Melbourne School of Population and Global Health, The University of Melbourne, Victoria 3010, Australia; Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Victoria 3168, Australia; Research and Training Centre for Community Development, Hanoi, Vietnam.
Department of Medicine (RMH/WH), The University of Melbourne, The Royal Melbourne Hospital, Victoria 3050, Australia.
J Affect Disord. 2014 May;160:104-12. doi: 10.1016/j.jad.2013.12.034. Epub 2014 Jan 2.
Little is known about the effect of common mental disorders (CMD) among women in the perinatal period on infant development in low-income countries. The aim of this study was to examine the effect of exposures to maternal symptoms of ante- and post-natal CMD on infant social-emotional development in a low-income setting.
A prospective community-based investigation in which a cohort of pregnant women was recruited in rural northern Vietnam and followed until 6 months postpartum. Psychosocial and biological data were collected in four assessment waves. The outcome was 6-month old infants' scores on the Bayley Scales of Infant and Toddler Development Social-Emotional Questionnaire. Direct and indirect effects of maternal CMD on the outcome were tested simultaneously with path analysis.
Complete data were available for 378 mother-infant dyads. There were no direct effects of ante- or post-natal CMD on infant Social-Emotional scores. However, there was an indirect pathway (path coefficient -1.11, 95% CI -1.79 to -0.42) in which antenatal CMD were associated with increased likelihood of postnatal CMD, which were associated with reduced parenting self-efficacy and less affectionate and warm parenting practices, which were associated with lower infant social-emotional scores. Parenting self-efficacy and practices also mediated the adverse effects of a woman being young or of high parity or experiencing poverty, intimate partner violence, a poor relationship with her own mother, non-economic life adversity and insufficient breastmilk, on infant social-emotional development.
We acknowledge some limitations including (1) a moderate rate of attrition, (2) the use of a screening test for perinatal CMD, (3) the Bayley scales are not yet validated for use in Vietnam and (4) possible response bias in which maternal perceptions of their infants were influenced by their mood.
These data indicate that women's antenatal and postnatal mental health is a crucial but currently inadequately understood determinant of the social and emotional development of infants in low-income settings.
在低收入国家，围产期常见精神障碍（CMD）对婴儿发育的影响知之甚少。本研究旨在探讨在低收入环境下，产妇产前和产后 CMD 症状暴露对婴儿社会情感发展的影响。
这是一项前瞻性的基于社区的调查，在越南北部农村招募了一组孕妇，并在产后 6 个月进行随访。在四个评估阶段收集了心理社会和生物学数据。结果是 6 个月大婴儿在贝利婴幼儿发展量表社会情感问卷上的得分。通过路径分析同时测试了产妇 CMD 对结果的直接和间接影响。
共有 378 对母婴对完成了完整的数据。产前或产后 CMD 对婴儿社会情感评分没有直接影响。然而，存在一条间接途径（路径系数-1.11，95%CI-1.79 至-0.42），其中产前 CMD 与产后 CMD 的发生几率增加相关，产后 CMD 与育儿自我效能降低以及较少的关爱和温暖的育儿实践相关，而这些又与婴儿社会情感评分较低相关。育儿自我效能和实践也介导了妇女年龄较小、多胎次、贫困、亲密伴侣暴力、与自己母亲关系不佳、非经济生活逆境和母乳不足等因素对婴儿社会情感发展的不利影响。
我们承认存在一些局限性，包括（1）较高的失访率，（2）围产期 CMD 使用的筛查测试，（3）贝利量表尚未在越南得到验证，以及（4）可能存在的响应偏差，即母亲对婴儿的看法受到她们情绪的影响。
这些数据表明，妇女产前和产后的心理健康是影响低收入环境下婴儿社会和情感发展的一个关键但目前尚未充分理解的决定因素。
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