Exploring caregiver mental health and child development in Nyanza, Kenya

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Integrative Statement

Mental health problems can greatly affect a parent or caregiver’s ability to care for and raise a child; previous research shows that caregiver mental health problems have direct and significant effects on child behavior (Britto et. al., 2017). In this paper, we share findings from a study of caregiver depression, anxiety, and stress in a rural district in Kenya, and look at associations between caregiver and child mental health. We sought to determine the extent of mental health problems in adults and children, and hypothesized that higher rates of caregiver mental health would be associated with worse child outcomes.

Baseline cross-sectional data was collected from children enrolled in Plan International’s Community-Led Action for Children program in Nyanza Province, Kenya, and their caregivers. We randomly selected 20 ECCD centers of varying quality as recruitment sites for the study. Children ages 4-5 were eligible for recruitment if they were attending one of these selected ECCD centers; 497 children and 465 caregivers were recruited and assessed at baseline.

We employed and trained a local team to interview caregivers and conduct child assessments. To measure child behavior, data collectors asked caregivers questions from the Strengths and Difficulties Questionnaire. To measure caregiver mental health, we used the Patient Health Questionnaire-9 (to gauge depressive symptoms), the Generalized Anxiety Disorders-7 (to gauge anxiety symptoms), and the Parenting Distress subset from the Parenting Stress Index-Short Form, as well as a standalone question on help-seeking. After identifying salient variables in univariate regressions, a multivariate linear regression model was used to assess significance.

Altogether, 245 caregivers, or 52.5% of our sample, had high levels of symptoms of depression, anxiety, or both; furthermore, 101 caregivers (21.7%) scored 10 or higher on both the PHQ-9 and GAD-7. Although a high proportion of our sample reported seeking emotional or spiritual support, only 35% of the depressed/anxious caregiver subsample had sought support. In our model, caregiver depression (p = 0.03), anxiety (p = 0.03) and parenting stress (p = 0.00) were all significant and correlated with child behavioral problems. Parenting stress was significantly correlated with the anxiety symptoms, depression symptoms, and help-seeking variables.

There was a high prevalence of adults in our sample with mental health symptomology, higher than previous estimates from Kenya. The low numbers of caregivers registering mental health symptoms who indicated seeking support likely indicates stigma or accessibility challenges surrounding mental health help-seeking, which has been reported in other African settings. We found a strong predictive effect of caregiver anxiety status on child behavioral outcomes—specifically, caregiver anxiety. There is a need for further research in LMICs on caregiver mental health and child wellbeing.

Authors

• Christina Laurenzi, Stellenbosch University
  Presenting Author

• Sarah Skeen, Stellenbosch University
  Non-Presenting Author

• Phillip Sundin, UCLA
  Non-Presenting Author

• Xanthe Hunt, Stellenbosch University
  Non-Presenting Author

• Robert E. Weiss, UCLA
  Non-Presenting Author

• Mark Tomlinson, Stellenbosch University
  Non-Presenting Author