Abstract
Background:
The negative impacts of maternal depression on child mental health outcomes are well-documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle-income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience.
Methods:
Using data from the 2004 Pelotas Birth Cohort (N=4,231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥ 2 out of 5 assessment waves; n=1,132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent-report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (at 24 and 48 months) and IQ (at 6 years), and from cognitive stimulation to resilience via IQ, using counterfactual mediation.
Results:
A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via cognitive stimulation (OR = 1.76, 95% CI 1.02-3.38) and IQ (OR = 1.19, 95% CI 1.01-1.42), such that higher SES was associated with resilience via both higher levels of cognitive stimulation and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01-3.76) and total effect (OR = 1.94, 95% CI 1.05-3.89) of cognitive stimulation on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined.
Conclusions:
These findings suggest that cognitive stimulation in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.
The negative impacts of maternal depression on child mental health outcomes are well-documented. However, some children show adaptive functioning following exposure to maternal depression, demonstrating resilience. In a large birth cohort from Brazil, a middle-income country, we examined direct and indirect pathways, considering socioeconomic, family, and individual factors, contributing to the development of resilience.
Methods:
Using data from the 2004 Pelotas Birth Cohort (N=4,231), we restricted the sample to those exposed to maternal depression up to age 6 years (depression present at ≥ 2 out of 5 assessment waves; n=1,132; 50% boys). Resilience was defined as scoring below or equal to the mean of the unexposed group on all four problem subscales of the parent-report Strengths and Difficulties Questionnaire at age 11 years. We examined pathways from socioeconomic status (SES; measured at birth) to resilience via cognitive stimulation (at 24 and 48 months) and IQ (at 6 years), and from cognitive stimulation to resilience via IQ, using counterfactual mediation.
Results:
A minority of children exposed to maternal depression showed resilience (12.4%). There was evidence of indirect pathways from SES to resilience via cognitive stimulation (OR = 1.76, 95% CI 1.02-3.38) and IQ (OR = 1.19, 95% CI 1.01-1.42), such that higher SES was associated with resilience via both higher levels of cognitive stimulation and higher IQ, which, in turn, were each positively associated with resilience. Furthermore, there was evidence of a direct (OR = 1.86, 95% CI 1.01-3.76) and total effect (OR = 1.94, 95% CI 1.05-3.89) of cognitive stimulation on resilience, even after controlling for SES. However, these effects varied depending on how persistent and severe depression was defined.
Conclusions:
These findings suggest that cognitive stimulation in early childhood may represent a modifiable protective factor for children exposed to maternal depression and a promising intervention target to promote child resilience in the context of maternal depression exposure.
| Original language | English |
|---|---|
| Article number | e12188 |
| Number of pages | 10 |
| Journal | JCPP Advances |
| Volume | 3 |
| Issue number | 4 |
| Early online date | 3 Oct 2023 |
| DOIs | |
| Publication status | Published - 31 Dec 2023 |
Bibliographical note
ACKNOWLEDGEMENTSThe authors would like to thank the participating families and staff who contributed to the various stages of the 2004 Pelotas Birth Cohort study. This work was supported by the Brazilian Association of Public Health (ABRASCO); the Children's Pastorate; the World Health Organization [Grant no. 03014HNI]; the National Support Program for Centers of Excellence (PRONEX) [Grant no. 04/0882.7]; the Brazilian National Research Council (CNPq) [Grant no. 481012-2009-5; 484077-2010-4; 470965-2010-0; 481141-2007-3; 426024/2016-8]; the Brazilian Ministry of Health [Grant no. 25000.105293/2004-83]; the São Paulo Research Foundation (FAPESP) [Grant no. 2014/13864-6]. JMM is supported by FAPESP [Grant no. 2017/22723-5]. GH is supported by a Sir Henry Wellcome Postdoctoral Fellowship (grant number 209138/Z/17/Z).
