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Centre de recherche
Tuesday, September 20 2016

Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries

MONTRÉAL, September 20, 2016 – A special 2-part series published this week in the The Lancet Psychiatry highlights the important influence of maternal depression on early child development, with a focus on low and middle income countries. Prevalence of maternal depression in low- and middle-income countries is two- to three- times higher than in high-income countries. A review in this series more specifically considered how maternal depression might be associated with child mental health in low- and middle-income countries, where most of today's children live. Both biological and psychosocial factors were used to show how maternal depression during pregnancy and depression in the postnatal period could be associated with compromised child development, albeit through different mechanisms. The review was carried out by a team of researchers from Canada (Herba), Peru (Rondon) and the UK (Glover & Ramchandani).

"A better understanding of the factors and the mechanisms implicated will be important for developing more effective interventions" reported Dr. Catherine Herba, lead author of the study, who is a researcher at CHU Sainte-Justine Research Center and assistant professor in the Department of Psychology at UQAM. However, studies examining mechanisms are lacking in low- and middle-income countries where maternal depression is highly prevalent and stressful factors are heightened. Although the authors highlight that the mechanisms linking maternal depression and child outcome are likely similar in high income versus low and middle-income countries, it is probable that the context in which the depression occurs is different. For instance, in many low and middle income countries, mothers may face additional challenges, such as important threats to their well-being and health (e.g. through nutritional deficits and increased prevalence of illnesses such as HIV or Tuberculosis) and heightened political and interpersonal violence. An accompanying review in this series by Gelaye and colleagues* highlights a number of risk factors for maternal depression such as intimate partner violence, child abuse, maternal low educational attainment and socio-economic status, as well as little social support.

Dr. Vivette Glover, a professor at Imperial College London in the UK and a co-author of the study, also noted that "during pregnancy, maternal depression may impact child outcomes through altered placental function, changes in gene expression in the child and also increased reactivity to stress. As well, dietary deficiencies in both the mother and child and infection, may also affect outcome". Dr. Ramchandani, a co-author from Imperial College London, added that 'an important challenge is to disentangle the complex nature of depression and its interplay with other related risk factors, such as nutritional deficiencies, serious infections like HIV and other psychosocial adversities'.

Dr. Rondon, a psychiatrist in Peru and co-author, noted that 'strategies striving to address the problem of maternal depression will likely require a multi-faceted social approach that can address a range of issues including  violence against women and children, poverty, poor ,education, and inequitable access to  health services'.

Both reviews in this series highlighted the importance of conducting longitudinal studies in these countries. 'Such studies incorporating both biological and psychosocial information will be important to help us to understand how children exposed to maternal depression may be at increased risk for a range of difficulties' added Dr. Herba. She further highlighted that it would be important to conduct intervention studies across different low and middle-income countries to be able to develop appropriate interventions that take account of socio-cultural factors that can vary widely across these settings.

The authors conclude that a better integration of maternal mental health into perinatal and primary health care settings in low-income and middle-income countries is of central importance.

About the study

The study “Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries” was published in the prestigious journal The Lancet Psychiatry on September 17, 2016. Findings were based on previously published studies on maternal depression and child outcome. Researchers from the Université du Québec à Montréal, Universidad Peruana Cayetano Heredia, and Imperial College London contributed to this review.


CHU Sainte-Justine research center

CHU Sainte-Justine Research Center is a leading mother-child research institution affiliated with Université de Montréal. It brings together more than 200 research investigators, including over 90 clinician-scientists, as well as 385 graduate and postgraduate students focused on finding innovative prevention means, faster and less invasive treatments, as well as personalized approaches to medicine. The Center is part of CHU Sainte-Justine, which is the largest mother-child center in Canada and second pediatric center in North America. More on research.chusj.org

Université du Québec à montréal

Located in the heart of one of the most beautiful metropolises in North America, Université du Québec à Montréal (UQAM) is defined by its urban character and its openness to the world. It is a public, French-language university, with a campus in one of Montreal’s most stimulating neighbourhoods, reminiscent of European charm in the heart of French North America. The quality of its programs, its research activities grounded in social concerns, and its innovations in the arts have helped establish UQAM’s reputation at home and around the world. A window on the world, UQAM integrates an international dimension in all its programs, and attracts students from diverse backgrounds and cultures. It has established a network of international partnerships that facilitates exchanges and joint activities abroad for its students and faculty members. UQAM is signatory to the Berlin Declaration on open access to knowledge in the sciences and the humanities. More on www.uqam.ca


CHU Sainte-Justine

Communications, Centre de recherche du CHU Sainte-Justine

Media contact:
Mélanie Dallaire
Senior consultant, Media Relations
CHU Sainte-Justine
Office : 514-345-7707 / Pager : 514-415-5727

Persons mentioned in the text

* Bizu Gelaye, Marta B Rondon, Ricardo Araya, Michelle A Williams: "Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries", The Lancet Psychiatry, September 17, 2016

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