Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial. Impact of maternal depression on infant nutritional status and illness: a cohort study. Improving quality of mother-infant relationship and infant attachment in socioeconomically deprived community in South Africa: randomised controlled trial Nutrition in early life and the fulfillment of intellectual potential. Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial Effects of support group intervention in postnatally distressed women. A controlled study in Taiwan. Maternal depressive symptoms, parenting self-efficacy, and child growth. The effectiveness of counseling on anxiety and depression by minimally trained counselors: a randomized controlled trial.
CONTEXT Despite the importance of mental illness in Africa , few controlled intervention trials related to this problem have been published . OBJECTIVES To test the efficacy of group interpersonal psychotherapy in alleviating depression and dysfunction and to evaluate the feasibility of conducting controlled trials in Africa . DESIGN , SETTING , AND PARTICIPANTS For this cluster r and omized , controlled clinical trial ( February-June 2002 ) , 30 villages in the Masaka and Rakai districts of rural Ug and a were selected using a r and om procedure ; 15 were then r and omly assigned for study ing men and 15 for women . In each village , adult men or women believed by themselves and other villagers to have depressionlike illness were interviewed using a locally adapted Hopkins Symptom Checklist and an instrument assessing function . Based on these interviews , lists were created for each village totaling 341 men and women who met Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition ( DSM-IV ) criteria for major depression or subsyndromal depression . Interviewers revisited them in order of decreasing symptom severity until they had 8 to 12 persons per village , totaling 284 . Of these , 248 agreed to be in the trial and 9 refused ; the remainder died or relocated . A total of 108 men and 116 women completed the study and were reinterviewed . INTERVENTION Eight of the 15 male villages and 7 of the 15 female villages were r and omly assigned to the intervention arm and the remainder to the control arm . The intervention villages received group interpersonal psychotherapy for depression as weekly 90-minute sessions for 16 weeks . MAIN OUTCOME MEASURES Depression and dysfunction severity scores on scales adapted and vali date d for local use ; proportion of persons meeting DSM-IV major depression diagnostic criteria . RESULTS Mean reduction in depression severity was 17.47 points for intervention groups and 3.55 points for controls ( P<.001 ) . Mean reduction in dysfunction was 8.08 and 3.76 points , respectively ( P<.001 ) . After intervention , 6.5 % and 54.7 % of the intervention and control groups , respectively , met the criteria for major depression ( P<.001 ) compared with 86 % and 94 % , respectively , prior to intervention ( P = .04 ) . The odds of postintervention depression among controls was 17.31 ( 95 % confidence interval , 7.63 - 39.27 ) compared with the odds among intervention groups . Results from intention-to-treat analyses remained statistically significant . CONCLUSIONS Group interpersonal psychotherapy was highly efficacious in reducing depression and dysfunction . A clinical trial proved feasible in the local setting . Both findings should encourage similar trials in similar setting s in Africa and beyond BACKGROUND The risk for emotional and behavioral problems is known to be high among children of depressed mothers , but little is known about the impact of prenatal and postnatal depression on the physical health of infants . OBJECTIVE To determine whether maternal depression is a risk factor for malnutrition and illness in infants living in a low-income country . DESIGN Prospect i ve cohort study . SETTING Rural community in Rawalpindi , Pakistan . PARTICIPANTS Six hundred thirty-two physically healthy women were assessed in their third trimester of pregnancy to obtain at birth a cohort of 160 infants of depressed mothers and 160 infants of psychologically well mothers . MAIN OUTCOME MEASURES All infants were weighed and measured at birth and at 2 , 6 , and 12 months of age , and they were monitored for episodes of diarrhea and acute respiratory infections . The mothers ' mental states were reassessed at 2 , 6 , and 12 months . Data were collected on potential confounders of infant outcomes , such as birth weight and socioeconomic status . RESULTS Infants of prenatally depressed mothers showed significantly more growth retardation than controls at all time points . The relative risks for being underweight ( weight-for-age z score of less than -2 ) were 4.0 ( 95 % confidence interval [ CI ] , 2.1 to 7.7 ) at 6 months of age and 2.6 ( 95 % CI , 1.7 to 4.1 ) at 12 months of age , and the relative risks for stunting ( length-for-age z score of less than -2 ) were 4.4 ( 95 % CI , 1.7 to 11.4 ) at 6 months of age and 2.5 ( 95 % CI , 1.6 to 4.0 ) at 12 months of age . The relative risk for 5 or more diarrheal episodes per year was 2.4 ( 95 % CI , 1.7 to 3.3 ) . Chronic depression carried a greater risk for poor outcome than episodic depression . The associations