Maternal mental illness, infant growth and infant psychomotor functioning in rural Masaka district, Uganda : a longitudinal cohort study
Date
2020-20
Authors
Journal Title
Journal ISSN
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Publisher
Stellenbosch : Stellenbosch University
Abstract
ENGLISH ABSTRACT: Background: Maternal mental illness (postpartum depression, generalised anxiety disorder [GAD] or Acute Adjustment Disorder with Anxiety (AADA), and comorbidity of maternal postpartum depression and GAD) occur during a critical stage in the infant’s life. It is a stage in life when the infant psychomotor functioning and growth is likely to be affected by maternal mental illness. The purpose of the study was to investigate the association between maternal mental illness at six weeks and six months postpartum, infant growth and infant psychomotor functioning in rural Masaka district.
Methods: A longitudinal cohort study design was used and quantitative methods used for data collection and analysis. Mother-infant dyads were assessed at six weeks postpartum (baseline) and followed up when the infants were six months old (follow-up). A total of 167 and 149 mother-infant dyads were investigated at baseline and follow-up, respectively. Postpartum depression, GAD, and comorbidity of maternal postpartum depression and GAD) was measured using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders IV Axis I Disorders–Research Version–Non-Patient Edition (SCID-I-RV/NP), The Edinburgh Postnatal Depression Scale (EPDS) and The Self-Reporting Questionnaire (SRQ-20). Relationship discord was measured using the Relationship Dynamics Scale (RDS) while Social support was measured using the Multidimensional Scale of Perceived Social Support (MSPSS). Poverty was measured using an asset register Infant growth was measured using a portable digital weighing scale and with a tape measure. Psychomotor development was measured using the Kilifi Developmental Inventory (KDI) and the Developmental Milestones Checklist (DMC).
Data was analysed using the IBM Statistical Package for the Social Sciences (IBM SPSS Version 23) computer program. The WHO’s ANTHRO software (World Health Organization, 2011) was used for the anthropometric calculations. In the bivariate analysis, Independent Sample T-test, Analysis of variance (ANOVA), and Pearson chi-squared test were used. Variables that were found to have an association were further analysed using multivariate logistic regression analysis. Receiver operating characteristic (ROC) analysis was used for the validation of the EPDS and SRQ-20.
Results: At baseline (six weeks postpartum), approximately one-third of the participants (34.70%) were diagnosed with a major depressive episode while less than a quarter (22.75%) of the participants met the criteria for AADA. The comorbidity rate for participants who had both maternal depression and maternal AADA at baseline was 16.20%. There was a significant association between maternal depression and marital status.X2 (1, N = 167) = 4.4, p = .036. There was a significant difference in weight for age (WAZ) for participants with maternal psychological distress (M= -.50 SD=1.28) and those without (M=-.13 SD=1.02) t (165) = 2.08, p = 0.039. Participants’ poverty and maternal depression were significantly associated X2 (4, N = 167) = 11.21, p = .024.There was a significant association between relationship discord and maternal mental illness (depression X2 (1, N = 167) = 4.39, p = .036, anxiety X2 (1, N = 167) = 7.43, p = .006, psychological distress X2 (1, N = 167) = 21.87, p = <.001 and comorbidity X2 (2, N = 167) = 8.59, p = .012). There was a significant association between social support and maternal depression X2 (1, N = 167) = 7.33, p = .007. Social support was also significantly associated with maternal psychological distress X2 (1, N = 167) = 4.44, p = .035.
At follow-up (six months postpartum), 14.09% of the participants met the criteria for major depressive episode whereas only 6.71% of the participants met the criteria for GAD. The comorbidity rate for participants who had both maternal depression and maternal GAD during the follow-up period was 3.4%. There was a significant difference in WAZ for infants whose mothers were depressed (M= -.95, SD=1.52) and those whose mothers were not depressed (M= -.18, SD=1.15), t (147) = 2.72, p = 0.007). There was a significant difference in weight for height Z-score (WHZ) for infants whose mothers were depressed (M= .60, SD=1.53) and those whose mothers were not depressed (M= 1.28, SD=1.28), t (147) = 2.17, p = 0.032). There was a significant difference in WAZ for infants at six months postpartum whose mothers were exclusively breastfeeding at six weeks postpartum(M= -.18, SD=1.25) and those whose mothers were not (M= -.84, SD=1.00), t (147) = 2.43, p = 0.016). There was a significant difference in WHZ for infants at six months postpartum whose mothers were exclusively breastfeeding at six weeks postpartum(M= 1.28, SD=1.36) and those whose mothers were not (M= .68, SD=1.12), t (147) = 2.03, p = 0.044).
