摘要：Objectives . We assessed whether maternal depressive symptoms and parenting self-efficacy were associated with child growth delay. Methods. We collected data from a random sample of 595 low-income mothers and their children aged 6 to 24 months in Teresina, Piauí, Brazil, including information on sociodemographic characteristics, mothers’ depressive symptoms and parenting self-efficacy, and children’s anthropometric characteristics. We used adjusted logistic regression models in our analyses. Results. Depressive symptoms among mothers were associated with 1.8 times higher odds (95% confidence interval [CI] = 1.1, 2.9) of short stature among children. Parenting self-efficacy was not associated with short stature, nor did it mediate or modify the relationship between depressive symptoms and short stature. Maternal depressive symptoms and self-efficacy were not related to child underweight. Conclusions. Our results showed that among low-income Brazilian families maternal depressive symptoms, but not self-efficacy, were associated with short stature in children aged 6 to 24 months after adjustment for known predictors of growth. Stunting caused by undernutrition disproportionately affects the poor, 1 is indirectly responsible for more than half of deaths among young children worldwide, 2 and is associated with inadequate physical and cognitive development and limited social mobility. 3 – 6 Research from industrialized countries shows that failure to thrive (growth delay) is more likely to occur in children of depressed care-givers, 6 , 7 but few studies have examined this relationship in developing countries. Previous studies in which both short stature and underweight have been used as indicators suggest an association between maternal depression and inadequate growth. 8 One investigation involving a clinic-based sample in Jamaica showed that rates of depression were higher and parenting self-esteem was lower in a group of mothers with underweight children than in a group of mothers with well-nourished children. 9 In another study, psychiatric disorders among mothers living in favelas (shanty towns) in São Paulo were associated with child underweight. 10 A study comparing 4 developing countries showed a relationship between maternal depression and child underweight in India and Vietnam but not in Peru or Ethiopia. 11 Reasons for such regional variations are not well understood. Psychosocial conditions have received increasing attention in efforts to explain children’s growth and development. The concept of collateral health effects (the transfer of health benefits from one individual to another through social rather than biological pathways 12 ) may be pertinent because optimizing mothers’ mental health may foster positive caregiving behaviors that benefit their infants. Parenting self-efficacy (a parent’s level of confidence in performing in her or his role as a caregiver) and depression are closely related, 13 – 15 and high self-efficacy is related to a variety of positive parenting behaviors 16 – 19 (e.g., responsive feeding practices and breast-feeding duration) that may affect child growth. Maternal psychosocial care has been shown to be associated with child nutritional status, 20 but it may play a more important role in lower- and middle-income countries than in affluent countries. 8 For example, maternal depressive symptoms and parenting self-efficacy may be especially salient in low-income populations facing economic stressors. We examined relationships between low-income Brazilian mothers’ depressive symptoms and self-efficacy as exposures and short stature and underweight among their infants as outcomes.
