Ahun Marilyn N, Appiah Richard, Aurino Elisabetta, Wolf Sharon
Department of Medicine, McGill University, Montréal, Canada.
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
PLOS Glob Public Health. 2024 Sep 13;4(9):e0003724. doi: 10.1371/journal.pgph.0003724. eCollection 2024.
While there is a strong link between caregiver mental health, caregiver engagement, and child development, limited research has examined the underlying mechanisms of these associations in Africa. We examined the mediating role of dimensions of caregiver engagement in the association of caregiver psychological distress with children's academic and socioemotional outcomes in Ghana. Data came from 4,714 children (aged 5-17 years) and their caregivers in five regions of northern Ghana. Caregiver psychological distress and engagement (i.e., engagement in education, emotional supportiveness, and parenting self-efficacy) were self-reported by children's primary caregiver. Children's academic (literacy and numeracy) and socioemotional (prosocial skills and socioemotional difficulties) outcomes were directly assessed using validated measures. Structural equation modelling was used to estimate mediation models. We tested moderation by caregiver exposure to formal education, child's age, and child's sex. Fourteen percent of caregivers experienced elevated psychological distress. Higher levels of psychological distress were associated with children's poorer literacy and numeracy skills, and higher socioemotional difficulties, but not prosocial skills. The mediating role of caregiver engagement varied by caregiver exposure to formal education but not child's age or sex. Caregiver engagement in education explained the association between psychological distress and children's literacy skills (but not numeracy or socioemotional) in families where the caregiver had no formal education (indirect effect: β = 0.007 [95% CI: 0.000, 0.016]), explaining 23% of the association. No mediator explained the association of psychological distress with child outcomes among families where the caregiver had some formal education. The mechanisms through which caregiver psychological distress is associated with child outcomes in rural Ghana differ as a function of caregivers' exposure to formal education. These results highlight the importance of developing multi-component and culturally-sensitive programs to improve child outcomes. Further research in similar contexts is needed to advance scientific understanding on how to effectively promote child and family wellbeing.
虽然照顾者心理健康、照顾者参与度和儿童发展之间存在紧密联系，但在非洲，针对这些关联背后机制的研究却很有限。我们在加纳考察了照顾者参与度的各个维度在照顾者心理困扰与儿童学业及社会情感发展结果之间的关联中所起的中介作用。数据来自加纳北部五个地区的4714名儿童（年龄在5至17岁之间）及其照顾者。照顾者的心理困扰和参与度（即参与教育、情感支持和育儿自我效能感）由儿童的主要照顾者自行报告。儿童的学业（读写和算术）及社会情感（亲社会技能和社会情感困难）发展结果通过经过验证的测量工具直接评估。采用结构方程模型来估计中介模型。我们检验了照顾者接受正规教育程度、孩子年龄和孩子性别的调节作用。14%的照顾者经历了较高水平的心理困扰。较高水平的心理困扰与儿童较差的读写和算术技能以及较高的社会情感困难相关，但与亲社会技能无关。照顾者参与度的中介作用因照顾者接受正规教育程度的不同而有所差异，但不受孩子年龄或性别的影响。在照顾者没有接受过正规教育的家庭中，照顾者参与教育解释了心理困扰与儿童读写技能（但不包括算术或社会情感技能）之间的关联（间接效应：β = 0.007 [95%置信区间：0.000, 0.016]），解释了该关联的23%。在照顾者接受过一些正规教育的家庭中，没有中介变量能够解释心理困扰与儿童发展结果之间的关联。在加纳农村地区，照顾者心理困扰与儿童发展结果之间的关联机制因照顾者接受正规教育程度的不同而有所不同。这些结果凸显了制定多成分且具有文化敏感性的项目以改善儿童发展结果的重要性。需要在类似背景下开展进一步研究，以增进对如何有效促进儿童和家庭福祉的科学理解。
