Psychological, social & biological predictors of child mental health and development: shared and distinctive risk and protective factors in UK & India

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WHO figures estimate mental health problems affect 12.8% of children in India, which equates to 60 million children. There is an urgent need for culturally sensitive longitudinal studies of community samples starting in pregnancy, designed to examine the earliest origins of child mental health problems to optimally inform the development of new and early interventions. Our study aims to do this in India and the UK. Research in western settings suggest that child mental health problems arise from a complicated mix of social, psychological and biological influences, in which key factors probably include, prenatal stress, early infant temperament, and harsh parenting as risks, and warm parenting as protective factors. There is now good evidence that individual variations and environmental exposures in early life contribute to risk for mental health problems in later childhood and beyond. However, previous research has been conducted almost exclusively in countries with Westernised standards of medical care and family arrangements, and where additional risks such as low birth weight and under-nutrition are rare. The aims of the proposed research are to compare early risk and protective factors for childhood mental health problems in UK and India to identify those that are common to Western and South Asian populations and those that are distinctive. We propose to follow up around 741 families of children in the Bangalore Child Health and Development study (BCHADS) who are living in the urban slums of Bangalore city, at age 4.5 years and age 7 years. We will compare the information we gather on these children's lives to that of the children taking part in our UK Wirral Child Health and Development Study (already collected). In both studies we have two rich data sets with parallel measures of risk and protective factors for child mental health outcomes from pregnancy onwards, including age 8-10 wks, 6 months, 14 months, 2 years, 4 years and 7 years of age. We have gathered detailed repeated measurement of key likely 'shared risks' and associated 'mechanisms' for conferring risk (e.g., gene activity, stress reactivity) and these include measures of early life stress, social support, poverty and economic adversity, early temperament, and caregiving (touch, interaction quality, parenting quality), cognitive and physical development. We will also assess risk and protective factors that may be 'distinctive' or particularly relevant to the South Asian setting: maternal nutrition in pregnancy, early immune function and gender discrimination associated with cultural favouring of the male child, and the practice of shared-caregiving as opposed to primary maternal rearing in Western societies. We also aim to advance cross-cultural measurement methods and develop new culturally sensitive measures of gender discrimination and the 'shared caregiving' parenting environment in India. This work will aid clinicians and researchers to refine their measurements in clinical practice and be able to conduct more reliable research when trying to combine data from multiple cohorts. Finally, this is a joint UK-Indian study and together we will run a series of training events to build capacity and share expertise in conducting longitudinal cohort studies, sampling and retention, measurement issues, data management and state of the art statistical methods needed in longitudinal analysis of complex data sets.