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      Adversity, social capital, and mental distress among mothers of small children: A cross-sectional study in three low and middle-income countries

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          Abstract

          Background

          Maternal mental health is becoming recognized as a global health priority. Mental distress among mothers of young children may be exacerbated by exposure to adversity. Social capital may buffer the impact of adversity on mental distress during the postnatal period and beyond. This paper examines the relationship between adversity, cognitive social capital and mental distress among mothers of young children in three low and middle-income countries.

          Methods

          This study uses data from the Young Lives study on 5,485 women from Ethiopia, India, and Vietnam. Logistic regression was used to examine the association between exposure to stressful life events (SLEs) and mental distress in women between 6 months and 1.5 years post-partum. Logistic and linear regression was used to examine the potential for effect modification by social capital.

          Results

          The proportion of women with mental distress during the period between 6–18 months following the birth of a child in the sample was 32.6% in Ethiopia, 30.5% in India and 21.1% in Vietnam. For each additional SLE to which a woman was exposed, the odds of MMD increased by 1.28 (95% CI: 1.22, 1.36; p<0.001) in Ethiopia, 1.17 (1.11, 1.25; p<0.001) in India, and 1.98 (1.75, 2.25; p<0.001) in Vietnam. Exposure to family SLEs was significantly associated with MMD in all three countries with odds ratios of 1.76 (95% CI: 1.30, 2.38; p<0.001), 1.62 (95% CI: 1.12, 2.33; p<0.01 in India), 1.93 (95% CI: 1.27, 2.92; p<0.01), respectively. In Ethiopia and India, economic SLEs were also significantly associated with MMD after adjustment (Ethiopia OR: 1.68; 95% CI: 1.12, 2.52; p<0.01 and India OR: 1.44; 95% CI: 1.01, 2.05; p<0.05), while in India, crime SLEs (OR: 1.93; 95% CI: 1.27, 2.92; p<0.01) were associated with MMD. Cognitive social capital was found to modify the association between SLEs and symptomology of mental distress in Ethiopia, India and Vietnam.

          Conclusions

          This study suggests that adversity may increase the risk of maternal mental distress in three LMICs, while social capital may buffer its effect.

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          Most cited references36

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          Stress, social support, and the buffering hypothesis.

          S. Cohen, T A Wills (1985)
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            Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice.

            Harry B. Harlow, Ken Kleinman, Hadine Joffe … (2006)
            Data are scarce regarding the sociodemographic predictors of antenatal and postpartum depression. This study investigated whether race/ethnicity, age, finances, and partnership status were associated with antenatal and postpartum depressive symptoms. 1662 participants in Project Viva, a US cohort study. Mothers indicated mid-pregnancy and six month postpartum depressive symptoms on the Edinburgh postpartum depression scale (EPDS). Associations of sociodemographic factors with odds of scoring >12 on the EPDS were estimated. The prevalence of depressive symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers had a higher prevalence of depressive symptoms compared with non-Hispanic white mothers. These associations were explained by lower income, financial hardship, and higher incidence of poor pregnancy outcome among minority women. Young maternal age was associated with greater risk of antenatal and postpartum depressive symptoms, largely attributable to the prevalence of financial hardship, unwanted pregnancy, and lack of a partner. The strongest risk factor for antenatal depressive symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the strongest risk for postpartum depressive symptoms was depressive symptoms during pregnancy (6.78; 4.07, 11.31) or a history of depression before pregnancy (3.82; 2.31, 6.31). Financial hardship and unwanted pregnancy are associated with antenatal and postpartum depressive symptoms. Women with a history of depression and those with poor pregnancy outcomes are especially vulnerable to depressive symptoms during the childbearing year. Once these factors are taken in account, minority mothers have the same risk of antenatal and postpartum depressive symptoms as white mothers.
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              Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

              Jane Fisher, Meena Cabral de Mello, Vikram Patel … (2012)
              OBJECTIVE: To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. METHODS: Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. FINDINGS: Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CONCLUSION: CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.
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                Author and article information

                Contributors
                Jewel Gausman:
                ORCID: http://orcid.org/0000-0002-9880-2591
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                S. Bryn Austin: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                S. V. Subramanian: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Ana Langer: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: Writing – review & editing
                Florian Fischer: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 30 January 2020
                Publication date Collection: 2020
                Volume: 15
                Issue: 1
                Electronic Location Identifier: e0228435
                Affiliations
                [1 ] Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
                [2 ] Division of Adolescent and Young Adult Medicine, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston Children’s Hospital, Boston, MA, United States of America
                [3 ] Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America
                [4 ] Women and Health Initiative, Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, United States of America
                Bielefeld University, GERMANY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-9880-2591
                Article
                Publisher ID: PONE-D-19-09099
                DOI: 10.1371/journal.pone.0228435
                PMC ID: 6992203
                PubMed ID: 31999768
                SO-VID: f6e3f4c3-4ce0-456d-8624-a4f6e340927b
                Copyright © © 2020 Gausman et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 31 March 2019
                Date accepted : 15 January 2020
                Page count
                Figures: 3, Tables: 4, Pages: 15
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: India
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Africa
                Subject: Ethiopia
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: People and Places
                Subject: Geographical Locations
                Subject: Asia
                Subject: Vietnam
                Subject: Social Sciences
                Subject: Sociology
                Subject: Criminology
                Subject: Crime
                Subject: People and Places
                Subject: Population Groupings
                Subject: Age Groups
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Children
                Subject: People and Places
                Subject: Population Groupings
                Subject: Families
                Subject: Mothers
                Subject: Medicine and Health Sciences
                Subject: Mental Health and Psychiatry
                Subject: Mood Disorders
                Subject: Depression
                Custom metadata
                Data Availability All data files are available via the Uk Data Service at: ( http://doi.org/10.5255/UKDA-SN-5307-3) The full citation for the dataset used is: Huttly, S and Jones, N (2014). Young Lives: an International Study of Childhood Poverty: Round 1, 2002. [Data Collection]. UK Data Service, Colchester, Essex, United Kingdom. ( http://doi.org/10.5255/UKDA-SN-5307-2) To access the data used in this study, interested researchers should go to the UK Data Service website ( https://beta.ukdataservice.ac.uk/myaccount/login) and follow the instructions on the website to create a user name and password in order to access the data. Interested researchers can replicate the study findings in their entirety by directly obtaining the data from the UK Data Service. The authors of this study did not have any special access privileges to any additional data that others would not have by following the instructions above.

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