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Impact of perinatal and repeated maternal common mental disorders on educational outcomes of primary school children in rural Ethiopia: population-based cohort study

  • Habtamu Mekonnen (a1), Girmay Medhin (a2), Mark Tomlinson (a3), Atalay Alem (a4), Martin Prince (a5) and Charlotte Hanlon (a6)...

Abstract

Background

There have been no studies from low- or middle-income countries to investigate the long-term impact of perinatal common mental disorders (CMD) on child educational outcomes.

Aims

To test the hypothesis that exposure to antenatal and postnatal maternal CMD would be associated independently with adverse child educational outcomes in a rural Ethiopian.

Method

A population-based birth cohort was established in 2005/2006. Inclusion criteria were: age between 15 and 49 years, ability to speak Amharic, in the third trimester of pregnancy and resident of the health demographic surveillance site. One antenatal and nine postnatal maternal CMD assessments were conducted using a self-reporting questionnaire, validated for the local use. Child educational outcomes were obtained from the mother at T1 (2013/2014 academic year; mean age 8.5 years) and from school records at T2 (2014/2015 academic year; mean age 9.3 years).

Results

Antenatal CMD (risk ratio (RR) = 1.06, 95% CI 1.05–1.07) and postnatal CMD (RR = 1.07, 95% CI 1.06–1.09) were significantly associated with child absenteeism at T2. Exposure to repeatedly high maternal CMD scores in the preschool period was not associated with absenteeism after adjusting for antenatal and postnatal CMD. Non-enrolment at T1 (odds ratio 0.75, 95% CI 0.62–0.92) was significantly but inversely associated with postnatal maternal CMD. There was no association between maternal CMD and child academic achievement or drop-out.

Conclusions

Our findings support the hypothesis of a critical period for exposure to maternal CMD for adverse child outcomes and indicate that programmes to enhance regular school attendance in low-income countries need to address perinatal maternal CMD.

Declaration of interest

None.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Correspondence: Charlotte Hanlon, Department of Psychiatry, 6th Floor, College of Health Sciences Building, PO 9086, Addis Ababa University, Addis Ababa, Ethiopia. Email: charlotte.hanlon@kcl.ac.uk