remained significant after adjustment for confounders by multivariate analyses . CONCLUSIONS Maternal depression in the prenatal and postnatal periods predicts poorer growth and higher risk of diarrhea in a community sample of infants . As depression can be identified relatively easily , it could be an important marker for a high-risk infant group . Early treatment of prenatal and postnatal depression could benefit not only the mother 's mental health but also the infant 's physical health and development Objective To assess the efficacy of an intervention design ed to improve the mother-infant relationship and security of infant attachment in a South African peri-urban settlement with marked adverse socioeconomic circumstances . Design R and omised controlled trial . Setting Khayelitsha , a peri-urban settlement in South Africa . Participants 449 pregnant women . Interventions The intervention was delivered from late pregnancy and for six months postpartum . Women were visited in their homes by previously untrained lay community workers who provided support and guidance in parenting . The purpose of the intervention was to promote sensitive and responsive parenting and secure infant attachment to the mother . Women in the control group received no therapeutic input from the research team . Main outcome measures Primary outcomes : quality of mother-infant interactions at six and 12 months postpartum ; infant attachment security at 18 months . Secondary outcome : maternal depression at six and 12 months . Results The intervention was associated with significant benefit to the mother-infant relationship . At both six and 12 months , compared with control mothers , mothers in the intervention group were significantly more sensitive ( 6 months : mean difference=0.77 ( SD 0.37 ) , t=2.10 , P<0.05 , d=0.24 ; 12 months : mean difference=0.42 ( 0.18 ) , t=−2.04 , P<0.05 , d=0.26 ) and less intrusive ( 6 months : mean difference=0.68 ( 0.36 ) , t=2.28 , P<0.05 , d=0.26 ; 12 months : mean difference=−1.76 ( 0.86 ) , t=2.28 , P<0.05 , d=0.24 ) in their interactions with their infants . The intervention was also associated with a higher rate of secure infant attachments at 18 months ( 116/156 ( 74 % ) v 102/162 ( 63 % ) ; Wald=4.74 , odds ratio=1.70 , P<0.05 ) . Although the prevalence of maternal depressive disorder was not significantly reduced , the intervention had a benefit in terms of maternal depressed mood at six months ( z=2.05 , P=0.04 ) on the Edinburgh postnatal depression scale ) . Conclusions The intervention , delivered by local lay women , had a significant positive impact on the quality of the mother-infant relationship and on security of infant attachment , factors known to predict favourable child development . If these effects persist , and if they are replicated , this intervention holds considerable promise for use in the developing world . Trial registration Current Controlled Trials IS RCT N25664149 The effects of early supplementary feeding on cognition are investigated using data collected during two periods in four Guatemalan villages . The first was the Institute of Nutrition of Central America and Panama ( INCAP ) longitudinal study from 1969 to 1977 and the second was a cross-sectional follow-up of former participants carried out in 1988 - 1989 . The principal objective of these studies was to assess the differential effect of two dietary supplements , Atole containing 163 kcal/682 kJ and 11.5 g protein per cup or 180 mL and Fresco containing 59 kcal/247 kJ and 0 g protein per cup , that were given to mothers , infants and young children . Performance was assessed on a battery of psychoeducational and information processing tests that were administered during adolescence . Consistent differences between groups were observed on psychoeducational tests . Subjects receiving Atole  scored significantly higher on tests of knowledge , numeracy , reading and vocabulary than those given Fresco . Atole ingestion also was associated with faster reaction time in information processing tasks . In addition , there were significant interactions between type of dietary supplement and socioeconomic status ( SES ) of subjects . In Atole villages , there were no differences in performance between subjects in the lowest and highest SES categories . On the other h and , performance in Fresco villages was best in the highest compared with the lowest SES group . After close scrutiny of alternative hypotheses , it is concluded that dietary changes produced by supplementation provide the strongest explanation for the test performance differences observed in the follow-up between subjects exposed to Atole and those exposed to Fresco supplementation Summary Background The treatment of perinatal depression is a public-health priority because of its high prevalence and association with disability and poor infant development . We integrated a cognitive behaviour therapy-based intervention into the routine work of community-based primary health workers in rural Pakistan and assessed the effect of this intervention on  maternal depression and infant outcomes . Methods We r and omly assigned 40 Union Council clusters in rural Rawalpindi , Pakistan , in equal numbers to intervention or control . Married