Habtamu Mekonnen^{1, 2}, Girmay Medhin³, Mark Tomlinson⁴, Atalay Alem¹, Martin Prince⁵ and Charlotte Hanlon^{1, 5}

1. Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University;
2. Department of Psychology, College of Education and behavioral science, Jimma University, Jimma.
3. Centre for Global Mental Health, Institute of Psychiatry, King’s College London;
4. Aklilu-Lemma Institute of Pathobiology, Addis Ababa University;
5. Department of Psychology, Stellenbosch University, Stellenbosch, South Africa;

Corresponding Author: Habtamu Mekonnen, Department of Psychology, College of Behavioural Sciences and Education, Jimma University and Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University

E-mail: mhkurmane@gmail.com or Habtamu.kurmane@ju.edu.et

Tel: +251-912-947830

Acknowledgements: This study was funded by the Welcome Trust UK.

Conflict of Interest: None

Background

The postnatal period is a critical period for exposure to maternal common mental disorders (CMD; depression and anxiety symptoms) leading in many cases to enduring effects on the child regardless of subsequent maternal mental health. However, some studies find ongoing repeated exposure to maternal CMD during early childhood to be more strongly associated with adverse child outcomes than simply early postnatal exposure.

Aim

To examine the independent associations between antenatal, two months postnatal and repeated exposure to maternal CMD in early childhood on child educational outcomes between 7 and 9 years of age.

Methods

Out of 1234 eligible women in the third trimester of pregnancy living in the Butajira Demographic Surveillance Site, Ethiopia, 1065 (86.3%) were recruited between July 2005 and February 2006 and have been followed up to date. One antenatal and nine postnatal assessments were carried out on mother-child dyads. Cumulative maternal CMD was defined as the number of assessment time points participant scoring 6 or more on a validated measure of CMD excluding the 2 months postnatal time-point. Educational outcomes of the child were obtained from the mother when the child was aged between 7 and 8 years (2013/14 academic year) and from school records when the children were aged between 8 and 9 years (2014/15 academic year).

Results

Antenatal CMD (Risk Ratio (RR) 1.06; 95% Confidence Interval (CI): 1.05, 1.07) and postnatal CMD (RR 1.07; 95% CI: 1.06, 1.09) were significantly associated with child absenteeism at T2. Recurrent exposure to pre-school maternal CMD was not associated with absenteeism after adjusting for antenatal and postnatal CMD. Non-enrolment at T1 (Odds Ratio 0.75; 95% CI: 0.62, 0.92) was significantly but inversely associated with postnatal maternal CMD. There was no association between maternal CMD and child academic achievement or drop-out.

Conclusions

Our findings support the hypothesis of a critical period of exposure to maternal CMD for adverse child outcomes and indicate that programs aimed at enhancing regular school attendance need to address maternal CMD from pregnancy onwards.

Keywords: Child Education, Absenteeism, Maternal Mental Health, Depression, postnatal depression, sub-Saharan Africa