Risk and resilience: Evaluating the multigenerational effect of a psychosocial maternal depression intervention against COVID-19-related stressors

ABSTRACT COVID-19 is a global public health crisis with disproportionate mental health impacts on populations living in vulnerable contexts. Emerging research suggests that the economic shocks resulting from lock-down policies have had an especially devastating impact, yet it is less clear how long lasting these deleterious impacts will be. Furthermore, the pandemic's impact on maternal mental health combined with worsening economic conditions have significant consequences for the mental health of children, resulting in multi- generational impacts. In order to mitigate the devastating impact on mental health across generations, it is crucial to better understand the characteristics of mothers and children who were most at risk from COVID- related stressors and to evaluate the potential buffering effects of preventative interventions. Using longitudinal experimental and observational data from an ongoing study of women in rural Pakistan, the overarching goal of the proposed study is to gain insights into the multi-generational mental health impacts of COVID-19 stressors and identify risk and protective factors, including a psychosocial depression intervention. This study leverages existing data and infrastructure from the Bachpan study, an NIH funded longitudinal cohort with an embedded cluster-randomized control trial of a psychosocial maternal depression intervention with a life course implementation strategy (U19MH095687; R01HD075875). In the main study, women were recruited during their third trimester of pregnancy starting in 2015 and are currently participating in the 8th wave of data collection, at child age 6 (final n=>793). The rich dataset includes information on multiple domains of women's and children's social context as well as high-quality measures mental health. A novel COVID module measuring household exposure to a broad range of COVID-related stressors was added to the 6-year wave. In our first aim we will examine the role of economic shocks and uncertainty during the first two years of the pandemic on maternal and child mental health at child age 6 years and provide evidence of how an environment of heightened uncertainty might impact both maternal and child mental health, above and beyond the realized reduction in economic means. In the second aim, we will examine whether participating in a psychosocial maternal depression intervention in the past leads to increased resilience against worsening mental health during the pandemic. In the third aim, using ongoing data collection through child age 8, we will examine predictors of recovery or longer impacts. The major public health contribution of this project will be to generate knowledge on how COVID-19 stressors impacted trajectories of mental health for women and children in a low resource context and whether a psychosocial depression intervention provided resilience against worsening mental health during the pandemic.