Differences in maternal behaviors affecting child health status in probably depressed and non-depressed mothers in rural Uganda

Postpartum depression (PPD) is a common perinatal mental health disorder (CPMD) extensively linked to poor child health outcomes, including increased risk of illness, stunting and underweight. Rates of PPD and child malnutrition are consistently elevated in Sub-Saharan Africa compared to other regions of the world. This includes Northern Uganda, a region devastated by armed conflict and enduring poverty. While the link between PPD and adverse child health outcomes is firmly established, the mechanisms underlying this association remain poorly understood.The current study addresses this gap in the literature through investigating in a sample of Ugandan mothers of children 0 to 23 months how maternal behaviors promoting child health differ in the presence or absence of probable depression. This study also explores how perceived social support and women’s empowerment may moderate the relationship between PPD and mothers’ engagement in these health-promoting behaviors. The study is based on cross-sectional, baseline data collected for a project sponsored by Food for the Hungry Uganda, an international relief and development organization, and in partnership with the Global Mental Health Lab at Teachers College, Columbia University and World Vision International. The study’s sample included 1028 probably depressed and 284 nondepressed Ugandan mothers with at least one child under 24 months of age at the time of interviewing. The study’s findings yielded evidence to support the reliability and validity of the Patient Health Questionnaire-9 and Multidimensional Scale of Perceived Social Support for this sample. While as expected, probable depression was positively associated with child underweight, recent child illness, delayed care seeking for sick children and unsafe disposal of child feces, positive associations were also found between depression and important health-promoting behaviors, for which there is little evidence in the extant literature, including provision of the same amount or more food to a sick child, knowledge of danger signs of childhood illness, and some WASH behaviors. Perceived social support and women’s empowerment indicators were also found to moderate the association between probable depression and some IMCI, IYCF and WASH behaviors. Study limitations, clinical implications and recommendations for further research are discussed.