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

世卫组织的数据估计，印度12.8%的儿童受到心理健康问题的影响，相当于6000万儿童。迫切需要从怀孕开始对社区样本进行文化敏感的纵向研究，旨在检查儿童心理健康问题的最早起源，以最佳地为新的早期干预措施的发展提供信息。我们的研究目标是在印度和英国做到这一点。在西方环境下的研究表明，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，其中的关键因素可能包括产前压力、婴儿早期的气质和作为风险的严厉的父母，以及作为保护因素的温暖的父母。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增加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保健和家庭安排标准西方化的国家进行的，在这些国家，低出生体重和营养不良等额外风险很少。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，以确定哪些是西方和南亚人口的共同因素，哪些是独特的。我们建议对班加罗尔儿童健康与发展研究（BCHADS）中生活在班加罗尔城市贫民窟的大约741个儿童家庭进行随访，年龄分别为4.5岁和7岁。我们将把收集到的这些儿童的生活信息与参加我们的英国儿童健康与发展研究（已经收集到的）的儿童的生活信息进行比较。在这两项研究中，我们有两个丰富的数据集，对从怀孕开始的儿童心理健康结果的风险和保护因素进行平行测量，包括8-10周、6个月、14个月、2岁、4岁和7岁。我们收集了详细的重复测量关键可能的“共同风险”和相关的风险“机制”（例如，基因活性，压力反应），这些包括早期生活压力，社会支持，贫困和经济逆境，早期气质，照顾（触摸，互动质量，养育质量），认知和身体发育的测量。我们还将评估可能与南亚环境“独特”或特别相关的风险和保护因素：怀孕期间的孕产妇营养，早期免疫功能和与偏爱男孩的文化相关的性别歧视，以及与西方社会的主要母亲抚养相反的共同照顾的做法。我们还致力于推进跨文化测量方法，并在印度开发新的性别歧视和“共同照顾”育儿环境的文化敏感措施。这项工作将有助于临床医生和研究人员在临床实践中改进他们的测量方法，并能够在尝试合并来自多个队列的数据时进行更可靠的研究。最后，这是一项英国和印度的联合研究，我们将共同开展一系列培训活动，在进行纵向队列研究、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方面建立能力并分享专业知识。

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.