Congolese mother and child mental health in response to early child development interventions

PROJECT SUMMARY Background. Among social factors affecting vulnerability to mental illness, family is key, and the quality of care that parents provide for their children perhaps being the most strategic. However, it is still unclear whether the early childhood parenting support programs offer later mental health benefits for the child; and if they do, which

mechanisms explain the association between early parenting support programs and mental health at school age. Specifically, it is not well understood how family social factors (e.g., parent sense of self-efficacy, family dynamics, quality of caregiving environment, school attendance) are associated with mental health outcomes in

childhood. Therefore, in this project we will evaluate the long-term effect of a parenting support program on child mental health outcomes at school age, and test the impacts of social family, maternal mental health, and child growth factors as predictors of longer-term child mental health. We will conduct a 3-year observational

longitudinal follow-up assessment (once each year) of 100 children whose mothers previously completed the year-long biweekly mediational intervention for sensitizing caregivers (MISC), and 114 children whose mothers were randomized to the No MISC (treatment as usual) arm. Specific Aims for this study are: Aim 1: To evaluate

long-term mental health outcomes (e.g., executive functioning/self-regulation, emotional responses, social communication, emotion regulation behaviors in caregiver-child interactions) of the MISC intervention among school-age children living in the DR Congo 5-years after their mothers received MISC or no MISC training. Child

mental health outcomes will be evaluated annually for 3 consecutive years with a range of validated and direct measures (video recordings of parent/child interactions, psychopathology checklists, eye tracking measures of child response to short video vignettes of child caregiving interactions). We hypothesize that children of mothers

who received MISC intervention will have more positive psychosocial and eye tracking based emotional outcomes at school age compared to children of mothers who did not receive MISC. Aim 2: To examine the family social, child growth, and maternal mental health factors gathered both in early childhood during the MISC

trial, and again in the proposed follow-up study, as simultaneous or consecutive mediators of the MISC effects on child mental health. We will also evaluate these factors as independent predictors of child mental health outcomes at 5-12-years of age. Findings on indirect effects of MISC through these factors or their effects

independent of MISC will help guide future efforts on how to best enhance the trajectory of mental health from early to middle childhood. Aim 3: Controlling for the receipt of the MISC intervention, assess longitudinal dyadic interdependence of maternal and child mental health outcomes to determine if there are reciprocating effects

between mother and child mental health over time. Overall Impact. Establishing how early childhood parenting support reduces psychopathology -- along with the family social, child growth, and maternal mental health factors driving this process -- will sustainably enhance child mental health in low- and middle-income countries (LMICs).