Predictors of Parent Mental Health and Associations with Child Outcomes - Evidence from a Randomized Controlled Trial in Cote d’Ivoire

• In Event: Mental health and school safety: Current situations and implied solutions

Proposal

Context

As of 2020, 17% of the world’s population lives in Africa, and more than half of the global population growth between 2015 and 2050 is expected to occur there, making it the fastest growing continent (World Bank 2018, United Nations 2019). Projections estimate that by 2050, one in every three children under 18 will be African (UNICEF, 2014). Alongside this rapid growth in population, extreme poverty (living on < US$1.90 per day) is becoming increasingly concentrated in Sub-Saharan Africa. Unlike the global trend, the total number of extremely poor people in Sub-Saharan Africa is increasing, from 278 million in 1990 to 413 million in 2015 (World Bank, 2018).
Poverty gives a psychological meaning to economic hardship (Chaudry & Wimer, 2016). 73% and 79% of 115 studies based in 36 low- and middle-income countries (LMICs) reported positive associations between a variety of poverty measures and common mental disorders (Lund et al., 2012). Parenting and family factors are the critical drivers of children’s early healthy growth and development and are thus primary in determining the immediate severity of poverty-related impacts on young children.
Only 3% of clinical trials focusing on mental health have been conducted in LMICs. The few country-specific indicators point to disproportionate depression rates in various African countries versus western countries. The current prevalence of depression in Canada averages at 6%, which is similar to other western countries (the female-to-male ratio average is 2:1) (Stephens et al., 2004). The prevalence in LMICs is much higher: 29% of women in Uganda as suffering from depression, with depression being labeled as the “number one disabler of women'', and 39% of pregnant women in a South African sample were classified as depressed (Bolton et al., 2003; Hartley et al., 2011). In Ghana, 26.6% of women showed a substantially depressed mood. In Cote d’Ivoire, this figure was even higher (32.9%). Comorbidity of depression and anxiety was common, affecting about 7.7% of Ghanaian and 12.6% of Ivorian participants (Bindt et al., 2011). Depression affects about 20% of women in LMICs during their lifetime, with pregnancy being a period of high vulnerability, with the prevalence of depression during pregnancy ranging from 4% to 20% (Ajinkya et al., 2013).
Côte d’Ivoire remains one of the countries with the highest gender inequality rates in the world, and a poverty rate of 46.3% of the net population (World Bank, 2019).

Inquiry

Using evidence from a 2018 clustered Randomized Controlled Trial in Cote d’Ivoire, we explore parent mental health, predictors of depressive and anxiety symptoms, and associations with child outcomes. The project that informs this paper collected longitudinal data pertaining to various domains that influence children’s developmental outcomes via interviews. The study includes 2,500 parents and 2,500 children selected from 100 schools in two regions of Côte d’Ivoire. Using the Goldberg 18-item Depression test, caregivers were assessed in a cross-sectional study for depressive and anxiety symptoms during baseline interviews. By analyzing inter-item correlation scores and conducting a confirmatory factor analysis, we validate the reliability of the test instruments and results. We define a regression model predicting anxiety and depression symptoms with huber-white standard errors to correct for clustering by schools.


Findings- Predictors of parent mental health

Parent Education
Parent’s education impacts children’s development in multiple domains, and influences parents’ mental health and their coping strategies (Hsieh et. al., 2017). Respondents who completed higher levels of education were less likely to exhibit depressive and anxiety symptoms than the parents with lower/no education.
Female
Women respondents are more likely to exhibit depression and anxiety symptoms than male respondents. Cote d’Ivoire consistently ranks among the lowest in the world on the Gender Parity Index. Women complete lesser schooling than men- the secondary completion rate for girls is 42.7% while for boys, it is 55.5% (Bindt et al., 2011).
Marital status
For unmarried mothers, unemployment, housing problems, and inadequate income were among those stressors most strongly associated with depressive symptoms. Sub-Saharan Africa has the highest percentage of single mothers worldwide, at 32% (Gallup World Poll, 2018). Unmarried women may not only experience a greater number of persistent daily stressors than married women, but they may also be more affected by daily stressors. The latter possibility may be due to the greater availability of internal coping resources or social resources among the married resources which may buffer the psychological impact of everyday stressors. Respondents who are divorced and widowed were significantly associated with depression and anxiety symptoms. Respondents who were married but separated were less likely to exhibit both depression and anxiety symptoms.
Family Income
Parents from higher monthly earnings are less likely to exhibit depressive and anxiety symptoms. Lower SES is linked to increased household stress, inhibiting parents’ abilities to seek support for themselves and invest in their children’s complex needs. However, SES was not linked to disability level depression and anxiety in studies from Ghana and Cote d’Ivoire. The unemployment rate in Cote D’Ivoire of young people between the ages of 15 and 35 is 36% (World Bank, 2019).

Authors

• Anahita Kumar, University of Pennsylvania

• Berta Bartoli, University of Pennsylvania