Global Health
Perinatal depression, maternal engagement, and child social-emotional development in Kenya Anna Larsen* Anna Larsen John Kinuthia Felix Abuna Julia C. Dettinger Lauren Gomez Mary Marwa Nancy Ngumbau Ben Odhiambo Salphine Watoyi Joshua Stern Barbra A. Richardson Grace John-Stewart Jillian Pintye
We assessed relationships between perinatal depression, mother-child engagement, and child social-emotional development among Kenyan mother-child pairs.
Mother-child pairs attending maternal-child health services in four sites in Western Kenya were followed from pregnancy through early childhood. Study nurses serially assessed perinatal depression (pregnancy, 6 weeks, and 9 months postpartum with the Center for Epidemiologic Studies Depression scale, CESD-10 scores ≥10), mother-child engagement activities (6-monthly, 24 to 60 months post-delivery with UNICEF Multiple Indicator Cluster Surveys), and child social-emotional delay (6-monthly, 30 to 60 months post-delivery with Ages and Stages Questionnaires). We used generalized estimating equations to identify correlates of low mother-child engagement and social-emotional delay.
Among 884 mothers, median age was 26 years (IQR:22.0-30.3), 92% were married, and 37% had perinatal depression. High mother-child engagement (≥4 activities in prior 3-days) ranged 27%-94% from 24 to 60 months post-delivery. Frequency of child social-emotional delay ranged 4%-27% from 30 to 60 months (higher frequency earlier in childhood). Low mother-child engagement at any point (<4 activities) was more common among women with perinatal depression (aRR:1.2, 95% CI:1.1-1.3) and associated with twice the risk of child social-emotional delay (aRR:2.2, 95% CI: 1.8-2.8). Mothers who reported adverse childhood experiences (ACES) (aRR:1.1, 95% CI:1.0-1.1) and intimate partner violence (IPV) (aRR:1.3, 95% CI:1.1-1.5) interacted less frequently with their children than women not reporting these experiences. Having a mother with more ACES (aβ:0.8, 95% CI:0.03-1.6) and IPV (aβ:4.7, 95% CI:0.9-8.6) increased a child’s risk of poorer social-emotional development.
In this large cohort of Kenyan mother-child pairs, maternal perinatal depression was associated with lower mother-child engagement, which doubled risk of child social-emotional delay.
