Research on the relationship between maternal mental health and childhood delay in growth and development is substantially underexplored. Limited research and knowledge has been found about the connection between mothers’ mental health and the growth and developmental outcomes of their children. Although evidence suggests that a mother’s mental health and infant development are strongly correlated, there is a lack of comprehensive and in-depth studies that thoroughly explore the underlying mechanisms of this relationship and its long-term effects on the child’s growth and development. This research gap emphasizes the need for additional investigation in this area. The objective of our study is to address this gap by examining the effect of maternal mental health on the delay in development and growth of children, thereby bridging the existing knowledge deficit.

To explore the association of maternal mental health on the development and growth of children under two years old from Wardha.

1.

To study the association of maternal mental health, i.e., toxic stress and depression, on developmental delays in children under two years old.

The study protocol is approved by the Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research (letter number DMIMS (DU)/IEC/2023/1036).

Written informed consent will be obtained from the study participants after explaining the study’s purpose, nature, procedure and publication of the article in prescribed pro forma before the data collection.

The present study will be a cross-sectional study.

The study will be carried out at the Datta Meghe Institute of Higher Education and Research in Seloo Block of Wardha, Maharashtra.

Study participants

Mothers with children under two years.

Inclusion criteria

Mothers with children under two years.

Exclusion criteria 1.

Pregnant mothers.

The list of mothers with children under two years old will be obtained from Anganwadi Centre (AWC) of the village. After obtaining the list from AWC the recruitment will be made from house to house considering the inclusion criteria. The study participants will be explained the process and purpose of the study. Written informed consent will be taken. The participants will be surveyed using semi-structured questionnaires.

The outcome variables of the study are height for age, weight for age. The exposure variables include depression and toxic stress. The predictors are age in years, occupation, education, socioeconomic status, number of children, approximate family income, religion, weight of child (kg), weight of mother (kg), height of child (cm). The effect modifiers include the child’s age, sex and support system of the mother.

Face to face interactions will be conducted with every respondent at their household. The questionnaires that will be used are Edinburg Postnatal Depression Scale (EPDS) and Parent Stress Scale (PSS), these are previously published, widely used questionnaires. We will be taking written informed consents via forms from the participants. We will be going to each participants household and perform face to face interviews using the questionnaire we have provided. Once the sample size is achieved we will know that we have reached the adequate number of interviews. All data will be analysed using SPSS version 26. The quantitative measurement of the EPDS and PSS will be presented by mean, median, standard deviation, minimum, and maximum.

Semi-structured questionnaires containing the following sections will be used to conduct the interviews: i) Section A will include: Questions Related to Demographic Profile Section - demographic variables such as age (years), occupation, education, socioeconomic status, number of children, approximate family income, religion, weight of child (kg), weight of mother (kg), height of child (cm), will be measured; ii) Section B will include: Questions about Maternal Mental Health, the Edinburg Postnatal Depression Scale (EPDS) ²² and Parent Stress Scale (PSS) will be used to assess maternal mental health including depression and toxic stress ²³ ; and iii) Section C will include: Tools to measure stunting, wasting and underweight in children under two years old using the WHO growth chart. ²⁴ Section A has been created by our team and can be found as Extended data. ³⁵

The tools that will be used to measure maternal mental health include the EPDS ²² and PSS. ²³ EPDS is a well-known self-report test used to screen and evaluate a mother’s postpartum depression. In our study we will be using the EPDS questionnaire to assess depression in mothers. After giving birth, some women have postpartum depression, also known as postnatal depression. It aims to identify depression and anxiety symptoms that new mothers may experience. The EPDS includes questions about various emotional states, including suicidal thoughts, despair, anxiety, guilt, and sleep issues. Each question receives a score between 0 and 3, with 0 meaning “Never” and 3 meaning “Most of the time”. The likelihood of experiencing postnatal depression will then be calculated from the overall scores, and higher scores imply a higher probability of having it. To gauge how stressed out parents are concerning their role as carers, a measurement tool called the PSS will be used. It aims to highlight the challenges parents have when raising children. Toxic stress in mothers will be assessed using the PSS. The PSS consists of a series of inquiries that centre on several potentially stressful parenting-related subjects. These inquiries are meant to look at different parenting pressures, such as the interpersonal, logistical, and emotional challenges of parenthood. A total of 18 questions make up the PSS. Less stress is indicated by a lower score, which runs from 18 to 90.

