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Maternal postnatal depression and children's growth and behaviour during the early years of life: exploring the interaction between physical and mental health
  1. Bilal Avan1,
  2. Linda M Richter2,
  3. Paul G Ramchandani1,
  4. Shane A Norris3,
  5. Alan Stein1
  1. 1Section of Child and Adolescent Psychiatry, University of Oxford, Oxford, UK
  2. 2Child Youth Family and Social Development (CYFSD), Human Sciences Research Council, Durban, South Africa
  3. 3Department of Paediatrics and Child Health, University of the Witwatersrand, Johannesburg, South Africa
  1. Correspondence to Paul Ramchandani, Department of Psychiatry, University of Oxford, Warneford Hospital, Headington, Oxford OX3 7JX, UK; paul.ramchandani{at}


Objective To assess the association between maternal postnatal depression and child behaviour problems and child growth at age 2 years

Methods This was a longitudinal birth cohort study in Johannesburg, South Africa. Primary analysis on the ‘Birth to Twenty’ cohort was performed for the association between maternal postnatal depression and child behaviour problems (n=1035) and growth (n=891) at age 2 and subgroup analyses (n=635) were carried out to assess the role of poor child growth in this association. Main outcome measures were the association between maternal postpartum depression (measured at 6 months postnatally using the Pitt depression inventory) and child behaviour problems (Richman child behaviour scale) and child growth at age 2 years.

Results Maternal postnatal depression was significantly associated with child behaviour problems at age 2, independent of socioeconomic status (β=0.353, p value=0.015). There was some evidence that children of depressed mothers were also at increased risk for having stunted growth, compared to non-depressed mothers (OR 1.61 (95% CI 1.02 to 2.56). The association between postnatal depression and child behavioural problems was significantly mediated by the stunted growth of the child (β=0.294, p value=0.111).

Conclusions Maternal postnatal depression is associated with later child behaviour problems independent of the socioeconomic status of the family. This association is mediated by the child's growth, demonstrating the importance of considering a child's physical and mental health together.

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  • Funding The Birth to Twenty Research Programme is financially supported by the Wellcome Trust (UK, grant number 077210), Medical Research Council of South Africa, Human Sciences Research Council of South Africa and the University of the Witwatersrand, Johannesburg. PGR and AS are supported by the Wellcome Trust. BA, LMR and SAN report no biomedical financial interests.

  • Competing interest None.

  • Ethics approval This study was conducted with the approval of the Ethics committee of the University of the Witwatersrand.

  • Provenance and peer review Not commissioned; externally peer reviewed.