title: Effect of a food supplementation and psychosocial stimulation trial for severely malnourished children on the level of maternal depressive symptoms in Bangladesh.
abstract: BACKGROUND
  Maternal depression is associated with poor child development and growth in low-income countries. This paper evaluates the effect of a community-based trial providing psychosocial stimulation and food supplements to severely malnourished children on maternal depressive symptoms in Bangladesh.
  
  
  METHODS
  Severely underweight (weight-for-age Z-score < -3) hospitalized children aged 6-24 months (n = 507), were randomly assigned to: psychosocial stimulation (PS), food supplementation (FS), PS+FS, clinic control (CC) and hospital control (CH) at discharge. PS included play sessions with children and parental counselling to mothers during fortnightly follow-up visit at community clinics, conducted by trained play leaders for 6 months. FS involved cereal-based supplements (150-300 kcal/day) for 3 months. All groups received medical care, micronutrient supplements and growth monitoring. We used Bayley scales, Home Observation for Measurement of Environment (HOME) inventory and a parenting questionnaire to assess child development, home stimulation and mothers' child-rearing practices, respectively. We assessed mothers' depressive symptoms using a modified version of Centre for Epidemiologic Studies Depression Scale at baseline and at 6 months post intervention.
  
  
  RESULTS
  Maternal depressive symptoms were significantly lower in the CH group at baseline (P = 0.014). After 6 months of intervention there was no significant effect of intervention after adjusting for baseline scores and all possible confounders. Maternal depressive symptoms were higher among poorer (P = 0.06), older (P = 0.057) and less educated (P = 0.019) mothers, who were housewives (P = 0.053), and whose husbands had more unstable jobs (P = 0.058). At 6 months post intervention, children's cognitive (P = 0.045) and motor (P = 0.075) development, HOME (P = 0.012) and mother's parenting score (P = 0.057) were higher among mothers with lower depressive symptoms.
  
  
  CONCLUSIONS
  The study did not show a significant effect of the intervention on the level of maternal depressive symptoms. Interventions with higher intensity and/or of longer duration focusing directly on maternal psychosocial functioning are probably needed to reduce maternal depressive symptoms.
authors.affiliation: Centre for Nutrition and Food Security (CNFS), International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; International Maternal and Child Health (IMCH), Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
authors.forename: B
authors.initials: B
authors.lastname: Nahar
authors.forename: I
authors.initials: I
authors.lastname: Hossain
authors.forename: J D
authors.initials: JD
authors.lastname: Hamadani
authors.forename: T
authors.initials: T
authors.lastname: Ahmed
authors.forename: S
authors.initials: S
authors.lastname: Grantham-McGregor
authors.forename: L-A
authors.initials: LA
authors.lastname: Persson
mesh_terms: D001459:Bangladesh / Q000453:epidemiology; D002657:Child Development; D019052:Depression, Postpartum / Q000150:complications* / Q000628:therapy; D019587:Dietary Supplements; D005260:Female; D015438:Health Behavior; D006801:Humans; D007223:Infant; D008297:Male; D044342:Malnutrition / Q000517:prevention & control* / Q000523:psychology; D009034:Mother-Child Relations / Q000523:psychology*; D009035:Mothers / Q000523:psychology; D016487:Parenting / Q000523:psychology*; D010290:Parents / Q000193:education* / Q000523:psychology; D010988:Play and Playthings; D011795:Surveys and Questionnaires
keywords: Bangladesh; food supplementation; maternal depressive symptoms; psychosocial stimulation; severe malnutrition