There was a significant difference in language development of Infants whose mothers were depressed at six weeks postpartum (M= 3.88, SD=1.06) and those whose mothers were not depressed (M= 4.32, SD=1.23), t (147) = 2.17, p = 0.031). There was a significant difference in language development of Infants whose mothers were psychologically distressed at six weeks postpartum (M= 3.83, SD=1.14) and those whose mothers were not (M=4.40, SD=1.17), t (147) = 2.91, p = 0.004). Maternal depression at six weeks postpartum was associated with maternal depression at six months postpartum X2 (1, N = 149) 3.89, p = .049. Maternal AADA at six weeks postpartum was associated with maternal depression at six months postpartum X2 (1, N = 149) 4.90, p = .027. Maternal psychological distress at six weeks postpartum was associated with maternal depression at six months postpartum X2 (1, N = 149) 18.16, p = < .001. Maternal psychological distress at six weeks postpartum was associated with maternal GAD at six months postpartum X2 (1, N = 149) 11.02, p = < .001. Maternal psychological distress at six weeks postpartum was associated with maternal psychological distress at six months postpartum X2 (1, N = 149) 7.61, p = < 006. Maternal psychological distress at six weeks postpartum was associated with comorbidity at six months postpartum X2 (3, N = 149) 23.20, p = < .001. There was a significant association between poverty and maternal psychological distress X2 (4, N = 149) 11.73, p = .019. There was a significant association between relationship discord at six months postpartum and depression X2 (2, N = 149) 24.50, p = <.001. Furthermore, there was a significant association between relationship discord at six months and maternal psychological distress X2 (2, N = 149) 18.84, p = <.001. There was also a significant association between relationship discord at six months and comorbidity of maternal depression and maternal GAD X2 (2, N = 149) 30.45, p = <.001.
Results from the DMC showed that a strong positive correlation between psychomotor functioning and social support r(147)=.189 p=.021. KDI results showed no significant relationship between psychomotor functioning and relationship discord or social support r(147)=.273 p=.001. Relationship discord at six weeks postpartum was negatively related with locomotor functioning on the KDI at six months postpartum r(147)=-.194 p=.018. On the DMC, relationship discord at six weeks postpartum was negatively correlated with language development at six months postpartum r(147)=.-.179p=.029
As far as effectiveness of Screening Tools for Depression was concerned, the ROC analysis was run for the EPDS and SRQ-20 using the SCID as a gold standard for diagnosis. The results of ROC analysis for the EPDS and the SCID show that the EPDS at the baseline had an AUC of 0.92 (95% CI: 0.88–0.97) with a standard error of 0.22 while the results of ROC analysis for the SRQ-20 at the baseline had an AUC of 0.78 (95% CI: 0.69–0.86) with a standard error of 0.042, indicating fair accuracy. The results of ROC analysis show that the EPDS with an ROC area of 0.92 performed significantly better as a screening tool for depression than the SRQ-20, which had an ROC area of 0.87
Multiple logistic regression was performed to find out which predictor variables were strongest in predicting maternal mental illness. For maternal depression at six weeks postpartum three independent variables – SSE, relationship discord and social support – were included in the analysis. The strongest predictor of maternal depression was relationship discord with an odds ratio of 1.17. For maternal psychological distress at six weeks postpartum, relationship discord and social support were assessed as predictors for maternal psychological distress. Relationship discord significantly contributed to the model and was the strongest predictor of maternal psychological distress with an odds ratio of 1.4. Relationship discord at six months, relationship discord at six weeks, maternal psychological distress at six weeks, maternal AADA at six weeks and maternal depression at six weeks were included in the analysis as independent variables for maternal depression at six months. The strongest predictor of maternal depression at six months was relationship discord at six months, recording an odds ratio of 1.18. Poverty, maternal psychological distress at six weeks postpartum and relationship discord were included in the analysis as predictors for psychological distress. The strongest predictor of maternal psychological distress was poverty, recording an odds ratio of 9.23.
