About this paper symposium

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Panel information
Panel 16. Prevention and Interventions

Paper #1
The Effectiveness of a Maternal Mental Health Promotion Intervention on Early Childhood Development in China
Author information	Role
Dr. Yiwei Qian, Southwestern University of Finance and Economics, China	Presenting author
Abstract
Introduction: An estimated 250 million children under the age of 5 in low- and middle-income countries (LMICs) are at risk of not reaching their developmental potential, representing 43% of all young children in these regions. A substantial body of research indicates that poor maternal mental health is associated with reduced responsive caregiving and poorer child development outcomes. However, there is limited evidence on whether promoting caregiver mental health can effectively improve the developmental skills of children aged 0 to 3. This study leverages a large-scale, multi-arm, clustered randomized controlled trial (RCT) with a factorial design to examine the impact of a mental health promotion intervention on early childhood development. We hypothesize that the mental health promotion intervention enhances early childhood development by increasing responsive caregiving practices. Methods: The study utilized data from a factorial clustered RCT involving 120 rural villages and over 1,200 caregiver-child dyads. Villages were randomly assigned to one of four groups: a parenting stimulation arm, a mental health arm, a combined intervention arm, or a control group with no intervention. Caregivers and their children, aged 6–24 months at baseline, were invited to participate. The mental health intervention (Thinking Healthy Extended Program, THEP) consisted of 24 bi-weekly group sessions led by community lady workers. Each session centered around themes related to the caregiver’s personal health, the caregiver-child relationship, or the caregiver’s relationships with close family members and friends. The structured activities included discussions and games aimed at teaching caregivers simplified cognitive-behavioral therapy (CBT) strategies, promoting healthy practices in daily life, sharing child-rearing experiences, and fostering peer support. Child development outcomes, caregiver mental health (depression, anxiety, and stress), responsive caregiving practices, social support, caregiver relationships, and parenting perceptions (efficacy and stress) were measured at both baseline and follow-up surveys. Results: Compared to the pure control group, mental health promotion alone did not effectively enhance child development, although it did bring improvements in interactive parental practices. However, when pairing the mental health support intervention with parenting stimulation intervention, the combined program resulted in a significant improvement in child cognitive and language development, alongside substantial increases in the frequency of interactive parenting practices. The effect heterogeneity and potential mechanisms will be presented and discussed. Our results underscore the importance of integrating maternal mental health support into parenting stimulation programs in LMICs to maximize the intervention effectiveness on child development outcomes.

Paper #2
Process Evaluation of the Implementation of a Maternal Mental Health Intervention in Rural China
Author information	Role
Boya Wang, Stanford University, United States	Presenting author
Abstract
Introduction: Despite one in four women living in low- and middle-income countries (LMICs) experiencing depressive symptoms during pregnancy and the first year postpartum, over 90% of them lack access to treatment. A substantial body of research highlights the link between poor maternal mental health and reduced responsive caregiving, leading to poorer child development outcomes. This contributes to an estimated 250 million children under the age of five in LMICs being at risk of developmental delays. Methods: We developed the Thinking Healthy Extended Program (THEP), an adaptation of the WHO Thinking Healthy Program, designed to support the mental well-being of caregivers—primarily mothers and grandmothers—of children aged 6-36 months in rural China. The intervention comprises 24 biweekly (group) sessions, facilitated by community lady workers without an educational background in Health or Psychology. THEP was implemented in 50 rural villages in China as part of a large-scale clustered RCT starting in May 2022. To evaluate the fidelity and quality of the implementation and explore barriers and facilitators, we designed a process evaluation framework and conducted in-depth interviews and focus groups with 42 caretakers and 12 group facilitators in the first quarter, second quarter, and third quarter of its implementation course, respectively. Results: THEP was well-received by both caregivers and facilitators, with attendance rates ranging from 50% to 85%. Most caregivers actively participated in sessions and adopted healthy practices, although mothers more frequently utilized psychological strategies compared to grandmothers. Caregivers reported feeling emotionally relieved and experiencing improved relationships with their children. However, few noted improvements in mental health or relationships with family members or friends. The quality of implementation improved over time, with key facilitators including interactive group dynamics, involvement of other family members, engagement with children during sessions, prior relationships with facilitators, and support supervision. Barriers included time constraints, distance, interruptions from children, and a lack of facilitator capacity to engage participants between sessions. We provide several recommendations for improving the implementation quality of the intervention. Discussion: This study demonstrates how process evaluations conducted along the implementation can offer valuable insights for program adaptation and quality improvement.

