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Multidimensional predictors of common mental disorders among Indian mothers of 6- to 24-month-old children living in disadvantaged rural villages with women's self-help groups: A cross-sectional analysis.

ABSTRACT: Common mental disorders (CMD) among mothers cause disability, negatively affect child development, and have high long-term economic costs. Little is known about how factors across multiple life dimensions, modeled together, are differentially related to maternal mental health in high poverty contexts. Further, there is limited evidence on determinants of CMD in areas where self-help groups (SHGs) exist to promote women's wellbeing. Filling this evidence gap is important given the high prevalence of CMD and the rapid expansion of SHGs in rural India. Cross-sectional data were collected from 1644 mother-infant pairs living in disadvantaged rural villages across five Indian states-Jharkhand, Madhya Pradesh, West Bengal, Odisha, and Chhattisgarh-surveyed in the Women Improving Nutrition through Group-based Strategies study. CMD were assessed using the 20-item Self Reporting Questionnaire (SRQ). We examined 31 factors across four life dimensions: work (work type, time spent in labor, domestic and caretaking activities), agency (SHG membership, decision-making, gender attitudes), health/nutrition (underweight, fertility, diet diversity, child illness), and household/environment (dependency ratio, wealth, food security, shocks, water, sanitation). Survey-adjusted multivariate logistic and ordinary least squares regression models were fit to examine predictors of CMD or SRQ score. On average, mothers were 26 (range 18-46) years old and their children were 15 (range 6-24) months old. CMD defined as ? 8 positive SRQ responses were reported by 262 women (16%). Protective factors included being engaged in agricultural labor as a main occupation relative to being a housewife (AOR 0.18, 95% CI 0.10-0.32), more time working (0.85, 0.77-0.93), higher decision-making (0.33, 0.16-0.69), SHG membership (0.73, 0.56-0.96), and having an improved toilet (0.49, 0.33-0.72). Risk factors included food insecurity (1.13, 1.07-1.20) and shocks to non-farm livelihoods (2.04, 1.10-3.78). Practitioners and policymakers should aim to improve food security, economic wellbeing and social capital, such as that created through SHG membership, to improve maternal mental health. Future research should aim to understand why working outside the home, albeit in agricultural work, appears to protect maternal mental health in this context.

SUBMITTER: Scott S

PROVIDER: S-EPMC7310838 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Multidimensional predictors of common mental disorders among Indian mothers of 6- to 24-month-old children living in disadvantaged rural villages with women's self-help groups: A cross-sectional analysis.

Scott Samuel S Arrieta Alejandra A Kumar Neha N Menon Purnima P Quisumbing Agnes A

PloS one 20200623 6

Common mental disorders (CMD) among mothers cause disability, negatively affect child development, and have high long-term economic costs. Little is known about how factors across multiple life dimensions, modeled together, are differentially related to maternal mental health in high poverty contexts. Further, there is limited evidence on determinants of CMD in areas where self-help groups (SHGs) exist to promote women's wellbeing. Filling this evidence gap is important given the high prevalence ...[more]

PMID: 32574218

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Project description:ObjectivesTo assess how the health coordination and emergency referral networks between women's self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India.DesignA pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups.SettingThe study was conducted in 18 villages located in three districts in Uttar Pradesh, India.InterventionTo improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation.ParticipantsA purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders).Main outcome measuresSocial network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels.ResultsThe health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members.ConclusionsThe creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.

Project description:BackgroundInfant cognitive development is influenced by maternal factors that range from obesity to early feeding and breast milk composition. Animal studies suggest a role for human milk oligosaccharide (HMO), 2'-fucosyllactose (2'FL), on learning and memory, yet no human studies have examined its impact on infant cognitive development relative to other HMOs and maternal factors.ObjectiveTo determine the impact of 2'FL from breast milk feeding on infant cognitive development at 24 months of age relative to maternal obesity and breast milk feeding frequency.Methods and materialsHispanic mother-infant pairs (N = 50) were recruited across the spectrum of pre-pregnancy BMI. Breast milk was collected at 1 and 6 months, and feedings/day were reported. Nineteen HMOs were analyzed using high-performance liquid chromatography, with initial interest in 2'FL. Infant cognitive development score was assessed with the Bayley-III Scale at 24 months. Linear regressions were used for prediction, and bootstrapping to determine mediation by 2'FL.ResultsMaternal pre-pregnancy BMI was not related to feedings/day or HMOs, but predicted poorer infant cognitive development (β = -0.31, P = 0.03). Feedings/day (β = 0.34) and 2'FL (β = 0.59) at 1 month predicted better infant cognitive development (both P≤ 0.01). The association of feedings/day with infant cognitive development was no longer significant after further adjustment for 2'FL (estimated mediation effect = 0.13, P = 0.04). There were no associations of feedings/day and 2'FL at 6 months with infant cognitive development.ConclusionsOur findings suggest that maternal factors influence infant cognitive development through multiple means. Though maternal obesity may be a separate negative influence, greater frequency of breast milk feeding at 1 month contributed to infant cognitive development through greater exposure to 2'FL relative to other HMOs. The influence of 2'FL was not significant at 6 months, indicating that early exposure to 2'FL may be a critical temporal window for positively influencing infant cognitive development.

Project description:BACKGROUND:People from socioeconomically disadvantaged population groups are less likely to be physically active and more likely to experience adverse health outcomes than those who are less disadvantaged. In this umbrella review we examined across all age groups, (1) the effectiveness of interventions to improve physical activity among socioeconomically disadvantaged groups, (2) the characteristics of effective interventions, and (3) directions for future research. METHODS:PubMed/MEDLINE and Scopus were searched up to May 2017 to identify systematic reviews reporting physical activity interventions in socioeconomically disadvantaged populations or sub-groups. Two authors independently conducted study screening and selection, data extraction (one author, with data checked by two others) and assessment of methodological quality using the 'Assessment of Multiple Systematic Reviews' scale. Results were synthesized narratively. RESULTS:Seventeen reviews met our inclusion criteria, with only 5 (30%) reviews being assessed as high quality. Seven (41%) reviews focused on obesity prevention and an additional four focused on multiple behavioural outcomes. For pre school children, parent-focused, group-based interventions were effective in improving physical activity. For children, school-based interventions and policies were effective; few studies focused on adolescents and those that did were generally not effective; for adults, there was mixed evidence of effectiveness but characteristics such as group-based interventions and those that focused on physical activity only were associated with effectiveness. Few studies focused on older adults. Across all ages, interventions that were more intensive tended to be more effective. Most studies reported short-term, rather than longer-term, outcomes and common methodological limitations included high probability of selection bias, low response rates, and high attrition. CONCLUSIONS:Interventions can be successful at improving physical activity among children from socioeconomically disadvantaged groups, with evidence for other age groups weak or inconclusive. More high-quality studies in this population group are needed, which adopt strategies to increase recruitment rates and reduce attrition, report longer term outcomes, and provide adequate intervention details, to allow determination of the characteristics of effective interventions. We recommend that the benefits of physical activity be recognised more broadly than obesity prevention in future studies, as this may have implications for the design and appeal of interventions.

Dataset Information

Multidimensional predictors of common mental disorders among Indian mothers of 6- to 24-month-old children living in disadvantaged rural villages with women's self-help groups: A cross-sectional analysis.

Publications

Multidimensional predictors of common mental disorders among Indian mothers of 6- to 24-month-old children living in disadvantaged rural villages with women's self-help groups: A cross-sectional analysis.

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