Conclusion: This study shows that maternal mental illness is a significant predictor of infant growth and psychomotor development in rural Uganda. The research provides useful information regarding the factors that impact maternal mental health provision of system interventions within the communities, that is critical for averting adverse impacts of maternal mental illness on the infant’s growth and infant psychomotor functioning. A high level of prevalence for maternal mental illness in rural areas was observed as compared to urban settings in other studies. This study informs and improves our understanding of infant growth and infant psychomotor functioning, providing evidence for interventions at the psychological, social and public health levels that focus not only on the participants but also on the infants.
AFRIKAANSE OPSOMMING: Agtergrond: Moederlike geestesiektes (Nageboorte depressie, Algemene angsversteuring (GAD) of Akute Aanpassingsversteuring met Angs, en komorbiditeit van moederlike nageboorte depressie en GAD) gebeur gedurende ʼn kritiese stadium van ʼn baba se lewe. Gedurende die stadium van die baba se lewe kan die baba se psigomotoriese funksionering en groei geaffekteer word deur moederlike geestesiektes. Die doel van die studie was om die verband tussen moederlike geestessiektes (op ses weke en ses maande na geboorte) en die groei van die baba en baba-psigomotoriese funksionering in die landelike Masaka-distrik te ondersoek. Metodes: ʼn Longitudinale kohortstudie-ontwerp en kwantitatiewe metodes was gebruik vir data-insameling en analise. Moeder-baba paartjies was op ses weke na geboorte (basislyn) geassesseer en is opgevolg toe die babas ses maande oud was (opvolg). In totaal was 167 en 149 moeder-baba paartjies geasseseer gedurende basislyn en opvolg ondersoek. Nageboorte depressie, GAD, en comorbiditeit van moederlike nageboorte depressie en GAD was gemeet deur die Gestruktureerde kliniese onderhoud vir diagnostiese en statistiese handleiding vir geestesversteurings IV As I-steurings - Navorsingsweergawe - Nie-pasiënt-uitgawe (SCID-I-RV / NP), Die Edinburgh Postnatale Depressieskaal (EPDS) en Die selfrapporteringsvraelys (SRQ-20). Verhoudings-onmin was gemeet deur die gebruik van die Verhouding Dinamiek Skaal (RDS), terwyl sosiale ondersteuning gemeet was met behulp van die Multidimensionele Skaal van Ervare Sosiale Ondersteuning (MSPSS). Armoede was gemeet deur die gebruik van ʼn bateregister. Die groei van die baba is gemeet met ʼn digitale weegskaal en met ʼn maatband. Psigomotoriese ontwikkeling is gemeet deur gebruik te maak van die Kilifi Ontwikkelings Inventaris (KDI) en die Kontrolelys vir Ontwikkelingsmylpale (DCM). Data is geanaliseer met behulp van die IBM Statistical Package for the Social Sciences (IBM SPSS Version 23) rekenaarprogram. Die WGO se ANTHRO-sagteware (World Health Organization, 2011) is gebruik vir die antropometriese berekeninge. In die tweeveranderlike analise is onafhanklike monster-T-toets, variansie-analise (ANOVA) en Pearson chi-kwadraat-toets gebruik. Waar daar gevind is dat veranderlikes ʼn assosiasie met mekaar het, was die veranderlikes verder geanaliseer met behulp van meerveranderlike logistieke regressie-analise. Ontvanger-bedryfskenmerkanalise (ROC) -analise is gebruik vir die validering van die EPDS en SRQ-20. Resultate: Aan die beginpunt (ses weke na geboorte) is ongeveer 'n derde van die deelnemers (34,70%) gediagnoseer met 'n ernstige depressiewe episode, terwyl minder as 'n kwart (22,75%) van die deelnemers aan die kriteria vir AADA voldoen het. Die comorbiditeitskoers vir deelnemers wat beide moederlike depressie en AADA was 16,20%. Daar was 'n beduidende verband tussen moederlike depressie en huwelikstatus X2 (1, N = 167) = 4.4, p = .036. Daar was 'n beduidende verskil in gewig vir ouderdom (WAZ) vir deelnemers met moederlike sielkundige nood (M = -.50 SD = 1.28) en dié sonder (M=-.13 SD=1.02) t (165) = 2.08, p = 0.039. Deelnemers se armoede en moederlike depressie was beduidend geassosieer X2 (4, N = 167) = 11.21, p = .024. Daar was ʼn beduidende verband tussen verhoudings-onmin en die geestesongesteldheid van die moeder (depressie X2 (1, N = 167) = 4.39, p = .036, angs X2 (1, N = 167) = 7.43, p = .006, sielkundige nood X2 (1, N = 167) = 21.87, p = <.001 and comorbiditeit X2 (2, N = 167) = 8.59, p = .012). Daar was 'n beduidende verband tussen sosiale ondersteuning en moederlike depressie X2 (1, N = 167) = 7.33, p = .007. Sosiale ondersteuning was ook beduidend geassosieer met moederlike sielkundige nood X2 (1, N = 167) = 4.44, p = .035. Na opvolging (ses maande na geboorte) het 14,09% van die deelnemers aan die kriteria vir ʼn ernstige depressiewe episodes voldoen, terwyl slegs 6,71% van die deelnemers aan die kriteria vir GAD voldoen het. Die komorbiditeitskoers vir deelnemers wat tydens die opvolgperiode beide moederlike depressie en GAD gehad het, was 3,4%. Daar was 'n beduidende verskil in WAZ vir babas wie se moeders depressief was (M = -.95, SD = 1.52) en die wie se moeders nie depressief was nie (M = -.18, SD = 1.15), t (147) = 2.72, p = 0,007). Daar was 'n beduidende verskil in gewig vir hoogte Z-telling (WHZ) vir babas wie se moeders depressief was (M = .60, SD = 1.53) en die wie se moeders nie depressief was nie (M = 1.28, SD = 1.28), t ( 147) = 2,17, p = 0,032). Daar was 'n beduidende verskil in WAZ vir babas op ses maande na geboorte wie se moeders eksklusief geborsvoed het (M = -.18, SD = 1.25) en die wie se moeders nie het nie (M = -.84, SD = 1.00) , t (147) = 2,43, p = 0,016). Daar was 'n beduidende verskil in WHZ by babas op ses maande na geboorte waarvan die moeders eksklusief op ses weke na geboorte geborsvoed het (M = 1.28, SD = 1.36) en die wie se moeders nie was nie (M = .68, SD = 1.12), t ( 147) = 2,03, p = 0,044). Daar was 'n beduidende verskil in taalontwikkeling in babas wie se moeders depressief was na ses weke na geboorte (M = 3,88, SD = 1,06) en dié wie se moeders nie depressief was nie (M = 4,32, SD = 1,23), t (147) = 2,17 , p = 0,031). Daar was 'n beduidende verskil in taalontwikkeling by babas wie se moeders sielkundig angstig was op ses weke na geboorte (M = 3,83, SD = 1,14) en dié wie se moeders nie was nie (M = 4,40, SD = 1,17), t (147) = 2,91 , p = 0,004). Moederlike depressie, op ses weke na geboorte, is geassosieer met moederlike depressie op ses maande na geboorte X2 (1, N = 149) 3.89, p = .049. Moederlike AADA, op ses weke na geboorte, is geassosieer met moederlike depressie op ses maande na geboorte X2 (1, N = 149) 4.90, p = .027. Moederlike sielkundige nood, op ses weke na geboorte, word geassosieer met moederlike depressie op ses maande na geboorte X2 (1, N = 149) 18.16, p = < .001. Moederlike sielkundige nood, op ses weke na geboorte, word geassosieer met moederlike GAD op ses maande na geboorte X2 (1, N = 149) 11.02, p = < .001. Moederlike sielkundige nood, op ses weke na geboorte, word geassosieer met moederlike sielkundige nood op ses maande na geboorte X2 (1, N = 149) 7.61, p = < 006. Moederlike sielkundige nood, op ses weke na geboorte, is geassosieer met komorbiditeit op ses maande na geboorte X2 (3, N = 149) 23.20, p = < .001. Daar was 'n beduidende verband tussen armoede en sielkundige nood by moeder X2 (4, N = 149) 11.73, p = .019. Daar was 'n beduidende verband tussen die verhouding-onmin, op ses maande na geboorte, en depressie X2 (2, N = 149) 24.50, p = <.001. Verder was daar 'n beduidende assosiasie tussen verhoudings-onmin op ses maande en moederlike sielkundige nood