Impaired height-for-age is referred to as stunting, which typically indicates chronic malnutrition. Stunting will be determined by taking the child’s height or length measurements when lying down (for height) or standing (for length), respectively. The relevant length-for-age or height-for-age growth chart will be used to compare the measurement. An average definition of stunting is a length/height-for-age Z-score of less than -2. We will use the WHO growth chart, ²⁴ reference ²⁵ to measure the Z score and percentile for length/height for age. Low weight-for-height or weight-for-length is known as “wasting”, which frequently denotes acute malnutrition. The child’s weight will be determined using a calibrated scale, and their height or length will be measured to determine the degree of wasting. A weight-for-length/height Z-score less than -2 is commonly used to describe wasting.

The sample size calculation based on the prevalence of childhood communication delay (13), gross motor delay, fine motor delay (13), problem-solving skills (13) and social skills (13) as 22, 15, 25, 21 and 27%, respectively. Using the sample size calculator with the formula, where α was taken 0.05, the estimated proportion(p) is 0.15, and the estimated error (d) is 0.05. A sample size of 196 was accepted.

All the results will be calculated and analysed using SPSS software version 26. Descriptive statistics over the demographic variable such as age (years), occupation, education, socioeconomic status, number of children, approximate family income, religion, weight of child (kg), weight of mother (kg), height of child (cm), locality categorical data will be displayed as frequency and percentage, and for quantitative measurement, mean and standard deviation minimum and maximum.

The quantitative measurement of the EPDS and PSS will be presented by mean, median, standard deviation, minimum, and maximum. Data will be tested for finding the normality over the parameters EPDS and PSS by using the Kolmogorov-Smirnov test. Variables with non-normal distribution will be transformed for normality using mathematical algorithms. If data persists with a non-normal distribution, then the non-parametric test will be used to find the significance at 5% (P≤0.05).

The EPDS has 10 questions. The maximum score is 30, and a score of 10 and above suggests possible depression. Each question from Q1, Q2 and Q4 has been scored 0, 1, 2, 3 from the top box to the bottom box with a maximum score of 3 and Q3, Q5-Q10 has been scored 3, 2, 1, 0 from the top box to the bottom box, respectively, with a maximum score of 3. A total score of less than 8 indicated depression was not likely, a score of 9-11 indicated depression is possible, a score of 12-13 indicated a fairly high possibility of depression, and a score of 14 and above indicated probable depression.

The PSS has 18 questions. The score ranges from 18 to 90, with lower scores indicating lower stress levels. To compute the parental stress scale, items 1, 2, 5, 6, 7, 8, 17 and 18 should be reversed and scored as follows: (1=5) (2=4) (3=3) (4=2) (5=1); the scores are then summed up.

Factors associated with maternal mental health with the development and growth of the child will be evaluated using the One-Way ANOVA test or the Non-parametric Kruskal Wallis Test. Association with demographic variables will be evaluated using Chi-square analysis. The relative risk for the associated factors will be evaluated with RR values. Confounding factors affecting the results will be evaluated using multivariate analysis.

Articles arising from the study will be published in indexed journals of public health.

Study yet to be started.

The study is cross-sectional and does not intend to establish direct causality, but it does demonstrate a link between risk factors for infant development. The participants in the study provide their own information, which cannot be evaluated or verified, is one of the study’s primary drawbacks.

In conclusion, the study’s findings will contribute to the growing body of research showing that maternal depression raises the risk of stunted growth and delayed development in children. ³⁰ Given that mothers are typically the primary carers for their children during the first year of life, a thorough analysis of mental health issues in women during the perinatal period must take into account how these issues affect babies. The infant needs a mother (or primary carer) who is both physically and emotionally capable, as well as a nurturing environment given by the father and extended family, in order to be adequately cared for. ³¹ The prevalence of maternal common mental disorders (CMD) is 38.8% overall. A greater understanding of the variables influencing mothers’ mental health should be considered, given the high prevalence of CMD among mothers. ³² Mothers with young children frequently experience mental health difficulties such as depression and anxiety, but these conditions are underreported, making it difficult for mothers to function normally. Children may be at higher risk for behavioural and emotional issues, cognitive delays, and psychiatric morbidity later in life due to their mother’s mental health issues. ³³ Compared to other developing nations that have been previously researched, maternal CMD prevalence is comparatively higher in low socioeconomic countries. Maternal CMD is shown to be related to maternal undernutrition and household food insecurity. ³⁴

The research emphasises the critical role of a mother’s mental health in shaping early childhood development and growth. Providing adequate support and interventions for mothers, particularly those at risk of mental health problems, is essential to promote optimal child development outcomes. This implies that there is a need for healthcare professionals, policymakers, and community stakeholders in Wardha and similar settings to focus on the need for integrated approaches that address both mother’s mental health and child development in early intervention programs.