Maternal depression and child development at 3 years of age: a longitudinal study in a Brazilian child development promotion program.

BACKGROUND: We tested the hypothesis that children of non-depressed mothers perform better in a developmental test at 3 years than children of depressed mothers. METHOD: Longitudinal analysis from a trial to assess the impact of a child development promotion program in 30 Brazilian municipalities. Mothers and children were appraised at first-year post-partum, 1 and 3 years after enrollment. Child development was assessed through the Ages and Stages Questionnaire (ASQ3) and maternal depression through the Edinburgh Postnatal Depression Scale (EPDS). Crude and adjusted beta coefficients were obtained by linear regression before and after multiple imputation. RESULTS: In total, 2098 mother/child dyads were included and 8.2% of the mothers had persistent depressive symptoms. There was a decrease in ASQ3 as the number of follow-ups with EPDS ≥ 10 increased (p for trend <0.001). In adjusted analysis, the direction of the association persisted but lost statistical significance. After multiple imputation, children from mothers with EPDS ≥ 10 in three follow-ups presented a decrease of about 14 points in ASQ3 (adjusted beta coefficient = -13.79; -22.59 to -5.00) (p for trend = 0.001). CONCLUSIONS: Identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil. IMPACT: In our population study, almost one in every ten women presented persistent depression symptoms across the first 3 years postpartum. In adjusted analysis there was a detrimental impact of persistent maternal depression on child development at 3 years of age. The persistent exposure to maternal depression across early childhood negatively influences children's development. Considering its prevalence, identification of women at increased risk of depression should be among the primary health care sector priorities in maternal and child health in Brazil.

Course of depression during the first 2 years postpartum among Brazilian women enrolled in a conditional cash transfer program.

BACKGROUND: Women living in low- and middle-income countries are more exposed to known risk factors for depression occurrence and persistency over time. AIM: Our aim was to investigate the course of depression in the first 2 years postpartum among Brazilian women enrolled in a cash transfer program. METHOD: Longitudinal analysis of baseline (T0; mean 3.7 months postpartum) and first follow-up data (T1; mean 18.6 months postpartum) from a trial to assess the impact of a child development promotion program in 30 municipalities from six Brazilian states. The program does not include any interventions against maternal depression. The Edinburgh Postnatal Depression Scale (EPDS) at cutoff ⩾10 was applied. Women were categorized into four groups based on EPDS at T0 and T1: absence of depression, persistence, discontinuity, or emergence pattern. Adjusted Poisson regressions were run using a multilevel hierarchical model. RESULTS: Two thousand eight hundred sixty-three women were assessed. Prevalence of depression was 26.4% [24.8, 28.1] at T0 and 24.4% [22.8, 26.0] at T1. Persistence, discontinuation, and emergence were found in 14.1% [11.3, 17.6%], 12.8% [11.4, 14.3%], and 10.2% [8.0, 13.0], respectively. In adjusted analyses, the persistence pattern was directly associated with parity and inversely associated with schooling of the woman and of the child's father. Living with husband/partner and support from the child's father and family members during pregnancy were protective against persistence. The discontinuity and the emergence patterns were not associated with any of the exposure variables. CONCLUSIONS: Depressive symptoms were highly prevalent during the first 2 years postpartum. About half of the women with depression at T1 were persistent cases that could have been detected earlier. Screening for maternal depression should be an essential component in every encounter of women with health professionals in primary health care settings.

Post-partum depression: a cross-sectional study of women enrolled in a conditional cash transfer program in 30 Brazilian cities.

OBJECTIVE: Investigate factors associated with symptoms of postpartum depression in mothers from families in social vulnerability. METHODS: Information was used from the baseline of a randomized trial to assess a child development program that enrolled 3,242 children < 12 months of age from beneficiary families of the Bolsa Família Program residing in 30 municipalities (counties) in six states of Brazil. The Edinburgh Postnatal Depression Scale (EPDS) was applied to the mothers, and depression was defined as score ≥10. Information on the mother (schooling, age, parity, marital status, skin color, smoking, number of prenatal appointments, and planning of the pregnancy), family (paternal schooling, household crowding, support from the child's father and the family during the pregnancy, and number of children under 7 years living in the household), and infant (sex, gestational age, birthweight, Apgar score, and child's age at the time of the interview) was collected. Prevalence rates for depressive symptoms were calculated with crude and adjusted odds ratios (OR) and 95% confidence intervals (95%CI), using hierarchical logistic regression, in a multilevel model. RESULTS: The analysis included 3,174 mothers with information on EPDS. The interviews were conducted on average 7.9 months (standard deviation= 2.9) after childbirth. Overall prevalence of depressive symptoms was 26.5% (25.0-28.1%). In the adjusted analysis, higher parity was associated with higher odds of postpartum depression (p <0.001). Women with ≥3 previous deliveries showed an odds 84% higher of presenting depressive symptoms (OR= 1.84; 1.43-2.35) than primiparae. Higher maternal and paternal schooling, presence of husband or partner, and having received support from the child's father and the family during the pregnancy were protective factors against postpartum depression. CONCLUSION: The study showed high prevalence of postpartum depressive symptoms. Promotion of parental education, alongside with the promotion of support to the woman during pregnancy by the child's father and by the family, as well as family planning leading to birth spacing are measures that may help to prevent postpartum depressive symptoms.