X2 (2, N = 149) 18.84, p = <.001. Daar was ook 'n beduidende verband tussen die verhoudings-onmin op ses maande en die komorbiditeit van moederlike depressie en moeder GAD X2 (2, N = 149) 30.45, p = <.001. Resultate van die DMC het getoon dat 'n sterk positiewe verband tussen psigomotoriese funksionering en sosiale ondersteuning r(147)=.189 p=.021. KDI-resultate het geen noemenswaardige verwantskap getoon tussen psigomotoriese funksionering en verhoudingsversoening of sosiale ondersteuning nie r(147)=.273 p=.001. Verhoudings-onmin by ses weke na geboorte was negatief verwant aan die lokomotoriese funksionering op die KDI op ses maande na geboorte r(147)=-.194 p=.018. Op die DMC was verhoudings-onmin op ses weke na geboorte negatief gekorreleer met taalontwikkeling op ses maande na geboorte r(147)=.-.179p=.029. Wat die effektiwiteit van siftingshulpmiddels vir depressie betref, is die ROC-analise uitgevoer vir die EPDS en SRQ-20 met behulp van die SCID as 'n goue standaard vir diagnose. Die resultate van ROC-analise vir die EPDS en die SCID toon dat die EPDS aan die basislyn 'n AUC van 0,92 (95% KI: 0,88–0,97) gehad het met 'n standaardfout van 0,22, terwyl die resultate van ROC-analise vir die SRQ-20 op die basislyn het 'n AUC van 0,78 (95% CI: 0,69–0,86) met 'n standaardfout van 0,042, wat 'n aanduiding is van billike akkuraatheid. ie resultate van ROC-analise toon dat die EPDS met 'n ROC-area van 0,92 aansienlik beter gevaar het as 'n siftingsinstrument vir depressie as die SRQ-20, wat 'n ROC-area van 0,87 gehad het. Veelvuldige logistieke regressie is uitgevoer om vas te stel watter voorspellerveranderlikes die sterkste was in die voorspelling van geestesongesteldheid van die moeder. Vir moederlike depressie, op ses weke na geboorte, is drie onafhanklike veranderlikes - SSE, verhoudings-onmin en sosiale ondersteuning - by die ontleding ingesluit. Die sterkste voorspeller van moederlike depressie was verhoudings-onmin met 'n kansverhouding van 1,17. Vir moederlike sielkundige nood, op ses weke na geboorte, is 'n verhoudings-onmin en sosiale ondersteuning beoordeel as voorspellers vir moederlike sielkundige. Verhoudings-onmin het 'n belangrike bydrae gelewer tot die model en was die sterkste voorspeller van sielkundige nood by moeder met 'n kansverhouding van 1,4. Verhoudings-onmin op ses maande, sielkundige nood op ses weke, moederlike AADA op ses weke en die moederlike depressie op ses weke is by die ontleding ingesluit as onafhanklike veranderlikes vir moederlike depressie op ses maande. Die sterkste voorspeller van moederlike depressie op ses maande was verhouding-onmin op ses maande, met 'n kansverhouding van 1,18. Armoede, moederlike sielkundige nood op ses weke na geboorte en 'n verhoudings-onmin is by die ontleding ingesluit as voorspellers vir sielkundige nood. Die sterkste voorspeller van sielkundige nood by moeders was armoede, met 'n kansverhouding van 9,23. Afsluiting: Hierdie studie wys dat moederlike geestesongesteldheid 'n beduidende voorspeller van babagroei en psigomotoriese ontwikkeling in landelike Uganda is. Die navorsing verskaf nuttige inligting rakende die faktore wat ʼn impak het op moederlike geestesgesondheid van stelselintervensies in die gemeenskappe wat van kritieke belang is om nadelige gevolge van moederlike geestesongesteldheid te voorkom op die baba se groei en baba se psigomotoriese funksionering. ‘n Hoë voorkoms van geestesongesteldheid in moeders op die platteland is waargeneem in vergelyking met stedelike omgewing in ander studies. Hierdie verbeter ons begrip van babagroei en baba-psigomotoriese funksionering, en lewer bewyse vir intervensies op die sielkundige, sosiale en openbare gesondheidsvlak wat nie net op die deelnemers nie, maar ook op die babas fokus.
