Early emotional and behavioral difficulties and adult educational attainment: an 18-year follow-up of the TEMPO study

Children who experience behavioral difficulties often have short and long-term school problems. However, the relationship between emotional difficulties and later academic achievement has not been thoroughly examined. Using data from the French TEMPO study (n = 666, follow-up 1991, 1999, 2009, mean age = 10.5, sd = 4.9 at baseline), we studied associations between internalizing and externalizing symptoms in: (a) childhood and (b) adolescence and educational attainment by young adulthood (< vs. ≥ high school degree), accounting for participants’ age, sex, juvenile academic difficulties, and family income. High levels of childhood (but not adolescent) internalizing and externalizing symptoms were associated with low educational attainment; however, in multivariate models only the association with childhood internalizing symptoms remained statistically significant (OR = 1.75, 95 % CI 1.00–3.02). Supporting children with internalizing problems early on could help improve their long-term educational attainment.     

Psychosocial support intervention for HIV-affected families in Haiti: implications for programs and policies for orphans and vulnerable children

Given the increased access of antiretroviral therapy (ART) throughout the developing world, what was once a terminal illness is now a chronic disease for those receiving treatment. This requires a paradigmatic shift in service provision for those affected by HIV/AIDS in low-resource settings. Although there is a need for psychosocial support interventions for HIV-affected youth and their caregivers, to date there has been limited empirical evidence on the effectiveness of curriculum-based psychosocial support groups in HIV-affected families in low-income countries. Therefore, the purpose of this study is to examine the feasibility and assess the preliminary effectiveness of a psychosocial support group intervention for HIV-affected youth and their caregivers in central Haiti. The study was conducted at six Partners In Health-affiliated sites between February 2006 and September 2008 and included quantitative as well as qualitative methods. HIV-affected youth (n = 168) and their caregivers (n = 130) completed a baseline structured questionnaire prior to participation in a psychosocial support group intervention. Ninety-five percent of families completed the intervention and a follow-up questionnaire. Psychological symptoms, psychosocial functioning, social support, and HIV-related stigma at baseline were compared with outcomes one year later. Qualitative methods were also used to assess the participants' perspectives of the intervention. Comparing pre- and post-intervention assessment, youth affected by HIV experienced decreased psychological symptoms as well as improved psychosocial functioning and social support. Caregivers (95% HIV-positive) demonstrated a significant reduction in depressive symptoms, improved social support, and decreased HIV-related stigma. Although further study is needed to assess effectiveness in a randomized controlled trial, corroborative findings from qualitative data reflected reduced psychological distress, less social isolation and greater hope for the future for families affected by HIV/AIDS following the intervention.     

Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis

Objective

To investigate the relationship between maternal depression and child growth in developing countries through a systematic literature review and meta-analysis.

Methods

Six databases were searched for studies from developing countries on maternal depression and child growth published up until 2010. Standard meta-analytical methods were followed and pooled odds ratios (ORs) for underweight and stunting in the children of depressed mothers were calculated using random effects models for all studies and for subsets of studies that met strict criteria on study design, exposure to maternal depression and outcome variables. The population attributable risk (PAR) was estimated for selected studies.

Findings

Seventeen studies including a total of 13 923 mother and child pairs from 11 countries met inclusion criteria. The children of mothers with depression or depressive symptoms were more likely to be underweight (OR: 1.5; 95% confidence interval, CI: 1.2–1.8) or stunted (OR: 1.4; 95% CI: 1.2–1.7). Subanalysis of three longitudinal studies showed a stronger effect: the OR for underweight was 2.2 (95% CI: 1.5–3.2) and for stunting, 2.0 (95% CI: 1.0–3.9). The PAR for selected studies indicated that if the infant population were entirely unexposed to maternal depressive symptoms 23% to 29% fewer children would be underweight or stunted.

Conclusion

Maternal depression was associated with early childhood underweight and stunting. Rigorous prospective studies are needed to identify mechanisms and causes. Early identification, treatment and prevention of maternal depression may help reduce child stunting and underweight in developing countries.     

The mental health and psychosocial effects of organized violence: A qualitative study in northern Haiti

Historically, organized violence has been a chronic pervasive problem in Haiti. We set out to elicit Haitians' views on its effects to guide the development of interventions. In March 2006 we studied a population in the slum area of Cap-Haitien, Haiti's second largest city, and the nearby towns of Milot and Limbe. A convenience sample of adults was asked to free list all current problems affecting victims of organized violence. Two major categories emerged: psychological problems and financial problems. The psychological problems of "feeling startled and loss of self control," "sadness/grief," "continuing to suffer from reliving/reexperiencing past events," "problems in the head/mental problems," "deep suffering in the heart," and "thinking too much" emerged as themes from key-informant interviews. These may correspond to constructs of depression, dysthymia, and anxiety disorders including posttraumatic stress disorder in psychiatric nosology. The development of effective interventions can therefore consider those known to be effective for these problems in other settings. However in selecting interventions, considerations must also include local acceptability, perceived causes of problems, and their social effects.     

Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh

Objectives Depression following pregnancy is common, but its extent and association with maternal morbidity in the first 6 months postpartum have not been well described in low resource settings such as rural Bangladesh. Methods We used data from a population-based, community trial of approximately 39,000 married rural Bangladeshi women aged 13–44 between 2001 and 2007 to examine the relation between women’s reported morbidity symptoms from childbirth to 3 months postpartum, and subsequent depressive symptoms assessed at 6 months postpartum. We calculated crude and adjusted risk ratios for depressive symptoms following women’s reports of reproductive, urinary, neurologic, nutrition and other illness measures constructed based on symptomatic reporting. Results In models adjusted for sociodemographic factors and co-morbidities, all postpartum illnesses were associated with an increased relative risk [RR, with 95% confidence intervals (CI) excluding 1] of depressive symptoms by 6 months postpartum. These morbidities included uterine prolapse (RR 1.20, 95% CI 1.04–1.39), urinary tract infection (RR 1.24, 95% CI 1.11–1.38), stress related incontinence (SRI) (RR 1.49, 95% 1.33–1.67), simultaneous SRI and continuously dripping urine (RR 1.60–2.96), headache [RR 1.20 (95% CI 1.12–1.28)], convulsions (RR 1.67, 95%CI 1.36–2.06), night blindness (RR 1.33, 95% CI 1.19–1.49), anemia (RR 1.38, 95% CI 1.31–1.46), pneumonia (RR 1.24, 95% CI 1.12–1.37), gastroenteritis (RR 1.24, 95% CI 1.17–1.31) and hepatobiliary disease (RR 2.10, 96% CI 1.69–2.60). Conclusions for Practice Illnesses during the first three postpartum months were risk factors for depressive symptoms, with the strongest associations noted for convulsions and hepatobiliary disease. Symptoms of depression may be of particular concern among women suffering from physical illnesses.Clinical trial registration: ClinicalTrials.gov NCT0019882.