ISLAMABAD: A new research report from the World Bank has found the prevalence of three facets of mental health — depression, anxiety and parenting stress — among mothers of children aged up to 6 years in Khyber-Pakhtunkhwa.

Maternal mental health concerns are significantly associated with lower levels of early childhood development.

The research also analyses how exposure to stress factors such as food insecurity, financial insecurity, being impacted by flooding, community crime, discrimination, and domestic violence exacerbate both maternal mental health and child outcomes, according to the research report.

In Khyber-Pakhtunkhwa specifically, 28 per cent of women and 58pc of pregnant women seen at health facilities have been found depressed.

An estimated 21pc of women in a study in Khyber-Pakhtunkhwa were found to have generalised anxiety disorder.

The report is based on a household survey commissioned by the World Bank and carried out by the Center for Evaluation and Development between December 2023 and February 2024 in Khyber Pakhtunkhwa. Households were selected based on being located in the catchment area of one of 200 public schools across Khyber-Pakhtunkhwa, excluding newly merged districts.

At health facilities, 28pc of women and 58pc of pregnant women were found depressed in KP

The regression analyses indicate a significant and negative compounding interaction of maternal depression, anxiety, and parenting stress on early childhood development for younger (below 3 years) and older (3-6 years) children, even after controlling for stressors and other covariates.

The World Bank research suggests policy improvements are needed that focus on at-risk communities, providing mental health services and reducing exposure to stressors within communities and households.

Parents in Khyber-Pakhtunkhwa confront a multitude of risks to child development that have worsened in the last decade.

Longstanding challenges include high rates of poverty, low access to high-quality education including preprimary education, and incomplete and inadequate coverage of social assistance cash transfers.

Added to these risks are maternal depression, anxiety and parenting stress, which have been found to be consistently negatively impacted by fragility, conflict and violence.

Various studies confirm that higher levels of parental depression, anxiety, and parenting stress respectively predict higher levels of children’s internalising behaviours, higher levels of externalising behaviours like anger, aggression, and reduced social-emotional competence like ability to self-regulate, follow instructions, get along with peers.

When multiple parental mental health problems co-occur, early childhood functioning is at increased risk.

The research paper says in Pakistan, rates of comorbidity of anxiety and depression have been found to range between 25pc and 34pc and higher rates are seen in women than men.

While these risks occur across the socio-economic spectrum, women in low-income households experience disproportionate levels of mental health concerns, such as depression, and display fewer characteristics that foster favourable early childhood development (ECD), such as maternal supportiveness and cognitive stimulation.

Vulnerable groups typically experience markedly higher rates of mental health concerns. Depression and anxiety during pregnancy have been shown to have a higher incidence among women from rural areas compared to those from urban areas in Pakistan.

A cross-sectional study in Khyber-Pakhtunkhwa found an association between women with low educational attainment and higher levels of maternal depression and anxiety.

Data from Pakistan shows correlations with maternal depression in the antenatal and postpartum periods, there is less research showing relationships between mothers’ mental health status and ECD through the preschool-age years. Pakistan has one of the highest estimates of maternal postpartum depression in Asian countries, with rates ranging from 28pc to 63pc — as well as evidence of paternal post-partum depression.

Published in Dawn, November 25th, 2024