AFRIKAANSE OPSOMMING: Agtergrond: Moederlike geestesiektes (Nageboorte depressie, Algemene angsversteuring (GAD) of Akute Aanpassingsversteuring met Angs, en komorbiditeit van moederlike nageboorte depressie en GAD) gebeur gedurende ʼn kritiese stadium van ʼn baba se lewe. Gedurende die stadium van die baba se lewe kan die baba se psigomotoriese funksionering en groei geaffekteer word deur moederlike geestesiektes. Die doel van die studie was om die verband tussen moederlike geestessiektes (op ses weke en ses maande na geboorte) en die groei van die baba en baba-psigomotoriese funksionering in die landelike Masaka-distrik te ondersoek. Metodes: ʼn Longitudinale kohortstudie-ontwerp en kwantitatiewe metodes was gebruik vir data-insameling en analise. Moeder-baba paartjies was op ses weke na geboorte (basislyn) geassesseer en is opgevolg toe die babas ses maande oud was (opvolg). In totaal was 167 en 149 moeder-baba paartjies geasseseer gedurende basislyn en opvolg ondersoek. Nageboorte depressie, GAD, en comorbiditeit van moederlike nageboorte depressie en GAD was gemeet deur die Gestruktureerde kliniese onderhoud vir diagnostiese en statistiese handleiding vir geestesversteurings IV As I-steurings - Navorsingsweergawe - Nie-pasiënt-uitgawe (SCID-I-RV / NP), Die Edinburgh Postnatale Depressieskaal (EPDS) en Die selfrapporteringsvraelys (SRQ-20). Verhoudings-onmin was gemeet deur die gebruik van die Verhouding Dinamiek Skaal (RDS), terwyl sosiale ondersteuning gemeet was met behulp van die Multidimensionele Skaal van Ervare Sosiale Ondersteuning (MSPSS). Armoede was gemeet deur die gebruik van ʼn bateregister. Die groei van die baba is gemeet met ʼn digitale weegskaal en met ʼn maatband. Psigomotoriese ontwikkeling is gemeet deur gebruik te maak van die Kilifi Ontwikkelings Inventaris (KDI) en die Kontrolelys vir Ontwikkelingsmylpale (DCM). Data is geanaliseer met behulp van die IBM Statistical Package for the Social Sciences (IBM SPSS Version 23) rekenaarprogram. Die WGO se ANTHRO-sagteware (World Health Organization, 2011) is gebruik vir die antropometriese berekeninge. In die tweeveranderlike analise is onafhanklike monster-T-toets, variansie-analise (ANOVA) en Pearson chi-kwadraat-toets gebruik. Waar daar gevind is dat veranderlikes ʼn assosiasie met mekaar het, was die veranderlikes verder geanaliseer met behulp van meerveranderlike logistieke regressie-analise. Ontvanger-bedryfskenmerkanalise (ROC) -analise is gebruik vir die validering van die EPDS en SRQ-20. Resultate: Aan die beginpunt (ses weke na geboorte) is ongeveer 'n derde van die deelnemers (34,70%) gediagnoseer met 'n ernstige depressiewe episode, terwyl minder as 'n kwart (22,75%) van die deelnemers aan die kriteria vir AADA voldoen het. Die comorbiditeitskoers vir deelnemers wat beide moederlike depressie en AADA was 16,20%. Daar was 'n beduidende verband tussen moederlike depressie en huwelikstatus X2 (1, N = 167) = 4.4, p = .036. Daar was 'n beduidende verskil in gewig vir ouderdom (WAZ) vir deelnemers met moederlike sielkundige nood (M = -.50 SD = 1.28) en dié sonder (M=-.13 SD=1.02) t (165) = 2.08, p = 0.039. Deelnemers se armoede en moederlike depressie was beduidend geassosieer X2 (4, N = 167) = 11.21, p = .024. Daar was ʼn beduidende verband tussen verhoudings-onmin en die geestesongesteldheid van die moeder (depressie X2 (1, N = 167) = 4.39, p = .036, angs X2 (1, N = 167) = 7.43, p = .006, sielkundige nood X2 (1, N = 167) = 21.87, p = <.001 and comorbiditeit X2 (2, N = 167) = 8.59, p = .012). Daar was 'n beduidende verband