Impact of maternal depression and treatment with interpersonal psychotherapy for groups on adoption of household behaviors affecting early childhood in Uganda

• In Event: Highlighted Session: Caregiver wellbeing in the context of COVID-19: evolving strategies to assess and respond to an evolving global crisis

Proposal

Maternal mental health is increasingly recognized globally as a critical component of women's human rights that has undeniable long-lasting impact on both her own wellbeing and also the health and development outcomes of her children. One in five mothers experience depression after birth in low and middle-income countries, where there is limited access to therapeutic interventions and mental health services. Maternal depression is associated with poor child health, growth, and development—ostensibly due to reduced caregiver responsiveness, functioning, and the uptake of caregiving practices.
With support from the Eleanor Crook Foundation—and in conjunction with Columbia University, Johns Hopkins University, and World Vision International—Food for the Hungry conducted a three-year cluster randomized controlled trial (C-RCT) in Kitgum, Uganda of 1,200 depressed mothers. The study tested the hypothesis that a World Health Organization-endorsed, community-based, evidence-based, attachment-focused psychotherapy called Interpersonal Therapy for Groups (IPT-G) can reduce maternal depression and thereby also improve the adoption of household health and caretaking behaviors associated with child wellbeing outcomes (0-23 months of age). Half of depressed mothers were randomized to the intervention arm, receiving three months of weekly IPT-G treatment prior to 15 months of peer-to-peer health education through Care Groups (an evidence-based cascading behavior change approach using volunteer, community-based health educators). The control arm of women participated in Care Groups without IPT-G treatment.
The study found that women treated with IPT-G had a greater reduction of depression (57.1%) than in control mothers (49.2%; p<0.05) six-weeks post treatment and significantly better improvements in perceived social support from significant others and functionality. By the end of the research trial, depression among all study participants – each of whom participated in the Care Group behaviour change intervention – continued to decline, which may be due to a therapeutic effect of the behavior change intervention itself. Depression had a profound influence on maternal adoption of behaviors. Following IPT-G treatment, the women in both arms who were no longer depressed were more likely to be practicing 11 of the 12 behaviors studied, and 10 of those 12 differences were statistically-significant.
These findings highlight that addressing caregiver depression is an important component of the nurturing care strategy for increasing adoption of behaviors that affect early childhood wellbeing. This research adds validity to the growing evidence base about the value of integrating mental health into traditional health, nutrition, and early childhood development programs. The findings have the potential to promote adaptive management among government ministries and the broader international non-governmental organization community by providing a case for inclusion of low cost mental health interventions with the involvement of non-specialized or community health providers into global health and education efforts.

Authors

• Erin Pfeiffer, Food for the Hungry

• Lisa Marie Easterbrooks, Food for the Hungry