Trajectories of Early Childhood Skill Development and Maternal Mental Health

Dilek Sevim; Victoria Baranov; Sonia Bhalotra; Joanna Maselko; Pietro Biroli

doi:10.3368/jhr.1222-12693R3

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Figure 1
Timeline of THPP+ Intervention and Follow-Ups
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Figure 2
Coefficient Plots of Factors
Notes: Plot of the adjusted beta coefficients reported in Online Appendix Table A22 and their 90 percent and 95 percent confidence intervals. Latent factors are normalized to mean zero and SD one in the control group at each time point to allow comparability of effect sizes in standard deviations. Coefficients are obtained from the regressions of items on the treatment indicator and its interactions with the (demeaned) baseline covariates including baseline PHQ Total, baseline WHODAS Total, baseline PSS Total, mother’s baseline age, weight, height, waist circumference and blood pressure, family structure, grandmother being resident, total adults in the household, people per room, number of living children (split by gender), whether the index child is the first child, parental education levels, asset-based socio economic status (SES index), life events checklist score, interviewer fixed effect, union council fixed effect, and days from baseline. All estimations control for child gender and age (in days). Standard errors clustered at the village cluster level. Factor scores are coded so that a higher score always indicates a better outcome and standardized to have mean zero and SD one in the control group at each time point.
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Figure 3
Coefficient Plots of Factors—Boys
Notes: Plot of the 90 percent and 95 percent confidence intervals and the adjusted beta coefficients obtained from the regressions, using only the sample of families where the index child is a boy, of items on the treatment indicator and its interactions with the (demeaned) baseline covariates including baseline PHQ Total, baseline WHODAS Total, baseline PSS Total, mother’s baseline age, weight, height, waist circumference and blood pressure, family structure, grandmother being resident, total adults in the household, people per room, number of living children (split by gender), whether the index child is the first child, parental education levels, asset-based SES index, life events checklist score, interviewer fixed effect, union council fixed effect, and days from baseline. All estimations control for age (in days). Standard errors clustered at the village cluster level. Factor scores are coded so that a higher score always indicates a better outcome and standardized to have mean zero and SD one in the control group at each time point.
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Figure 4
Coefficient Plots of Factors—Girls
Notes: Plot of the 90 percent and 95 percent confidence intervals and the adjusted beta coefficients obtained from the regressions, using only the sample of families where the index child is a girl, of items on the treatment indicator and its interactions with the (demeaned) baseline covariates including baseline PHQ Total, baseline WHODAS Total, baseline PSS Total, mother’s baseline age, weight, height, waist circumference and blood pressure, family structure, grandmother being resident, total adults in the household, people per room, number of living children (split by gender), whether the index child is the first child, parental education levels, asset-based SES index, life events checklist score, interviewer fixed effect, union council fixed effect, and days from baseline. All estimations control for age (in days). Standard errors clustered at the village cluster level. Factor scores are coded so that a higher score always indicates a better outcome and standardized to have mean zero and SD one in the control group at each time point.
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Figure 5
Relationship between Maternal Mental Health (6 Months) and Child Skills (12 Months)
Notes: (A) Theoretical representation of a concave relationship between maternal mental health (input) and children skills (output) and the consequence of log-linearization at different average levels of the input. (B) Kernel-weighted local polynomial smoothing of the relationship in the control group between maternal mental health at 6 months and child socio-emotional skill factor (solid dark line), child cognition factor (dashed gray line), and child physical health factor (dotted line) at 12 months. (C) Left y-axis is kernel-weighted local polynomial smoothing and 95 percent confidence interval of the relationship between maternal mental health at 6 months and child socio-emotional skill factor at 12 months in the control group (solid dark line) and the treatment group (dotted line). Right y-axis is kernel density estimation of the distribution of maternal mental health at 6 months in the control group (dash-dotted dark line) and the treatment group (dotted gray line).