tussen sosiale ondersteuning en moederlike depressie X2 (1, N = 167) = 7.33, p = .007. Sosiale ondersteuning was ook beduidend geassosieer met moederlike sielkundige nood X2 (1, N = 167) = 4.44, p = .035. Na opvolging (ses maande na geboorte) het 14,09% van die deelnemers aan die kriteria vir ʼn ernstige depressiewe episodes voldoen, terwyl slegs 6,71% van die deelnemers aan die kriteria vir GAD voldoen het. Die komorbiditeitskoers vir deelnemers wat tydens die opvolgperiode beide moederlike depressie en GAD gehad het, was 3,4%. Daar was 'n beduidende verskil in WAZ vir babas wie se moeders depressief was (M = -.95, SD = 1.52) en die wie se moeders nie depressief was nie (M = -.18, SD = 1.15), t (147) = 2.72, p = 0,007). Daar was 'n beduidende verskil in gewig vir hoogte Z-telling (WHZ) vir babas wie se moeders depressief was (M = .60, SD = 1.53) en die wie se moeders nie depressief was nie (M = 1.28, SD = 1.28), t ( 147) = 2,17, p = 0,032). Daar was 'n beduidende verskil in WAZ vir babas op ses maande na geboorte wie se moeders eksklusief geborsvoed het (M = -.18, SD = 1.25) en die wie se moeders nie het nie (M = -.84, SD = 1.00) , t (147) = 2,43, p = 0,016). Daar was 'n beduidende verskil in WHZ by babas op ses maande na geboorte waarvan die moeders eksklusief op ses weke na geboorte geborsvoed het (M = 1.28, SD = 1.36) en die wie se moeders nie was nie (M = .68, SD = 1.12), t ( 147) = 2,03, p = 0,044). Daar was 'n beduidende verskil in taalontwikkeling in babas wie se moeders depressief was na ses weke na geboorte (M = 3,88, SD = 1,06) en dié wie se moeders nie depressief was nie (M = 4,32, SD = 1,23), t (147) = 2,17 , p = 0,031). Daar was 'n beduidende verskil in taalontwikkeling by babas wie se moeders sielkundig angstig was op ses weke na geboorte (M = 3,83, SD = 1,14) en dié wie se moeders nie was nie (M = 4,40, SD = 1,17), t (147) = 2,91 , p = 0,004). Moederlike depressie, op ses weke na geboorte, is geassosieer met moederlike depressie op ses maande na geboorte X2 (1, N = 149) 3.89, p = .049. Moederlike AADA, op ses weke na geboorte, is geassosieer met moederlike depressie op ses maande na geboorte X2 (1, N = 149) 4.90, p = .027. Moederlike sielkundige nood, op ses weke na geboorte, word geassosieer met moederlike depressie op ses maande na geboorte X2 (1, N = 149) 18.16, p = < .001. Moederlike sielkundige nood, op ses weke na geboorte, word geassosieer met moederlike GAD op ses maande na geboorte X2 (1, N = 149) 11.02, p = < .001. Moederlike sielkundige nood, op ses weke na geboorte, word geassosieer met moederlike sielkundige nood op ses maande na geboorte X2 (1, N = 149) 7.61, p = < 006. Moederlike sielkundige nood, op ses weke na geboorte, is geassosieer met komorbiditeit op ses maande na geboorte X2 (3, N = 149) 23.20, p = < .001. Daar was 'n beduidende verband tussen armoede en sielkundige nood by moeder X2 (4, N = 149) 11.73, p = .019. Daar was 'n beduidende verband tussen die verhouding-onmin, op ses maande na geboorte, en depressie X2 (2, N = 149) 24.50, p = <.001. Verder was daar 'n beduidende assosiasie tussen verhoudings-onmin op ses maande en moederlike sielkundige nood X2 (2, N = 149) 18.84, p = <.001. Daar was ook 'n beduidende verband tussen die verhoudings-onmin op ses maande en die komorbiditeit van moederlike depressie en moeder GAD X2 (2, N = 149) 30.45, p = <.001. Resultate van die DMC het getoon dat 'n sterk positiewe verband tussen psigomotoriese funksionering en sosiale ondersteuning r(147)=.189 p=.021. KDI-resultate het geen noemenswaardige verwantskap getoon tussen psigomotoriese funksionering en verhoudingsversoening of sosiale ondersteuning nie r(147)=.273 p=.001. Verhoudings-onmin by ses weke na geboorte was negatief verwant aan die lokomotoriese funksionering op die KDI op ses maande na geboorte r(147)=-.194 p=.018. Op die DMC was verhoudings-onmin op ses weke na geboorte negatief gekorreleer met taalontwikkeling op ses maande na geboorte r(147)=.