Perinatal Depression, Maternal Engagement and Child Social–Emotional Development: A Cohort Study

ABSTRACT Background Evidence gaps remain regarding the influence of perinatal depression on mother–child engagement and child social–emotional development. Objectives We assessed relationships between perinatal depression, mother–child engagement and child social–emotional development among Kenyan mother–child pairs. Methods Mother–child pairs attending maternal‐child health services in four sites in Western Kenya were followed from pregnancy through early childhood. Study nurses serially assessed perinatal depression (pregnancy, 6 weeks, and 9 months postpartum with the Center for Epidemiologic Studies Depression scale, CESD‐10 scores ≥ 10), mother–child engagement activities (6‐monthly, 24 to 60 months post‐delivery with UNICEF Multiple Indicator Cluster Surveys) and child social–emotional delay (6‐monthly, 30 to 60 months post‐delivery with Ages and Stages Questionnaires). We estimated prevalence and correlates of low mother–child engagement and social–emotional delay. Results Among 884 mothers, the median age was 26 years (IQR 22.0, 30.3), 91.6% were married, and 36.8% had perinatal depression. High mother–child engagement (≥ 4 activities in the prior 3 days) ranged from 27.1% to 94.1% from 24 to 60 months post‐delivery. The frequency of child social–emotional delay ranged from 26.6% at 30 months to 4.4% at 60 months. Low mother–child engagement at any point (< 4 activities) was more common among women with perinatal depression (adjusted relative risk [RR] 1.20, 95% confidence interval [CI] 1.08, 1.33) and was associated with twice the risk of child social–emotional delay (RR 2.22, 95% CI 1.78, 2.77). Mothers who reported adverse childhood experiences (ACES) (RR 1.08, 95% CI 1.04, 1.11) and intimate partner violence (IPV) (RR 1.28, 95% CI 1.11, 1.47) interacted less frequently with their children than women without these experiences. Conclusion In this cohort of Kenyan mother–child pairs followed from pregnancy through childhood, perinatal depressive symptoms were associated with lower mother–child engagement, which was associated with double the risk of child social–emotional delay.