Maternal mental health and infant neurodevelopment at 6 months in a low-income South African cohort.

Maternal mental health disorders and the adverse consequences for infant neurodevelopment have received substantial research attention in high-income countries over the past five decades. In Africa, where relatively little work has been done on this topic, researchers have largely focused on infant physical health outcomes. This longitudinal study investigated the neurodevelopment of infants at 6 months post-term with exposure to mothers with a clinical diagnosis of persistent mental health disorders residing in low-income communities in Cape Town, South Africa. Adjusted models revealed no significant differences on the Bayley Scales of Infant and Toddler Development (BSID-III) domains (cognitive, motor, language, socio-emotional, and adaptive behavior) between infants exposed to maternal mental health disorders (n = 62) and the comparison group (n = 35) at 3 and 6 months. Subgroup analyses found no significant differences on the BSID-III domains between infants with exposure to mood disorders (n = 31), as well as infants with exposure to comorbid (i.e., a combination of two or three) mental health disorders (n = 14) and the comparison group. However, infants with exposure to psychotic disorders (n = 14) scored significantly lower on the cognitive and the motor domains and the fine motor subscale. These novel data provide an important contribution to the scientific literature especially in the field of maternal psychotic disorders in Africa.

Los trastornos de la salud mental materna y las consecuencias adversas para el neurodesarrollo del infante han recibido una considerable atención investigativa en países de altos niveles económicos a lo largo de las últimas cinco décadas. En África, donde se ha llevado a cabo relativamente poco trabajo sobre este tema, los investigadores se han enfocado por la mayor parte en los resultados de la salud física del infante. Este estudio longitudinal investigó el neurodesarrollo de infantes a los 6 meses después del término de gestación que habían sido expuestos a madres con un diagnóstico clínico de trastornos de salud mental persistentes quienes residían en comunidades de bajos recursos en Ciudad del Cabo, Sudáfrica. Los ajustados modelos no revelaron significativas diferencias en los dominios de las Escalas Bayley del Desarrollo del Infante y Niños Pequeñitos (BSID-III) (cognitivo, motor, lenguaje, comportamiento socioemocional y de adaptación) entre los infantes que habían estado expuestos a los trastornos de salud mental materna (n = 62) y el grupo de comparación (n = 35) a los 3 y 6 meses. Los análisis de subgrupo no encontraron diferencias significativas en los dominios de BSID-III entre los infantes que habían estado expuestos a los trastornos de estado de ánimo (n = 31), así como los infantes que habían estado expuestos a trastornos de salud mental comórbidos (v.g. una combinación de dos o tres) (n = 14) y el grupo de comparación. Sin embargo, los infantes que habían estado expuestos a trastornos sicóticos (n = 14) tuvieron puntajes significativamente más bajos en los dominios cognitivo y motor, así como en la subescala de las habilidades motoras finas. Estos novedosos datos ofrecen una contribución importante a la literatura científica especialmente en el campo de los trastornos sicóticos maternos en África.

Les troubles de la santé mentale maternelle et les conséquences négatives pour le neurodéveloppement du nourrisson ont reçu l'attention de beaucoup de recherches dans les pays à revenu élevé ces cinquante dernières années. En Afrique où relativement peu de travail a été fait sur ce sujet, les chercheurs se sont en grande partie penchés sur les résultats de la santé physique des nourrissons. Cette étude longitudinale s'est penchée sur le neurodéveloppement de nourrissons à 6 mois après terme avec une exposition aux mères avec un diagnostic clinique de troubles de la santé mentale persistants, résidant dans des communautés défavorisées à Cape Town, en Afrique du Sud. Les modèles ajustés n'ont révélé aucunes différences importantes dans les domaines (cognitif, moteur, langage, comportement socio-émotionnel et comportement adaptif) des Echelles Bayley du Développement du Nourrisson et du Jeune Enfant (BSID-III) entre les nourrissons exposés à des troubles de la santé mentale maternelle (n = 62) et le groupe de comparaison (n-35) à 3 et 6 mois. Les analyses de sous-groupes n'ont trouvé aucunes différences concernant les domaines BSID-III entre les nourrissons avec une exposition à des troubles de l'humeur (n-31), ainsi que des nourrissons avec une exposition à des troubles de santé mentale comorbides (c'est-à-dire une combinaison de deux ou trois) (n-14) et le groupe de comparaison. Cependant, les nourrissons ayant été exposés à des troubles psychotiques (n = 14) ont reçu des scores bien plus bas dans le domaine cognitif, dans le domaine moteur, et à la sous-échelle motrice fine. Ces nouvelles données offrent une contribution importante aux recherches scientifiques, surtout dans le domaine des troubles psychotiques maternels en Afrique.

Persistent Maternal Mental Health Disorders and Toddler Neurodevelopment at 18 Months: Longitudinal Follow-up of a Low-Income South African Cohort.

