Universiteit Stellenbosch
OpenAlex ID: W3133374634