Malcolm-Smith Susan, Lake Marilyn T, Krwece Akhona, du Plooy Christopher P, Hoffman Nadia, Donald Kirsten A, Zar Heather J, Stein Dan J
ACSENT Laboratory, Department of Psychology, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
Dev Psychopathol. 2023 May;35(2):982-999. doi: 10.1017/S095457942200027X. Epub 2022 Mar 15.
Mental health problems often begin in early childhood. However, the associations of various individual and contextual risk factors with mental health in the preschool period are incompletely understood, particularly in low- to middle-income countries (LMICs) where multiple risk factors co-exist. To address this gap, we prospectively followed 981 children in a South African birth cohort, the Drakenstein Child Health Study, assessing pre-and postnatal exposures and risk factors. The predictive value of these factors for child mental health (assessed by the Child Behavior Checklist) was modeled using structural equation modeling. We identified two key pathways to greater externalizing behavior: (1) prenatal exposure to substances (alcohol and smoking) directly predicted increased externalizing behavior (β = 0.24, p < 0.001); this relationship was partially mediated by an aspect of infant temperament (negative emotionality; β = 0.05, p = 0.016); (2) lower socioeconomic status and associated maternal prenatal depression predicted more coercive parenting, which in turn predicted increased externalizing behavior (β = 0.18, p = 0.001). Findings in this high-risk LMIC cohort cohere with research from higher income contexts, and indicate the need to introduce integrated screening and intervention strategies for maternal prenatal substance use and depression, and promoting positive parenting across the preschool period.
心理健康问题往往始于幼儿期。然而，人们对学前阶段各种个体和环境风险因素与心理健康之间的关联尚未完全了解，尤其是在多种风险因素并存的低收入和中等收入国家（LMICs）。为了填补这一空白，我们对南非一个出生队列——德拉肯斯堡儿童健康研究中的981名儿童进行了前瞻性跟踪，评估了产前和产后的暴露情况及风险因素。使用结构方程模型对这些因素对儿童心理健康（通过儿童行为检查表评估）的预测价值进行了建模。我们确定了导致更多外化行为的两条关键途径：（1）产前接触物质（酒精和吸烟）直接预测外化行为增加（β = 0.24，p < 0.001）；这种关系部分由婴儿气质的一个方面（消极情绪；β = 0.05，p = 0.016）介导；（2）较低的社会经济地位及相关的母亲产前抑郁预示着更多的强制型育儿方式，这反过来又预示着外化行为增加（β = 0.18，p = 0.001）。在这个高风险的低收入和中等收入国家队列中的研究结果与高收入背景下的研究一致，并表明需要针对母亲产前物质使用和抑郁引入综合筛查和干预策略，并在整个学前阶段促进积极的育儿方式。