One of the biggest threats to early childhood development in Africa is poor maternal mental health. The present study reports on the relationships between clinical diagnoses of persistent maternal mental health disorders (at 3- and/or 6- and 18-month post-term age) and toddler neurodevelopment at 18 months of age. Eighty-three mother-toddler dyads from low socio-economic status settings in Cape Town, South Africa, were included. At the 3-, 6- and 18-month postnatal visits, clinician-administered structured diagnostic assessments were carried out according to the Diagnostic and Statistical Manual of Mental Disorders-V (DSM-V) criteria. Toddler neurodevelopment at 18 months corrected age was assessed with the Bayley Scales of Infant and Toddler Development (BSID-III). No significant differences (p > 0.05) were found between toddlers with exposure to persistent mood or psychotic disorders in the different BSID-III domains compared to toddlers with no exposure. Toddlers exposed to persistent comorbid anxiety and mood disorders scored significantly higher on the cognitive (p = 0.049), motor (p = 0.013) and language (p = 0.041) domains and attained significantly higher fine motor (p = 0.043) and gross motor (p = 0.041) scaled scores compared to toddlers with no maternal mental health disorder exposure. Future investigations should focus on the role of protective factors to explain the pathways through which maternal mental health status is associated with positive toddler neurodevelopmental outcomes.

Protective Factors for Early Psychotic Phenomena Among Children of Mothers With Psychosis.

Background: Early identification of sub-clinical psychotic experiences in at-risk individuals is vital to prevent the development of psychosis, even before prodromal symptoms emerge. A widely-replicated risk factor is having a family member with psychosis. The Environmental Risk (E-Risk) Longitudinal Twin Study has shown that better cognitive functioning, a stimulating family environment, and a cohesive community, are protective against psychotic experiences among children; while engaging in physical activity, social support, and a cohesive community are protective for adolescents. In the current study we investigate whether these factors also protect against the development of sub-clinical psychotic phenomena among children and adolescents in this cohort who are at high-risk of psychosis by having a mother with psychosis. Methods: Data were utilized from the E-Risk Longitudinal Twin Study, a nationally-representative cohort of 2,232 twin children born in England and Wales in 1994-1995 followed to age 18. Psychotic phenomena were assessed in private interviews with children at ages 12 and 18, and mothers were interviewed about their own experiences of psychosis when children were aged 10 and 12. Bivariate and multivariate logistic regression analyses explored associations between individual, family, and community-level putative protective factors and absence of age-12 psychotic symptoms and age-18 psychotic experiences in children whose mothers had a diagnosis of a psychosis-spectrum disorder and/or reported psychotic symptoms. Results: Higher IQ (OR = 0.97, 95% CI 0.94-1.00, P = 0.036) and living in a more socially cohesive neighborhood (OR = 0.88, 95% CI 0.79-0.98, P = 0.023) were independently protective against age-12 psychotic symptoms among children of mothers with psychosis. Higher levels of perceived social support were independently protective against age-18 psychotic experiences among children of mothers with psychosis (OR = 0.92, 95% CI 0.87-0.98, P = 0.006). However, there were no significant interactions between these protective factors and maternal psychosis in relation to an absence of childhood or adolescent psychotic phenomena in the full sample, indicating that protective effects were not specific to this group of high-risk children. Conclusions: These findings provide preliminary evidence that preventive interventions for early psychotic phenomena could focus on improving cognition, social support, and cohesiveness of the local community. Given scarce resources these might usefully be targeted at high-risk children.

Assisted reproductive technology (ART) treatment in women with schizophrenia or related psychotic disorder: a national cohort study.

OBJECTIVES: To determine the prevalence rate of women with a diagnosis of schizophrenia or related psychotic disorder in assisted reproductive technology (ART) treatment and to study these women's fertility treatment outcome in comparison to women with no psychotic disorders. STUDY DESIGN: We used a national register-based cohort of 42,915 Danish women in ART treatment from 1.1.1994 to 30.9.2009. All women with a diagnosis of schizophrenia or related psychotic disorders before, during or after their ART treatment were identified by individual-level linkage of nationwide registers of ART treatment, psychiatric admission, birth and socio-demographic status. The comparison group (N=42,671) consisted of all women in the study cohort never diagnosed with psychotic disorders. Conventional descriptive methods were used for the statistical analyses. RESULTS: Two hundred and forty-four (0.6%) women in the study cohort received a diagnosis of psychotic disorder before (N=135-55.3%), during (N=7-2.9%) or after (N=102-41.8%) ART treatment. The mean time from last diagnosis of psychotic disorder to their first ART treatment in the 135 women with a psychiatric diagnosis prior to their first ART treatment was 7.1 ± 5.6 years (25-75% percentile: ±2.8-10.4 years). The most frequent diagnoses were acute and transient psychotic disorder. Women with a diagnosis of schizophrenia or related psychotic disorder before their first ART treatment had a lower ART treatment success rate as significantly fewer women obtained a live birth (40.0% vs. 51.9%, P<0.01). However, we found no statistical differences in perinatal outcomes for the children born by women in the study population and comparison group. CONCLUSIONS: The prevalence of women with a psychotic diagnosis in fertility treatment is lower than the prevalence in the general population. Women with a psychotic disorder prior to ART treatment have a lower fertility treatment success rate compared to women without psychotic disorder. Women with a psychotic disorder achieving delivery show similar obstetric outcomes to women with no psychotic disorder.