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There is compelling evidence for gradient effects of household income on school readiness. Potential mechanisms are described, yet the growth curve trajectory of maternal mental health in a child's early life has not been thoroughly investigated. We aimed to examine the relationships between household incomes, maternal mental health trajectories from antenatal to the postnatal period, and school readiness.
Prospective data from 505 mother–child dyads in a birth cohort in Singapore were used, including household income, repeated measures of maternal mental health from pregnancy to 2-years postpartum, and a range of child behavioural, socio-emotional and cognitive outcomes from 2 to 6 years of age. Antenatal mental health and its trajectory were tested as mediators in the latent growth curve models.
Household income was a robust predictor of antenatal maternal mental health and all child outcomes. Between children from the bottom and top household income quartiles, four dimensions of school readiness skills differed by a range of 0.52 (95% Cl: 0.23, 0.67) to 1.21 s.d. (95% CI: 1.02, 1.40). Thirty-eight percent of pregnant mothers in this cohort were found to have perinatal depressive and anxiety symptoms in the subclinical and clinical ranges. Poorer school readiness skills were found in children of these mothers when compared to those of mothers with little or no symptoms. After adjustment of unmeasured confounding on the indirect effect, antenatal maternal mental health provided a robust mediating path between household income and multiple school readiness outcomes (χ2 126.05, df 63, p < 0.001; RMSEA = 0.031, CFI = 0.980, SRMR = 0.034).
Pregnant mothers with mental health symptoms, particularly those from economically-challenged households, are potential targets for intervention to level the playing field of their children.
Antenatal mental health problems are well recognised to impact negatively on a woman and her developing fetus, influencing both the pregnancy outcome and quality of life. There is limited information on prevalence and risk factors of antenatal depression in Singaporean women.
To examine the prevalence of depressive disorders in pregnant women attending Singapore's National University Hospital (NUH) and the association between these conditions and socio-demographic factors.
To improve our knowledge and understanding of the epidemiology of antenatal depressive disorders in Singapore.
Pregnant women attending NUH (2009 to 2010) were screened for depressive symptoms using the Edinburgh Postnatal Depression Scale. Patients who screened positive (scores > 13) were clinically assessed by trained clinicians using DSM IV criteria for diagnosis. The cases were then discussed with a core group of 3 psychiatrists to reduce interrater variability.
From 530 screened women, the overall prevalence of antenatal depressive symptoms was 47.8% (EPDS > 13). 12.5% of patients were diagnosed with Major Depressive Disorder, 52.1% with Adjustment Disorder, 4.5% with Anxiety Spectrum illness (Panic Disorder, GAD, OCD, PTSD), 1.1% with Bipolar Disorder and 3.8% with Other diagnoses.
After adjustment with socio-demographic variables, depressive symptoms were significantly associated with single, divorced or separated pregnant women (OR = 4.09, 95% CI = 1.39−12.09, p < 0.05) and those with three or more social relationship problems (OR = 1.68, 95% CI = 1.00–2.84, p < 0.05).
Antenatal depressive symptoms are common in Singaporean women and they are associated with identifiable risk factors such as single status and limited social support.
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