title: Common mental disorders among women, social circumstances and toddler growth in rural Vietnam: a population-based prospective study.
abstract: BACKGROUND
  Common mental disorders (CMD) and adverse social circumstances are widespread among mothers of infants and toddlers in resource-constrained settings. These can undermine early childhood development through compromised caregiving and insufficient access to essential resources. The aim was to examine the effect of maternal CMD and social adversity in the post-partum year on toddler's length-for-age index in a rural low-income setting.
  
  
  METHODS
  A population-based prospective cohort study of women in Ha Nam province, Vietnam who completed baseline assessments in either late pregnancy or 4-6 weeks post partum and were followed up, with their toddlers, 15 months later. CMD were assessed at both points by psychiatrist-administered Structured Clinical Interviews for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition Diagnoses. Anthropometric indices were calculated from toddler's age, sex, weight and length using World Health Organization Child Growth Standards. Social adversities were assessed by study-specific questions and locally validated psychometric instruments. The hypothesized model of factors governing toddler's length-for-age Z score (LAZ) was tested using path analysis.
  
  
  RESULTS
  In total, 211/234 (90.1%) mother-toddler pairs provided complete data. Baseline prevalence of CMD among women was 33.6% and follow-up was 18.5%. The mean LAZ among toddlers was -1.03 and stunting prevalence (LAZ < -2) was 15.6%. Maternal CMD at baseline were indirectly related to toddler LAZ via maternal CMD at follow-up (regression coefficient = -0.05, 95% CI -0.11 to -0.01). Maternal CMD at follow-up was associated significantly with toddler LAZ (regression coefficient = -0.15, 95% CI -0.28 to -0.05). Poorer quality of marital relationship, mothers' experiences of childhood abuse and <30 days dedicated post-partum care were associated indirectly with lower toddler LAZ via maternal CMD.
  
  
  CONCLUSIONS
  Maternal post-natal CMD are associated with child growth measured by LAZ in this resource-constrained setting. Social adversities affect child growth indirectly through increasing the risk of maternal CMD. Interventions to reduce stunting in low-income settings may need to address maternal CMD and social adversities in order to improve impact.
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Research and Training Centre for Community Development, Hanoi, Vietnam.
authors.forename: T
authors.initials: T
authors.lastname: Tran
authors.affiliation: Research and Training Centre for Community Development, Hanoi, Vietnam.
authors.forename: T T
authors.initials: TT
authors.lastname: Nguyen
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: H
authors.initials: H
authors.lastname: Nguyen
authors.affiliation: Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
authors.forename: T D
authors.initials: TD
authors.lastname: Tran
mesh_terms: D000328:Adult; D000886:Anthropometry / Q000379:methods; D002657:Child Development; D016241:Child of Impaired Parents; D005260:Female; D006128:Growth; D006130:Growth Disorders / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D009035:Mothers / Q000523:psychology*; D011203:Poverty / Q000706:statistics & numerical data*; D011204:Poverty Areas; D011446:Prospective Studies; D012423:Rural Health / Q000706:statistics & numerical data; D014744:Vietnam / Q000453:epidemiology; D055815:Young Adult
keywords: child growth; low-income settings; maternal mental health