title: Perinatal mental distress and infant morbidity in Ethiopia: a cohort study.
abstract: OBJECTIVE
  (1) To investigate the impact of perinatal common mental disorders (CMD) in Ethiopia on the risk of key illnesses of early infancy: diarrhoea, fever and acute respiratory illnesses (ARI) and (2) to explore the potential mediating role of maternal health behaviours.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Demographic surveillance site in a predominantly rural area of Ethiopia.
  
  
  METHODS
  1065 women (86.3% of eligible) in the third trimester of pregnancy were recruited and 954 (98.6%) of surviving, singleton mother-infant pairs were followed up until 2 months after birth.
  
  
  METHODS
  High levels of CMD symptoms, as measured by the locally validated Self-Reporting Questionnaire (SRQ-20 ≥6), in pregnancy only, postnatally only and at both time-points ('persistent').
  
  
  METHODS
  Maternal report of infant illness episodes in first 2 months of life.
  
  
  RESULTS
  The percentages of infants reported to have experienced diarrhoea, ARI and fever were 26.0%, 25.0% and 35.1%, respectively. Persistent perinatal CMD symptoms were associated with 2.15 times (95% CI 1.39 to 3.34) increased risk of infant diarrhoea in a fully adjusted model. The strength of association was not affected by including potential mediators: breast feeding practices, hygiene, the infant's vaccination status or impaired maternal functioning. Persistent perinatal CMD was not associated with infant ARI or fever after adjusting for confounders.
  
  
  CONCLUSIONS
  Persistent perinatal CMD was associated with infant diarrhoea in this low-income country setting. The observed relationship was independent of maternal health-promoting practices. Future research should further explore the mechanisms underlying the observed association to inform intervention strategies.
authors.affiliation: Faculty of Medicine, Department of Psychiatry, Addis Ababa University, Addis Ababa, Ethiopia.
authors.forename: Joanna
authors.initials: J
authors.lastname: Ross
authors.forename: Charlotte
authors.initials: C
authors.lastname: Hanlon
authors.forename: Girmay
authors.initials: G
authors.lastname: Medhin
authors.forename: Atalay
authors.initials: A
authors.lastname: Alem
authors.forename: Fikru
authors.initials: F
authors.lastname: Tesfaye
authors.forename: Bogale
authors.initials: B
authors.lastname: Worku
authors.forename: Michael
authors.initials: M
authors.lastname: Dewey
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.forename: Martin
authors.initials: M
authors.lastname: Prince
mesh_terms: D000293:Adolescent; D000328:Adult; D016241:Child of Impaired Parents / Q000706:statistics & numerical data*; D015331:Cohort Studies; D015986:Confounding Factors, Epidemiologic; D003906:Developing Countries; D003968:Diarrhea, Infantile / Q000453:epidemiology* / Q000209:etiology; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000453:epidemiology / Q000209:etiology; D015438:Health Behavior; D006801:Humans; D007231:Infant, Newborn; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009035:Mothers / Q000523:psychology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology* / Q000523:psychology; D012140:Respiratory Tract Diseases / Q000453:epidemiology / Q000209:etiology; D012307:Risk Factors; D012423:Rural Health / Q000706:statistics & numerical data; D055815:Young Adult