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Education And Debate

Effect of maternal mental health on infant growth in low income countries: new evidence from South Asia

BMJ 2004; 328 doi: (Published 01 April 2004) Cite this as: BMJ 2004;328:820
  1. Vikram Patel (, chair1,
  2. Atif Rahman, research fellow2,
  3. K S Jacob, professor of psychiatry3,
  4. Marcus Hughes, research fellow4
  1. 1 London School of Hygiene and Tropical Medicine, and Sangath, Goa, India
  2. 2 School of Psychiatry and Behavioural Sciences, University of Manchester
  3. 3 Christian Medical College, Vellore 632002, India
  4. 4 Institute of Psychiatry, London
  1. Correspondence to: V Patel, Sangath, 841/1 Alto Porvorim, Goa, India 403521

    Impaired infant growth, a major problem in South Asia, may require interventions to improve maternal mental health in addition to current interventions targeting infant nutrition

    Unicef estimates that over 220 million children aged less than 5 years in the developing world have significantly impaired growth.1 The South Asian region is perhaps worst affected, being home to more than half of all the underweight children in the world.2 This article considers the relevance of new evidence on the epidemiology and impact of postnatal depression in South Asia on poor infant growth in low income countries. This evidence shows, for the first time, that a common and potentially treatable mental health problem in mothers is one of the causes of infant failure to thrive. We use this evidence to present a case that child focused interventions, largely aiming to provide supplementary nutrition, may need to be combined with mother focused interventions that target maternal mental health.

    Prevalence and risk factors for postnatal depression

    Postnatal depression is depressive disorder occurring in the postnatal period and is typically diagnosed about 4-12 weeks after childbirth (see box).

    Several recent studies from South Asia have documented substantial rates of postnatal depression.36 Patel et al's cohort study of women attending a district hospital antenatal clinic in Goa, India, reported a prevalence of 23%.4 Chandran et al's community cohort study from Tamil Nadu, India, documented prevalence and incidence of 19.8% and 11%, respectively.3 Rahman et al's community cohort study from Pakistan reported a prevalence of 28%.6 These studies also showed that depressed mothers had significantly higher levels of disability, and that more than half remained ill for at least six months.

    Consistent risk factors for postnatal depression were antenatal psychiatric morbidity, economic deprivation, low education, and marital disharmony. Education, support from extended family members, and employment were …

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