Our team had three Bachpan related presentations at the Interdisciplinary Association for Population Health Science meeting in Seattle
Our work has been profiled in The Economist:
How psychotherapy improves poor mothers’ finances
This study evaluated the medium-term impacts of treating maternal depression on women’s mental health, financial empowerment, and parenting decisions. We leveraged variation induced by a cluster-randomized control trial that provided psychotherapy to 903 prenatally depressed mothers in rural Pakistan. It was one of the world’s largest psychotherapy interventions, and it dramatically reduced postpartum depression. Seven years after psychotherapy concluded, we returned to the study site to find that impacts on women’s mental health had persisted, with a 17% reduction in depression rates. The intervention also improved women’s financial empowerment and increased both time and money intensive parental investments.
A Novel Adaptation of the HOME Inventory for Elders:
The Importance of the Home Environment Across the Life Course
Hale K., Østbye T., Perera B., Bradley R., Maselko J.
The context in which dependents, regardless of age, receive care affects their health. This study adapted the Home Observation for Measurement of the Environment (HOME) Inventory, originally designed for child development research, to assess the quality of stimulation and support available to elders in their habitual households in Sri Lanka and the subsequent relationship between adapted domains and indicators of health. Higher quality physical home environment was found to be related to improved cognitive, but not psychological outcomes. Additionally, the variety of stimulation available was linked with both better cognitive outcomes and lower psychological distress.
Father involvement in the first year of life:
Associations with maternal mental health and child development outcomes in rural Pakistan
Maselko J., Hagaman AK., Bates LM., Bhalotra S., Biroli P., Gallis JA., O'Donnell K.,
Sikander S., Turner EL., Rahman A.
The contribution of fathers to child development and maternal mental health is increasingly acknowledged, although research on this topic outside of high income countries is limited. This study characterized father involvement in a rural setting in Pakistan and investigated the link between father involvement in the first year of life and child development and maternal depression. Among present fathers, most mothers reported that fathers were involved: for example, approximately 40% reported that the father plays with the baby on a typical day. Higher father involvement was found to be associated with improved child socioemotional development. Additionally, trends were observed between higher father involvement and improved developmental milestones as measured by the BAYLEY scales and lower levels of maternal depressive symptoms.
The relationship between responsive caregiving and child outcomes:
evidence from direct observations of mother-child dyads in Pakistan
Scherer E., Hagaman A., Chung E., Rahman A., O'Donnell K., Maselko J.
Responsive caregiving, or interactions in which caregivers give appropriate responses to a child’s signals, is linked to improved psychosocial, cognitive and physical outcomes in children. This study examined predictors of maternal responsive caregiving and investigated how those interactions were associated with children’s development using a novel observational tool, the Observation of Maternal-Child Interaction (OMCI) measure. Higher maternal education attainment, lower number of children, greater socioeconomic assets, and lack of maternal depression were associated with higher levels of observed responsive caregiving behaviors. Additionally, higher total OMCI scores were associated with positive child socioemotional outcomes. These findings suggest that incorporating responsive caregiving into child health interventions in LMIC may have valuable impacts on child socioemotional development.
Criterion-related Validity and Reliability of the Urdu version of the Patient Health Questionnaire in community-based settings of Pakistan
Gallis JA., Maselko J., O’Donnell K., Song K., Saqib K., Turner EL., Sikander S.
Depression is one of the most prevalent, yet unrecognized mental disorders in low and middle income countries (LMICs). In such locations, screening tools that are easy-to-administer, valid, and reliable are needed to assist in detecting symptoms of depression. This study aimed to demonstrate the criterion-related validity and internal reliability of the Urdu version of the PHQ-9, a common depression screener, in a sample of community-based pregnant women in Pakistan as compared to the Structured Clinical Interview for DSM disorders (SCID). A total of 1,731 women in their third trimester of pregnancy were assessed for major depressive disorder. Of these women, 33% met the cutoff for significant depressive symptoms on PHQ-9, and 26% were assessed positive for depression using the SCID. The sensitivity and specificity of PHQ-9 at a cutoff of ≥10 was 94.7% and 88.9%, respectively. The positive and negative predictive values were 75.2% and 97.9%, respectively; and the area under the curve was 0.959. Internal reliability, as measured by Cronbach’s alpha, was 0.844. This study demonstrates that the Urdu version of the PHQ-9 has acceptable criterion-related validity and reliability for screening for depressive symptoms in Pakistan and that it can serve as an accurate screening tool for major depressive disorder.
Socioeconomic status indicators and common mental disorders:
Evidence from a study of prenatal depression in Pakistan
Maselko J., Bates LM., Bhalotra S., Gallis J., O’Donnell K., Sikander S., Turner E.
There is growing interest in the relationship between socioeconomic status (SES), poverty, and mental health in low and middle-income countries (LMIC). However, it is not clear whether a gradient approach focused on a wider SES distribution or a binary poverty approach is more salient for mental health in LMIC. We contributed to the literature by examining how multiple indicators of socioeconomic status contribute to prenatal depression symptoms in a LMIC context. Findings indicated that fewer assets, experiencing food insecurity, and having household debt are independently associated with worse depression symptoms. The association with assets was linear with no evidence of a threshold effect, supporting the idea of a gradient in the association between levels of SES and depression symptoms. Together, the asset, food insecurity, and debt indicators explained 14% of the variance in depression symptoms, more than has been reported in high-income country studies. These findings support the use of multiple SES indicators to better elucidate the complex relationship between socioeconomic status and mental health in LMIC.
Ashley Hagaman, a recent post-doctoral fellow who recently started a faculty position at Yale, presented a poster on risk factors for suicide ideation.
Esther Chung, a PhD student in Dr. Maselko’s lab presented her paper on grandmother involvement and child development.
Katherine LeMasters, a PhD student in Dr. Maselko’s lab presented her paper on cultural post-partum practices and maternal depression.
We have an upcoming paper on the longer term impacts of the Thinking Healthy Programme (THP) on mothers in the American Economic Review
Forthcoming at American Economic Review.
Our study on the longer term impacts of the Thinking Healthy Programme intervention is coming out in the American Economic Review (AER). We are especially excited about this publication because it’s a reflection of our commitment to truly cross-disciplinary research. Our initial analysis of the ‘Saving Brains’ project focused solely on the child outcomes and was published in Lancet Psychiatry. The upcoming paper takes a much deeper dive into the data to examine the impact of the original THP on women’s mental health, financial empowerment, and parenting investments seven years after the end of the intervention. The program resulted in a 17% reduction in maternal depression rates as well as meaningfully improving women’s financial empowerment and increasing parental investments.