Perinatal Depression, Maternal Engagement and Child Social-Emotional Development: A Cohort Study

Evidence gaps remain regarding the influence of perinatal depression on mother-child engagement and child social-emotional development.

We assessed relationships between perinatal depression, mother-child engagement and child social-emotional development among Kenyan mother-child pairs.

Mother-child pairs attending maternal-child health services in four sites in Western Kenya were followed from pregnancy through early childhood. Study nurses serially assessed perinatal depression (pregnancy, 6 weeks, and 9 months postpartum with the Center for Epidemiologic Studies Depression scale, CESD-10 scores ≥ 10), mother-child engagement activities (6-monthly, 24 to 60 months post-delivery with UNICEF Multiple Indicator Cluster Surveys) and child social-emotional delay (6-monthly, 30 to 60 months post-delivery with Ages and Stages Questionnaires). We estimated prevalence and correlates of low mother-child engagement and social-emotional delay.

Among 884 mothers, the median age was 26 years (IQR 22.0, 30.3), 91.6% were married, and 36.8% had perinatal depression. High mother-child engagement (≥ 4 activities in the prior 3 days) ranged from 27.1% to 94.1% from 24 to 60 months post-delivery. The frequency of child social-emotional delay ranged from 26.6% at 30 months to 4.4% at 60 months. Low mother-child engagement at any point (< 4 activities) was more common among women with perinatal depression (adjusted relative risk [RR] 1.20, 95% confidence interval [CI] 1.08, 1.33) and was associated with twice the risk of child social-emotional delay (RR 2.22, 95% CI 1.78, 2.77). Mothers who reported adverse childhood experiences (ACES) (RR 1.08, 95% CI 1.04, 1.11) and intimate partner violence (IPV) (RR 1.28, 95% CI 1.11, 1.47) interacted less frequently with their children than women without these experiences.

In this cohort of Kenyan mother-child pairs followed from pregnancy through childhood, perinatal depressive symptoms were associated with lower mother-child engagement, which was associated with double the risk of child social-emotional delay.