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

儿童早期发展是一个受遗传、环境和社会经济因素影响的复杂过程。它们从很小的时候(怀孕)就开始相互作用，形成多个发育领域，包括生长、认知和语言发展以及行为。到目前为止，我的研究重点是理清其中一些影响高收入国家(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，特别是在儿童不利经历的情况下。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(HIC)约有10%的妇女出现明显的抑郁症状，在低收入和中等收入国家(LMIC)约有18%-25%的妇女出现明显的抑郁症状。怀孕期间和生命早期的抑郁与认知和语言发育延迟、情感和行为问题、学业成绩(数学)较低以及18岁时抑郁发生率较高的风险增加有关。育儿是抑郁症影响儿童发展的关键机制之一，更具体地说，是影响前后不一致和反应迟钝的育儿方式。然而，孩子们不会受到同样程度的母性抑郁的影响。当面临社会经济逆境和缺乏支持时，抑郁母亲所生的孩子在认知发展、行为和成长方面受到损害的风险增加。作为这一研究金的一部分，我提议扩展我正在进行的一些工作，以审查社会经济逆境对围产期心理健康和儿童早期学习和行为的影响。巴西和南非是特别值得推广这项工作的国家，因为这两个国家都处于快速的经济和社会转型时期，而且都面临着高度的不平等。这两个国家都面临着社会经济群体之间日益扩大的差距，这既影响到经济结果，也影响到卫生结果。这些过渡给社区和家庭生活带来了很大的压力。特别是在LMIC，高度抑郁症状与贫困、缺乏支持和负面生活事件有关。社会经济逆境和父母抑郁都是发育不良的风险因素，这两个因素往往是同时发生的。这一点，再加上LMIC中较高的围产期抑郁率，使儿童面临更高的发育不良风险。这项研究金的目标是：1.扩大我目前的工作方案，审查快速转型社会背景下的社会经济逆境如何影响南非索韦托艾滋病毒阳性母亲的围产期心理健康和早期儿童学习和行为。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，在这些妇女中，母亲的精神健康和母亲的艾滋病毒感染将使儿童发展更加复杂，而这两者都与照料困难有关(1篇论文)。2.与Pelotas出生队列--巴西南部城市环境中相隔11年的两个队列--正在进行的工作中出版出版物(2004年和2015年，2篇论文)，以及在南非艾滋病毒阳性妇女及其子女的农村样本中提供早期儿童刺激和抑郁治疗综合一揽子治疗方案的可行性(1篇论文)。3.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结果。4.加强目前的合作，探索申请奖学金的机会。到南非和巴西旅行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.