Paper #3
Research on Effectiveness of Postpartum Mental Health Interventions: A Practice Based on Child Healthcare System
Author information	Role
Yuyin Xiao, Stanford University, United States	Presenting author
Abstract
Introduction: Postpartum mental health support is an important component of responsive care and has a range of impacts on women’s health, child wellbeing and long-term development, and family wellbeing. Currently, the pathways for supporting maternal mental health beyond 42 days postpartum are relatively unclear. Pediatric care provides a good opportunity to conduct repeated assessments for postpartum depression and implement follow-up strategies. Hypotheses Leveraging the existing child healthcare service system to provide digital postpartum mental health support services can effectively improve postpartum mental health outcomes and promote children's growth and development. Study population: A total of 2,326 cases who had participated in at least one assessment survey were included from 46 community health service centers in Shanghai. Ultimately, data from 2,228 mothers and children aged 0-2 were included in the analysis. Method: A multi-stage probability sampling method was applied to select the sample. Intervention and control communities were randomly selected in a 1:1 ratio. During the project period, mothers of children aged 0-2 who received pediatric care services in these communities were included. The intervention involved training pediatric care service personnel in the intervention communities and maternal and child health centers to enhance their ability to provide psychological services. For mothers identified as at risk through screening, online video interventions and regular follow-up were provided. All psychological health assessments, evaluations of child outcomes, and video interventions were conducted digitally at the time of child health check-ups. A mixed-effects model was used to analyze the results before and after the intervention, with the time variable and treatment effects treated as fixed effects, and individual differences among the samples treated as random effects. Regional grouping, enrollment age, child gender, maternal age, and feeding method were included as control variables. Various common covariance structures were used for estimation, ultimately selecting the covariance structure model with the smallest fit statistics for final fitting. Results: The baseline results show that the proportion of depression risk among all samples is 8.8%, anxiety risk is 11.9%, and stress risk is 7.0%. After the intervention, compared to the control group, the risk of depression for mothers of children aged 0-12 months in the intervention group significantly decreased during the first and second assessments after baseline (β = -1.9012, p < 0.001; β = -1.2894, p < 0.05). The risk of anxiety significantly decreased during the second assessment (β = -1.76395, p < 0.001). No significant differences were found between the intervention and control groups in the stress dimension or the ECD outcome dimension. Additionally, no similar intervention effects were observed among mothers of children aged 13-24 months. Discussion: The current practice of screening for postpartum depression during pregnancy and 42 days after delivery is insufficient for detection and management. Integrating diagnosis and management of postpartum depression into primary pediatric care is a promising approach to effectively manage this condition. Implementing this approach requires reshaping maternal and child healthcare services, strengthening referral systems, training health workers, reducing stigma, and fostering cross-sectoral collaboration.

Paper #4
Associations between Exposure to Intimate Partner Violence and Child Development: Moderating Role of Women’s Empowerment
Author information	Role
Ms. Anum Nisar, University of Liverpool, United Kingdom	Presenting author
Abstract
Background: Intimate Partner Violence (IPV) is a significant threat to women’s well-being and child development, particularly in lower- and middle-income countries (LMICs). Despite its prevalence, research in LMICs on the effects of IPV on child development remains limited. This study investigates the association between IPV and different domains of child development as well as the moderating role of women’s empowerment. Methods: We recruited 400 women during prenatal visits at Holy Family Hospital, Rawalpindi, Pakistan. Child development was assessed at six weeks postpartum using the Ages and Stages Questionnaires (ASQ-3), covering communication, gross and fine motor skills, problem-solving, and personal-social domains. IPV exposure from the beginning of pregnancy to six weeks postpartum was measured using items from the Pakistan Demographic and Health Survey. Women’s empowerment was assessed using measures of household empowerment. Data were analysed using multivariable linear regression. Interaction terms examined whether empowerment moderated the association between IPV and child development. Results: Our findings show significant, negative associations between IPV scores and all child development scores (adjusted Bs=-0.64 to -1.00, all p-values<0.05), suggesting poor development. Significant interactions were observed for communication, gross motor, and problem-solving domains (all p-values<0.05), with marginal significance for the personal-social domain (p=0.05). Among empowered women, the associations were not significant, while non-empowered women showed stronger negative impacts (adjusting Bs=-1.31 — -2.13, all p-values<0.05). Conclusion: Women’s empowerment may mitigate the adverse effects of IPV on child development. Empowerment initiatives could improve outcomes for children of mothers experiencing IPV.

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