Understanding early child development in the context of socioeconomic adversity and maternal depression in Brazil and South Africa

儿童早期发育是一个复杂的过程，受遗传、环境和社会经济因素的影响。这些因素从生命早期（怀孕）就开始相互作用，形成发育的多个领域，包括生长、认知和语言发展以及行为。到目前为止，我的研究主要集中在解开这些影响高收入（英国和荷兰）和低收入和中等收入国家（巴西和南非）儿童早期发展的过程中的一些过程，特别是在不利的童年经历的情况下。更具体地说，我的工作是研究围产期心理健康对儿童发展的影响。围产期抑郁症很普遍，在高收入国家约有10%的妇女出现严重的抑郁症状，在低收入和中等收入国家约有18-25%。怀孕期间和生命早期的抑郁与认知和语言发展延迟的风险增加、情绪和行为问题、学习成绩下降（数学）和18岁时患抑郁症的几率增加有关。养育是抑郁症影响儿童发展的关键机制之一，更具体地说，是不一致和反应迟钝的养育。然而，儿童不容易受到母亲抑郁的影响。当面临社会经济逆境和缺乏支持时，抑郁症母亲所生的儿童认知发育、行为和成长受损的风险更大。作为这项奖学金的一部分，我建议扩展我正在进行的一些工作，以研究社会经济逆境对围产期心理健康和幼儿学习和行为的影响。巴西和南非是特别有兴趣将这项工作扩展到的国家，因为它们都处于快速的经济和社会转型中，都面临着高度的不平等。这两个国家的社会经济群体之间的差距越来越大，这影响到经济和健康结果。这些转变给社区和家庭生活带来了很大的压力。特别是在低收入和中等收入国家，高水平的抑郁症状与贫穷、缺乏支持和消极的生活事件有关。社会经济逆境和父母抑郁都是发育不良的危险因素，两者往往同时发生。这与低收入和中等收入国家较高的围产期抑郁症发生率相结合，使儿童面临更大的发育不良风险。本奖学金的目标是：1。扩展我目前的工作计划，并在南非索韦托的艾滋病毒阳性母亲样本中研究快速转型社会背景下的社会经济逆境如何影响围产期心理健康和幼儿学习和行为。这一队列将提供来自社会经济上处于不利地位的妇女样本的数据，这些妇女的儿童发育将因母亲的心理健康和母亲感染艾滋病毒而复杂化，这两者都与照料困难有关（1篇论文）。2.根据与Pelotas出生队列（巴西南部城市环境中间隔11年的一组两个队列）正在进行的工作（2004年和2015年，2篇论文）和关于在南非农村艾滋病毒阳性妇女及其子女样本中提供早期儿童刺激和抑郁症治疗综合治疗方案的可行性（1篇论文）。通过两次国际会议和出版物以及针对南非社区工作者和当地非政府组织的讲习班，传播这些发现。加强目前的合作并探索申请奖学金的机会。前往南非和巴西将使我能够与团队和队列合作者会面，讨论未来的工作。

Early child development is a complex process influenced by genetics, environment and socioeconomic factors. These interact from very early life (pregnancy) to shape multiple domains of development including growth, cognitive and language development and behaviour. My research so far has focused on disentangling some of these processes which affect early child development in both high income (UK and the Netherlands) and low and middle income countries (Brazil and South Africa) particularly in the case of adverse childhood experiences. More specifically, my work examines the effects of perinatal mental health on child development. Perinatal depression is prevalent, with about 10% of women experiencing significant depressive symptoms in high income countries (HIC) and 18-25% in low and middle income countries (LMIC). Depression during pregnancy and in the early years of life has been associated with an increased risk of delayed cognitive and language development, emotional and behavioural problems, lower academic achievement (maths) and higher rates of depression at 18 years of age. Parenting is one of the key mechanisms through which depression affects child development and more specifically inconsistent and unresponsive parenting. Children however, are not susceptible to the effects of maternal depression to the same degree. When facing socioeconomic adversity and lack of support, children born to depressed mothers are at increased risk of compromised cognitive development, behaviour and growth. As part of this fellowship I propose to extend some of my ongoing work to examine the impact of socioeconomic adversities on perinatal mental health and early child learning and behaviour. Brazil and South Africa are particularly interesting countries to extend this work to as they are both in rapid economic and social transition and both face high levels of inequality. Both countries face increasing levels of disparities amongst socioeconomic groups, which affect both economic and health outcomes. These transitions place high levels of stress on community and family life. Particularly in LMIC high levels of depressive symptoms are associated with poverty, lack of support and negative life events. Socioeconomic adversity and parental depression are both risk factors for poor development, which often co-occur. This, in combination with the higher rates of perinatal depression in LMIC, places children at increased risk of poor development. The objectives of this fellowship are to:1.Extend my current programme of work and examine how socioeconomic adversities in the context of rapidly transitioning societies impact on perinatal mental health and early child learning and behaviour in a sample of HIV-positive mothers in Soweto, South Africa. This cohort will provide data from a sample of socioeconomically disadvantaged women, where child development will be compounded by maternal mental health and maternal HIV-infection both of which are associated with caregiving difficulties (1 paper). 2.Produce publications from ongoing work with the Pelotas birth cohorts, a set of two cohorts set 11 years apart in an urban setting in southern Brazil (2004 and 2015, 2 papers) and on the feasibility of delivering an integrated treatment package of early child stimulation and depression treatment in a rural sample of HIV-positive women and their children in South Africa (1 paper).3.Communicate these findings through two international conferences and publications as well as through workshops targeting community workers and local NGOs in South Africa. 4.Strengthen the current collaborations and explore opportunities for fellowship applications. Travelling to both South Africa and Brazil will enable me to meet with the teams and the cohort collaborators to discuss future work.