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

世界卫生组织的数据估计，印度有12.8%的儿童受到心理健康问题的影响，相当于6000万儿童。迫切需要对社区样本进行具有文化敏感性的纵向研究，从怀孕开始，旨在研究儿童心理健康问题的最早起源，以最佳方式为制定新的早期干预措施提供信息。我们的研究旨在印度和英国这样做。在西方环境中的研究表明，儿童心理健康问题是由社会，心理和生物影响的复杂组合引起的，其中关键因素可能包括，产前压力，早期婴儿气质，严厉的父母作为风险，温暖的父母作为保护因素。现在有充分的证据表明，早期生活中的个体差异和环境暴露会导致儿童后期及以后出现心理健康问题的风险。然而，以前的研究几乎都是在医疗和家庭安排标准西方化的国家进行的，而且这些国家很少有低出生体重和营养不良等额外风险。拟议研究的目的是比较英国和印度儿童心理健康问题的早期风险和保护因素，以确定那些在西方和南亚人群中常见的因素以及那些独特的因素。 我们建议对班加罗尔儿童健康与发展研究（BCHADS）中的约741个儿童家庭进行随访，这些儿童生活在班加罗尔市的城市贫民窟，年龄为4.5岁和7岁。我们将比较我们收集的这些儿童的生活信息，参加我们的英国维拉尔儿童健康和发展研究（已经收集）的儿童。在这两项研究中，我们有两个丰富的数据集，从怀孕开始，包括8-10周，6个月，14个月，2岁，4岁和7岁的儿童心理健康结果的风险和保护因素的平行措施。我们已经收集了对关键的可能的“共同风险”和相关的“机制”的详细重复测量，以赋予风险（例如，基因活性、压力反应性），这些指标包括衡量早期生活压力、社会支持、贫困和经济逆境、早期气质和发育（触摸、互动质量、养育质量）、认知和身体发育。我们还将评估风险和保护因素，可能是“独特的”或特别相关的南亚设置：孕产妇在怀孕期间的营养，早期免疫功能和性别歧视与文化有利于男孩的孩子，和实践的共享，而不是主要的产妇养育西方社会。我们还旨在推进跨文化的测量方法，并制定新的性别歧视和印度的“共同成长”养育环境的文化敏感措施。这项工作将帮助临床医生和研究人员在临床实践中完善他们的测量，并能够在尝试结合来自多个队列的联合收割机数据时进行更可靠的研究。最后，这是一项英国-印度联合研究，我们将共同开展一系列培训活动，以建立能力并分享进行纵向队列研究，抽样和保留，测量问题，数据管理和复杂数据集纵向分析所需的最先进统计方法的专业知识。

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.