TREATING MATERNAL DEPRESSION: Evidence of the impact on mental health, parenting, financial autonomy and child development

Providing cognitive behavioural therapy (CBT) to women in rural Pakistan who were suffering from perinatal depression has had persistent positive effects on their mental health, their parenting behaviour and their financial empowerment seven years later. These are the findings of research by Professor Sonia Bhalotra and colleagues, to be presented at the Royal Economic Society”s annual conference at the University of Bristol in April 2017.

A randomised controlled trial established seven years previously recruited about 900 women in 40 communities in rural Pakistan who were pregnant and also screened positive for depression. Women in 20 communities were randomised into the psychotherapy treatment, which involved 16 home visits over a 10-month period. Returning to the site when the children of the trial were age 7, the new study compares outcomes for treated women and children with their ”control group” counterparts. It finds that for the women who were exposed to CBT:

• They are less likely to have been depressed at any time in the seven subsequent years. They also report a more favourable perception of social support.

• There are large improvements in their parenting style (for example, responsiveness and encouragement of maturity) and in the time (for example, enrichment, help with studies, play) and money (for example, learning materials and opportunities, educational expenditure) that they invest in their children (at age seven).

• The mothers are more likely to be employed and to have control over household spending. It seems that the employment and empowerment gains derive directly from the sustained improvement in mental health.

• These improvements are larger in families in which the grandmother was absent before the intervention, and they are larger for girls than for boys.

• To date, their children perform no better on assessments of growth (for example, age adjusted height and weight, motor function, morbidities), cognition (for example, an IQ score, school performance), or socio-emotional development (measured using psychometric tests).

• This does not necessarily mean that improved parenting and higher parental investments in children have no impact on child development. Rather, these impacts may be latent and influence outcomes later in life. There is growing evidence that inputs to child development are reinforcing, both over time (for example, a child who is healthy early on is less likely to contract illness and their health advantage is likely to grow over time) and across domains (for example, socio-emotional development facilitates cognitive development and vice versa).

These findings are relevant to several public policy issues:

• First, they reinforce some of the scarce evidence of the long-term effects of CBT.

• Second, they present possibly the first evidence of the long-term effects of CBT for maternal depression.

• Third, they show that CBT can have long-term effects on employment and financial autonomy.

• They are of direct interest in the context of developing countries where fertility rates, poverty and the incidence of depression are high and women”s financial autonomy more limited. But the researchers expect that the persistence of impacts of CBT and behavioural impacts seen on parenting and financial autonomy is of more general relevance.

Maternal depression, financial autonomy and parenting: Evidence from a randomized control trial – Victoria Baranov, Sonia Bhalotra, Pietro Biroli, Joanna Maselko

Sonia Bhalotra