women ( aged 16–45 years ) in their third trimester of pregnancy with perinatal depression were eligible to participate . In the intervention group , primary health workers were trained to deliver the psychological intervention , whereas in the control group untrained health workers made an equal number of visits to the depressed mothers . The primary outcomes were infant weight and height at 6 months and 12 months , and secondary outcome was maternal depression . The interviewers were unaware of what group the participants were assigned to . Analysis was by intention to treat . The study is registered as IS RCT N65316374 . Findings The number of clusters per group was 20 , with 463 mothers in the intervention group and 440 in the control group . At 6 months , 97 ( 23 % ) of 418 and 211 ( 53 % ) of 400 mothers in the intervention and control groups , respectively , met the criteria for major depression ( adjusted odds ratio ( OR ) 0·22 , 95 % CI 0·14 to 0·36 , p<0·0001 ) . These effects were sustained at 12 months ( 111/412 [ 27 % ] vs 226/386 [ 59 % ] , adjusted OR 0·23 , 95 % CI 0·15 to 0·36 , p<0·0001 ) . The differences in weight-for-age and height-for-age Z scores for infants in the two groups were not significant at 6 months ( −0·83 vs −0·86 , p=0·7 and −2·03 vs −2·16 , p=0·3 , respectively ) or 12 months ( −0·64 vs −0·8 , p=0·3 and −1·10 vs −1·36 , p=0·07 , respectively ) . Interpretation This psychological intervention delivered by community-based primary health workers has the potential to be integrated into health systems in re source -poor setting s. Funding Wellcome Trust OBJECTIVE The symptoms of depression experienced by women during the postnatal period may have profound effects on the lifelong health of both the mother and the child . In this r and omized controlled study , we systematic ally evaluated the effects of weekly supportive group meetings for women with postnatal distress . METHODS Sixty postnatally distressed women were r and omly assigned to support ( n=30 ) and control ( n=30 ) groups . Women assigned to the support group participated in four supportive group sessions that comprised discussion s concerning transition to motherhood , postnatal stress management , communication skills , and life planning . RESULTS Subjects who attended the support sessions had significantly decreased scores on the Beck Depression Inventory ( BDI ) and the Perceived Stress Scale ( PSS ) , and significantly increased scores on the Interpersonal Support Evaluation List ( ISEL ) as evaluated at the end of the fourth weekly session . In contrast , no significant changes were observed in the control group during this period . CONCLUSION This is the first controlled study to provide evidence that participation in support groups for postnatally distressed women provides quantifiable psychosocial benefits OBJECTIVES We assessed whether maternal depressive symptoms and parenting self-efficacy were associated with  child growth delay .  METHODS We collected data from a r and om sample of 595 low-income mothers and their children aged 6 to 24 months in Teresina , Piauí , Brazil , including information on sociodemographic characteristics , mothers '  depressive symptoms  and  parenting self-efficacy  , and children 's anthropometric characteristics .  We used adjusted logistic regression models in our analyses . RESULTS Depressive symptoms among mothers were associated with 1.8 times higher odds ( 95 % confidence interval [ CI ] = 1.1 , 2.9 ) of short stature among children . Parenting self-efficacy was not associated with short stature , nor did it mediate or modify the relationship between depressive symptoms and short stature . Maternal depressive symptoms and self-efficacy were not related to child underweight . CONCLUSIONS Our results showed that among low-income Brazilian families  maternal depressive symptoms , but not self-efficacy , were associated with short stature in children aged 6 to 24 months after adjustment for known predictors of growth OBJECTIVE To assess if eight counseling sessions conducted by women minimally trained as community counselors  could reduce the mean level of anxiety and /or depression in women of their own community . DESIGN A r and omized controlled trial . SETTING A lower-middle-class , semi-urban community in Karachi , Pakistan . PARTICIPANTS 366 anxious and /or depressed women providing informed consent . METHOD Through systematic sampling , 1226 women were screened using an indigenous instrument . Out of these , 366 women were found to have anxiety and /or depression and were r and omized to intervention and control groups . Women from the same community were trained in 11 sessions as counselors . Subjects in the intervention group were counseled once weekly for eight weeks by the trained community counselors . After the 8th session , the screening question naire was re-administered to both the groups . RESULTS A significant reduction was found between the mean anxiety and depression scores of the two groups ( p value = 0.000 ) . CONCLUSION Counseling by minimally trained community counselors reduced levels of anxiety and /or depression in women of their own community
OBJECTIVE To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta- analysis .