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Table 1

Baseline Balance

	Baseline Sample (N = 1154)								6-Months (N = 929)		12-Months (N = 940)		24-Months (N = 903)		36-Months (N = 889)
	Control
	Mean	SD	Treatment Mean	Nondep. Mean	Diff. (ND-D)	p-Value	Diff. (T-C)	p-Value	Diff. (T-C)	p-Value	Diff. (T-C)	p-value	Diff. (T-C)	p-Value	Diff. (T-C)	p-Value
	(1)	(2)	(3)	(4)	(5)	(6)	(7)	(8)	(9)	(10)	(11)	(12)	(13)	(14)	(15)	(16)
Mother’s age	27.289	4.973	26.802	26.373	−0.674	0.023	−0.487	0.260	−0.595	0.215	−0.361	0.434	−0.310	0.510	−0.314	0.478
Mother’s height (cm)	156.330	6.088	157.429	157.105	0.230	0.545	1.100	0.074	0.996	0.145	1.043	0.109	1.352	0.031	1.023	0.131
Mother’s weight (kg)	61.241	12.883	60.172	59.887	−0.823	0.186	−1.070	0.359	−1.205	0.325	−0.861	0.476	−1.065	0.432	−1.286	0.385
Mother’s waist circ. (in.)	37.555	4.088	36.852	37.134	−0.071	0.746	−0.704	0.115	−0.793	0.068	−0.628	0.421	−0.843	0.075	−0.688	0.176
Mother’s blood pressure	72.326	12.790	70.915	71.667	0.043	0.950	−1.411	0.173	−0.352	0.723	−1.169	0.263	−0.339	0.748	−1.049	0.308
PHQ total	14.484	3.580	14.894	2.796	−11.891	0.000	0.410	0.248	0.400	0.305	0.484	0.227	0.364	0.362	0.380	0.347
WHODAS total	16.111	9.119	16.714	5.613	−10.798	0.000	0.602	0.475	0.600	0.513	0.814	0.376	0.999	0.291	0.809	0.423
PSS total	22.899	7.523	23.841	12.212	−11.154	0.000	0.942	0.100	1.311	0.036	1.113	0.072	1.216	0.062	1.020	0.151
Current major dep. episode	0.732	0.444	0.777	0.021	−0.734	0.000	0.046	0.373	0.055	0.359	0.039	0.509	0.044	0.461	0.045	0.443
Joint/extended family	0.634	0.483	0.580	0.707	0.100	0.000	−0.055	0.175	−0.058	0.228	−0.049	0.321	−0.060	0.206	−0.075	0.096
Grandmother present	0.666	0.473	0.629	0.717	0.070	0.005	−0.037	0.331	−0.028	0.504	−0.029	0.473	−0.043	0.329	−0.034	0.434
Total adults in the household	5.700	2.993	5.332	5.985	0.467	0.011	−0.368	0.201	−0.320	0.334	−0.325	0.316	−0.212	0.527	−0.281	0.402
People per room	2.473	1.870	2.792	2.215	−0.416	0.001	0.319	0.087	0.325	0.078	0.348	0.056	0.322	0.066	0.316	0.097
Number of girls	0.854	1.064	0.958	0.663	−0.243	0.000	0.104	0.328	0.071	0.120	0.090	0.433	0.124	0.308	0.051	0.655
Number of boys	0.787	0.961	0.855	0.560	−0.261	0.000	0.068	0.443	0.002	0.987	0.023	0.817	0.037	0.705	0.039	0.700
First child	0.251	0.434	0.230	0.363	0.123	0.000	−0.021	0.506	−0.002	0.951	0.005	0.869	−0.012	0.709	−0.023	0.468
SES asset index	−0.320	1.688	−0.560	0.422	0.861	0.000	−0.240	0.152	−0.133	0.201	−0.130	0.489	−0.161	0.398	−0.169	0.359
Mother’s education	6.801	4.546	6.827	8.567	1.753	0.000	0.025	0.957	0.376	0.428	0.311	0.537	0.087	0.863	0.096	0.849
Father’s education	8.331	3.288	7.848	9.151	1.059	0.000	−0.483	0.134	−0.560	0.117	−0.609	0.102	−0.844	0.026	−0.750	0.037
Life events checklist	4.098	2.335	4.696	2.896	−1.499	0.000	0.599	0.003	0.673	0.001	0.599	0.003	0.648	0.001	0.590	0.003
Observations	287		283	584
Joint test (p-value)								0.011		0.028		0.053		0.018		0.141

Notes: Table tests for balance of baseline characteristics. Columns 1, 3, and 4 show the mean in the control, treatment, and nondepressed group in the baseline sample, respectively. Column 5 shows the difference in means between nondepressed and depressed groups. Columns 7, 9, 11, 13, and 15 show the mean differences between treatment and control groups in the baseline sample and 6 months, 12 months, 24 months, and 36 months, respectively. p-values at the bottom of the table come from the F-test of overall significance from a regression of the treatment dummy on all the baseline controls.