-.179p=.029. Wat die effektiwiteit van siftingshulpmiddels vir depressie betref, is die ROC-analise uitgevoer vir die EPDS en SRQ-20 met behulp van die SCID as 'n goue standaard vir diagnose. Die resultate van ROC-analise vir die EPDS en die SCID toon dat die EPDS aan die basislyn 'n AUC van 0,92 (95% KI: 0,88–0,97) gehad het met 'n standaardfout van 0,22, terwyl die resultate van ROC-analise vir die SRQ-20 op die basislyn het 'n AUC van 0,78 (95% CI: 0,69–0,86) met 'n standaardfout van 0,042, wat 'n aanduiding is van billike akkuraatheid. ie resultate van ROC-analise toon dat die EPDS met 'n ROC-area van 0,92 aansienlik beter gevaar het as 'n siftingsinstrument vir depressie as die SRQ-20, wat 'n ROC-area van 0,87 gehad het. Veelvuldige logistieke regressie is uitgevoer om vas te stel watter voorspellerveranderlikes die sterkste was in die voorspelling van geestesongesteldheid van die moeder. Vir moederlike depressie, op ses weke na geboorte, is drie onafhanklike veranderlikes - SSE, verhoudings-onmin en sosiale ondersteuning - by die ontleding ingesluit. Die sterkste voorspeller van moederlike depressie was verhoudings-onmin met 'n kansverhouding van 1,17. Vir moederlike sielkundige nood, op ses weke na geboorte, is 'n verhoudings-onmin en sosiale ondersteuning beoordeel as voorspellers vir moederlike sielkundige. Verhoudings-onmin het 'n belangrike bydrae gelewer tot die model en was die sterkste voorspeller van sielkundige nood by moeder met 'n kansverhouding van 1,4. Verhoudings-onmin op ses maande, sielkundige nood op ses weke, moederlike AADA op ses weke en die moederlike depressie op ses weke is by die ontleding ingesluit as onafhanklike veranderlikes vir moederlike depressie op ses maande. Die sterkste voorspeller van moederlike depressie op ses maande was verhouding-onmin op ses maande, met 'n kansverhouding van 1,18. Armoede, moederlike sielkundige nood op ses weke na geboorte en 'n verhoudings-onmin is by die ontleding ingesluit as voorspellers vir sielkundige nood. Die sterkste voorspeller van sielkundige nood by moeders was armoede, met 'n kansverhouding van 9,23. Afsluiting: Hierdie studie wys dat moederlike geestesongesteldheid 'n beduidende voorspeller van babagroei en psigomotoriese ontwikkeling in landelike Uganda is. Die navorsing verskaf nuttige inligting rakende die faktore wat ʼn impak het op moederlike geestesgesondheid van stelselintervensies in die gemeenskappe wat van kritieke belang is om nadelige gevolge van moederlike geestesongesteldheid te voorkom op die baba se groei en baba se psigomotoriese funksionering. ‘n Hoë voorkoms van geestesongesteldheid in moeders op die platteland is waargeneem in vergelyking met stedelike omgewing in ander studies. Hierdie verbeter ons begrip van babagroei en baba-psigomotoriese funksionering, en lewer bewyse vir intervensies op die sielkundige, sosiale en openbare gesondheidsvlak wat nie net op die deelnemers nie, maar ook op die babas fokus.
Description
Thesis (DPhil)--Stellenbosch University, 2020.
Keywords
Rural -- Uganda, UCTD, Maternal health services, Infant development, Longitudinal method, Cohort analysis, Postpartum depression, Anxiety disorders