Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, United States of America.
Division of Adolescent and Young Adult Medicine, Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston Children's Hospital, Boston, MA, United States of America.
PLoS One. 2020 Jan 30;15(1):e0228435. doi: 10.1371/journal.pone.0228435. eCollection 2020.
Maternal mental health is becoming recognized as a global health priority. Mental distress among mothers of young children may be exacerbated by exposure to adversity. Social capital may buffer the impact of adversity on mental distress during the postnatal period and beyond. This paper examines the relationship between adversity, cognitive social capital and mental distress among mothers of young children in three low and middle-income countries.
This study uses data from the Young Lives study on 5,485 women from Ethiopia, India, and Vietnam. Logistic regression was used to examine the association between exposure to stressful life events (SLEs) and mental distress in women between 6 months and 1.5 years post-partum. Logistic and linear regression was used to examine the potential for effect modification by social capital.
The proportion of women with mental distress during the period between 6-18 months following the birth of a child in the sample was 32.6% in Ethiopia, 30.5% in India and 21.1% in Vietnam. For each additional SLE to which a woman was exposed, the odds of MMD increased by 1.28 (95% CI: 1.22, 1.36; p<0.001) in Ethiopia, 1.17 (1.11, 1.25; p<0.001) in India, and 1.98 (1.75, 2.25; p<0.001) in Vietnam. Exposure to family SLEs was significantly associated with MMD in all three countries with odds ratios of 1.76 (95% CI: 1.30, 2.38; p<0.001), 1.62 (95% CI: 1.12, 2.33; p<0.01 in India), 1.93 (95% CI: 1.27, 2.92; p<0.01), respectively. In Ethiopia and India, economic SLEs were also significantly associated with MMD after adjustment (Ethiopia OR: 1.68; 95% CI: 1.12, 2.52; p<0.01 and India OR: 1.44; 95% CI: 1.01, 2.05; p<0.05), while in India, crime SLEs (OR: 1.93; 95% CI: 1.27, 2.92; p<0.01) were associated with MMD. Cognitive social capital was found to modify the association between SLEs and symptomology of mental distress in Ethiopia, India and Vietnam.
This study suggests that adversity may increase the risk of maternal mental distress in three LMICs, while social capital may buffer its effect.
孕产妇心理健康正日益成为全球卫生重点。幼儿母亲可能因遭受逆境而导致精神困扰加剧。社会资本可能会缓冲产后和产后逆境对精神困扰的影响。本文研究了在三个中低收入国家，幼儿母亲所经历的逆境、认知社会资本与精神困扰之间的关系。
本研究使用来自埃塞俄比亚、印度和越南的 Young Lives 研究中 5485 名女性的数据。采用逻辑回归分析产后 6 至 18 个月间女性经历的应激性生活事件（SLEs）与精神困扰之间的关联。采用逻辑回归和线性回归分析社会资本对这种关联的潜在调节作用。
在样本中，孩子出生后 6-18 个月期间，出现精神困扰的女性比例在埃塞俄比亚为 32.6%，印度为 30.5%，越南为 21.1%。与女性所经历的每一个额外的 SLE 相比，其出现精神障碍的几率会增加 1.28（95%CI：1.22，1.36;p<0.001），在印度增加 1.17（95%CI：1.11，1.25;p<0.001），在越南增加 1.98（95%CI：1.75，2.25;p<0.001）。在所有三个国家，家庭 SLEs 的暴露均与 MMD 显著相关，其比值比（OR）分别为 1.76（95%CI：1.30，2.38;p<0.001）、1.62（95%CI：1.12，2.33;p<0.01）和 1.93（95%CI：1.27，2.92;p<0.01）。在埃塞俄比亚和印度，经济 SLEs 在调整后也与 MMD 显著相关（埃塞俄比亚 OR：1.68；95%CI：1.12，2.52;p<0.01；印度 OR：1.44；95%CI：1.01，2.05;p<0.05），而在印度，犯罪 SLEs（OR：1.93；95%CI：1.27，2.92;p<0.01）与 MMD 相关。认知社会资本被发现可以调节埃塞俄比亚、印度和越南 SLEs 与精神困扰症状之间的关联。
本研究表明，逆境可能会增加三个中低收入国家产妇出现精神困扰的风险，而社会资本可能会缓冲这种影响。
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