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Table 2

Trajectory of Summary Indexes

	Control
Measurement	Mean	SD	Treatment Mean	Nondep. Mean	Adjusted Beta	SE	p-Value	N
Maternal Factor Scores
Mental health (6 m)	0	1	0.16	0.648	0.205	0.052	0	929
Mental health (12 m)	−0.002	0.703	0.067	0.455	0.119	0.038	0.002	940
Mental health (36 m)	−0.023	0.76	0.078	0.399	0.204	0.059	0.001	889
Functioning (6 m)	0	1	0.108	0.547	0.182	0.075	0.015	929
Functioning (12 m)	0.013	0.781	0.138	0.382	0.152	0.054	0.005	940
Functioning (36 m)	0.043	0.856	0.139	0.365	0.246	0.069	0	889
Child Factor Scores
Physical health (6 m)	0	1	−0.016	−0.034	−0.021	0.079	0.792	929
Physical health (12 m)	−0.039	0.799	−0.003	−0.011	0.015	0.056	0.784	940
Physical health (36 m)	−0.026	0.806	−0.136	0.007	−0.134	0.071	0.06	889
SE skills (6 m)	0	1	0.167	0.1	0.187	0.056	0.001	940
SE skills (12 m)	−0.183	0.842	0.168	0.082	0.328	0.059	0	940
SE skills (36 m)	0.864	0.907	0.917	0.966	0.057	0.068	0.4	889
Cognition (12 m)	0	1	−0.059	0.069	−0.08	0.083	0.334	940
Cognition (36 m)	0.041	0.426	0.061	0.033	0.028	0.031	0.386	889
Investment Factor Scores
Investment (12 m)	0	1	0.062	0.448	0.075	0.086	0.382	940
Investment (36 m)	−0.002	0.643	0.041	0.23	0.072	0.049	0.143	889

Notes: SE skills = socio-emotional skills. The first two columns report the mean and standard deviation of the outcome variables in the control group. The following columns report the means for the treatment group and the group of mothers who were nondepressed at baseline (Nondep.). Adjusted beta coefficients are obtained from the regressions of items on the treatment indicator and its interactions with the (demeaned) baseline covariates including baseline PHQ Total, baseline WHODAS Total, baseline PSS Total, mother’s baseline age, weight, height, waist circumference and blood pressure, family structure, grandmother being resident, total adults in the household, people per room, number of living children (split by gender), whether the index child is the first child, parental education levels, asset-based SES index, life events checklist score, interviewer fixed effect, union council fixed effect, and days from baseline. All estimations control for child gender and age (in days). Standard errors clustered at the village cluster level are reported in the SE column. Reported p-values and standard errors refer to the adjusted beta coefficient. N reports the number of observations of each analysis. Factor scores are coded so that a higher score always indicates a better outcome.

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Table 3

Estimates of the Production Function and Input Equations I

	Socio-emotional Skills (12 m)	Physical Health (12 m)	Cognition (12 m)	Parental Investment (12 m)	Maternal Mental Health (12 m)
	(1)	(2)	(3)	(4)	(5)
SE skills (6 m)	0.450^***	0.004	0.065^*	0.034	0.031
	(0.042)	(0.014)	(0.035)	(0.024)	(0.024)
Physical health (6 m)	0.070	0.928^***	0.109^***	0.077^***	0.006
	(0.044)	(0.014)	(0.042)	(0.024)	(0.022)
Mother mental health (6 m)	0.117^*	0.083^***	0.131^*	−0.104	0.384^***
	(0.062)	(0.029)	(0.076)	(0.069)	(0.067)
Mother functioning (6 m)	−0.033	−0.044^**	−0.025	0.081^**	0.093^**
	(0.053)	(0.020)	(0.045)	(0.040)	(0.042)
Investment (12 m)	0.086	0.030	−0.016		0.162^**
	(0.082)	(0.022)	(0.060)		(0.053)
Interactions
Mother MH (6 m) × treat	−0.199^***	−0.061	−0.199^**	0.101	−0.022
	(0.076)	(0.038)	(0.096)	(0.085)	(0.073)
Mother MH (6 m) × nondep.	−0.052	−0.133^***	−0.066	0.106	−0.155^*
	(0.094)	(0.034)	(0.094)	(0.080)	(0.084)
Investment (12 m) × treat	−0.022	−0.030	0.346^***		−0.007
	(0.108)	(0.035)	(0.090)		(0.067)
Investment (12 m) × nondep.	−0.033	−0.026	0.206^***		−0.072
	(0.082)	(0.030)	(0.073)		(0.063)
Total Factor Productivity (TFP)
TFP	−0.567	−0.465	4.208^***	0.101	−0.453
	(0.887)	(0.346)	(0.919)	(0.799)	(0.664)
TFP × treat	0.257^***	0.033^*	−0.023	0.065	0.043
	(0.061)	(0.020)	(0.058)	(0.060)	(0.049)
TFP × nondep.	0.243^**	0.118^***	−0.069	0.022	−0.001
	(0.100)	(0.038)	(0.089)	(0.094)	(0.084)
Baseline Records
SES assets	−0.016	0.004	0.009	0.087^***	−0.019
	(0.020)	(0.007)	(0.024)	(0.016)	(0.015)
Mother’s education (years)	−0.003	0.005	−0.004	0.019^***	0.011^**
	(0.006)	(0.003)	(0.007)	(0.004)	(0.005)
Husband’s education (years)	0.001	−0.006^**	−0.002	0.016^**	0.001
	(0.007)	(0.003)	(0.006)	(0.007)	(0.006)
Observations	932	932	927	932	932
R²	0.430	0.881	0.258	0.384	0.429
Adjusted R²	0.387	0.873	0.202	0.340	0.387