References

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1Walker, S, Wachs, T, Gardner, J, Lozoff, B, Wasserman, G, Pollitt, E, et al. Child development: risk factors for adverse outcomes in developing countries. Lancet 2007; 369: 145–57.
2Goodman, HS. Depression in mothers. Annu Rev Clin Psychol 2007; 3: 107–35.
3Estrin, GL, Ryan, EG, Trevillion, K, Demilew, J, Bick, D, Pickles, A, et al. Young pregnant women and risk for mental disorders: findings from an early pregnancy cohort. BJPsych Open 2019; 5(2): e21.
4Grace, S, Evindar, A, Stewart, D. The effect of postpartum depression on child cognitive development and behavior: a review and critical analysis of the literature. Arch Womens Ment Health 2003; 6: 263–74.
5Fisher, J, Cabral de Mello, M, Patel, V, Rahman, A, Tran, T, Holton, S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 2012; 90: 139–49.
6Hay, DF, Asten, P, Mills, A, Kumar, R, Pawlby, S, Sharp, D. Intellectual problems shown by 11-year-old children whose mothers had postnatal depression. J Child Psychol Psychiatry 2001; 42: 871–89.
7Carter, SA, Garrity-Rokous, EF, Chazan-Cohen, R, Little, C, Briggs-Gowan, JM. Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies. J Am Acad Child Adolesc Psychiatry 2001; 40: 1826.
8Brennan, AP, Andersen, JM, Hammen, C, Bor, W, Najman, MJ, Williams, MG. Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Dev Psychol 2000; 36: 759–66.
9Patel, V, DeSouza, N, Rodrigues, M. Postnatal depression and infant growth and development in low income countries: a cohort study from Goa, India. Arch Dis Child 2003; 88: 34–7.
10Servili, C, Medhin, G, Hanlon, C, Tomlinson, M, Worku, B, Baheretibe, Y, et al. Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort. BMC Public Health 2010; 10: 693.
11Tomlinson, M, Cooper, P, Murray, L. The mother–infant relationship and infant attachment in a South African peri-urban settlement. Child Dev 2005; 76: 1044–54.
12Salt, P, Galler, JR, Ramsey, CF. The influence of early malnutrition on subsequent behavioural development. VII. The effect of maternal depressive symptoms. Dev Behav Pedatrics 1988; 9: 15.
13Galler, RJ, Ramsey, CF, Harrison, HR, Taylor, J, Cumberbatch, G, Forde, V. Postpartum maternal moods and infant size predict performance on a national high school entrance examination. J Child Psychol Psychiatry 2004; 45: 1064–75.
14Berhane, Y, Wall, S, Kebede, D, Emmelin, A, Enquoselassie, F, Byass, P, et al. Establishing an epidemiological field laboratory in rural areas - potentials for public health research and interventions (Special Issue). Ethiop J Health Dev 1999; 13: 147.
15Federal Democratic Government of Ethiopia Ministry of Education. Education Statistics 2008 E.C. (2015/2016). MoE, EMIS and ICT Directorate, 2017.
16Ministry of Education. The Education and Training Policy and its Implementation. Ministry of Education, 2002.
17Chen, P, Rice, C. Showing up Matters: Newark Chronic Absenteeism in the Early Years. Advocates for Children of New Jersey, 2016.
18Gottfried, MA. The detrimental effects of missing school: evidence from urban siblings. Am J Educ 2011; 117: 147–82.
19Beusenberg, M, Orley, J. A User's Guide to the Self Reporting Questionnaire (SRQ). World Health Organization, 1994.
20Hanlon, C, Medhin, G, Alem, A, Araya, M, Abdulahi, A, Hughes, M, et al. Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale. J Affect Disorders 2008; 108: 251–62.
21Brugha, TS, Bebbington, PE, Tennant, C, Hurry, J. The list of threatening experiences: a subset of 12 life event categories with considerable long-term contextual threat. Psychol Med 1985; 15: 189–94.
22World Health Organization. Physical Status: The Use and Interpretation of Anthropometry. Technical report series No. 854. WHO, 1995.
23World Health Organization. Anthro Software Version 3.2.2. WHO, 2011 (http://wwwwhoint/childgrowth/software/en/).
24Epidata. Epidata (Version 3.1): A Comprehensive Tool for Validated Entry and Documentation of Data. [Program] (3rd edn). The Epidata Association, 2003.
25Stata C. Stata Statistical Software Release 12. Stata Corporation, 2007.
26O'Connor, GT, Heron, J, Glover, V. Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. Acad Child Adolesc Psychiatry 2002; 41: 1470–7.
27O'Connor, TG, Ben-Shlomo, Y, Heron, J, Golding, J, Adams, D, Glover, V. Prenatal anxiety predicts individual differences in cortisol in pre-adolescent children. Biol Psychiatry 2005; 58: 211–7.
28Carter, SA, Garrity-Rokous, EF, Chazan-Cohen, R, Little, C, Briggs-Gowan, JM. Maternal depression and comorbidity: predicting early parenting, attachment security, and toddler social-emotional problems and competencies. J Am Acad Child Adolesc Psychiatry 2001; 40: 1826.
29Patel, V, DeSouza, N, Rodrigues, M. Postnatal depression and infant growth and development in low income countries: a cohort study from Goa, India. Arch Dis Child 2003; 88: 34–7.
30Hadley, C, Tegegn, A, Tessema, F, Asefa, M, Galea, S. Parental symptoms of common mental disorders and children's social, motor, and language development in sub-Saharan Africa. Ann Hum Biol 2008; 35: 259–75.
31Martins, C, Gaffan, EA. Effects of early maternal depression on patterns of infant–mother attachment: a meta-analytic investigation. J Child Psychol Psychiatry 2000; 41: 737–46.
32Servili, C, Medhin, G, Hanlon, C, Tomlinson, M, Worku, B, Baheretibeb, Y, et al. Maternal common mental disorders and infant development in Ethiopia: the P-MaMiE Birth Cohort. BMC Public Health 2010; 10: 693.
33Brennan, AP, Andersen, JM, Hammen, C, Bor, W, Najman, MJ, Williams, MG. Chronicity, severity, and timing of maternal depressive symptoms: relationships with child outcomes at age 5. Dev Psychol 2000; 36: 759–66.
34Jimerson, S, Egeland, B, Sroufe, AL, Carlson, B. A prospective longitudinal study of high school dropouts examining multiple predictors across development. J School Psychol 2000; 38: 525–49.
35Mekonnen, H, Medhin, G, Tomlinson, M, Alem, A, Prince, M, Hanlon, C. Impact of maternal common mental disorders on child educational outcomes at 7 and 9 years: a population-based cohort study in Ethiopia. BMJ Open 2018; 8: e018916.
36World Health Organization. Mental Health Gap Action Programme (mhGAP): Scaling up Care for Mental, Neurological, and Substance Use Disorders. WHO, 2008.
37Clarke, K, King, M, Prost, A. Psychosocial interventions for perinatal common mental disorders delivered by providers who are not mental health specialists in low-and middle-income countries: a systematic review and meta-analysis. PLoS Med 2013; 10: e1001541.

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Impact of perinatal and repeated maternal common mental disorders on educational outcomes of primary school children in rural Ethiopia: population-based cohort study

  • Habtamu Mekonnen (a1), Girmay Medhin (a2), Mark Tomlinson (a3), Atalay Alem (a4), Martin Prince (a5) and Charlotte Hanlon (a6)...
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