Evaluating perinatal mood and anxiety disorder in Kenyan: a mixed methods approach

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ABSTRACT This F32 project aims to advance understanding of perinatal mood and anxiety disorders (PMAD), their consequences to infant social-emotional development, modifiable behaviors to alleviate PMAD, and preferences for evidence-based PMAD management approaches. Approximately 20% of women worldwide report PMAD during pregnancy or within the first year postpartum—predominantly depression, anxiety, and high stress. Maternal PMAD increases risk of adverse infant outcomes. Risk of social-emotional developmental (SED) delays is 60% higher among infants born to women experiencing PMAD compared to infants unexposed to PMAD. Infant SED impacts mental health, social competence, and economic attainment throughout the lifespan. Little is known about particularly influential timing of PMAD within the perinatal period which could optimize intervention timing for maximal benefit to mother-infant dyads. Maternal engagement with infants through interactive behaviors like playing, talking, and singing may mitigate mechanisms connecting PMAD and infant SED delays. Low quality dyadic interactions are more likely with maternal PMAD and associated with suboptimal SED. Interventions that increase mother-infant engagement quality improve infant SED, yet improvement to maternal mental health is unclear. Gaps remain in understanding preferences for PMAD interventions among pregnant and postpartum women in the sub-Saharan African region where PMAD disproportionately affects women and maternal child health (MCH) clinics are widely attended, offering a high-impact access point for maternal mental health services. The proposed F32 research project leverages data from an ongoing cohort study (PrIMA-X, R01HD100201, PI: Pintye) among 1300 Kenyan mother-infant pairs followed from pregnancy through 36-months postpartum with longitudinal assessment of maternal perinatal mood and anxiety disorder, mother-infant engagement, and infant-child social-emotional development. In Aim 1, we will use dyadic data collected monthly in pregnancy and 6-monthly through 36 months postpartum to prospectively assess impact and timing of PMAD on SED delays among Kenyan mother-infant pairs. In Aim 2, we will determine the relationship between mother-infant engagement and PMAD remission timing longitudinally through 36 months postpartum, potentially highlighting an effective avenue for intervention. In Aim 3, we will evaluate acceptability and preferences for PMAD management approaches among perinatal Kenyan women to inform patient-driven intervention design using qualitative methods guided by the Theoretical Framework of Acceptability. This large- scale mixed method study will contribute novel data toward informing a future PMAD intervention. The research plan will provide the F32 candidate rigorous postdoctoral training including: 1) advanced epidemiologic and time- to-event methods using longitudinal data with repeated measures, 2) experience with qualitative methods to inform a patient-centered intervention, 3) content-area expertise in maternal-infant mental health—an area critical to closing MCH gaps.