Notes: SE = socio-emotional skills, MH = mental health. Dependent variables are child outcomes and parental investment and maternal mental health factors at 12 months postpartum. Independent variables include an indicator of treatment status (control, treatment, nondepressed), child and maternal factors at 6 months (except for cognition as we did not measure cognition at 6 months), and parental investment factor at 12 months. Maternal mental health and parental investment are interacted with the treatment status. All estimations control for baseline characteristics including, mother’s baseline age, weight, height, waist circumference and blood pressure, family structure, grandmother being resident, total adults in the household, people per room, number of living children (split by gender), whether the index child is the first child, parental education levels, asset based SES index, life events checklist score, interviewer fixed effect, union council fixed effect, days from baseline, and child age in days. Robust and clustered standard errors at the cluster level are reported in parentheses. Significance: ^*p < 0.1, ^**p < 0.05, ^***p < 0.01.

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Table 4

Estimates of the Production Function and Input Equations II

	Socio-emotional Skills (36 m)	Physical Health (36 m)	Cognition (36 m)	Parental Investment (36 m)	Maternal Mental Health (36 m)
	(1)	(2)	(3)	(4)	(5)
SE skills (12 m)	0.183^***	0.033^*	0.012	−0.075^**	0.024
	(0.037)	(0.020)	(0.023)	(0.031)	(0.032)
Physical health (12 m)	0.026	1.048^***	0.046^**	0.067^**	−0.023
	(0.042)	(0.026)	(0.023)	(0.029)	(0.038)
Cognition (12 m)	0.012	−0.017	0.059^***	0.029	−0.057^**
	(0.038)	(0.022)	(0.022)	(0.033)	(0.027)
Mother mental health (12 m)	0.083	0.045	−0.074	0.202^***	0.287^***
	(0.097)	(0.050)	(0.059)	(0.075)	(0.067)
Mother functioning (12 m)	−0.063	−0.049^*	0.065^**	−0.010	0.094^*
	(0.049)	(0.028)	(0.033)	(0.049)	(0.054)
Investment (36 m)	0.158^**	0.001	0.092^**		0.150^*
	(0.071)	(0.039)	(0.039)		(0.077)
Interactions
Mother MH (12 m) × Treat	0.057	−0.055	0.060	−0.152^*	−0.028
	(0.118)	(0.056)	(0.066)	(0.084)	(0.096)
Mother MH (12 m) × Nondep.	−0.001	0.003	−0.005	−0.074	−0.100
	(0.112)	(0.046)	(0.068)	(0.086)	(0.093)
Investment (36 m) × Treat	−0.214^*	0.034	−0.086		−0.117
	(0.112)	(0.053)	(0.059)		(0.080)
Investment (36 m) × Nondep.	0.017	−0.048	−0.008		−0.158^**
	(0.101)	(0.045)	(0.051)		(0.071)
Total Factor Productivity (TFP)
TFP	0.564	−1.546^**	1.960^**	1.918	1.344
	(2.503)	(0.702)	(0.949)	(1.380)	(1.332)
TFP × Treat	−0.031	−0.160^***	0.022	0.133^**	0.113
	(0.079)	(0.043)	(0.036)	(0.059)	(0.071)
TFP × Nondep.	−0.164	0.039	−0.046	0.120	−0.035
	(0.123)	(0.060)	(0.072)	(0.093)	(0.104)
Baseline Records
SES assets	−0.014	−0.004	−0.001	0.053^***	−0.004
	(0.015)	(0.012)	(0.011)	(0.019)	(0.018)
Mother’s education (years)	−0.006	0.006	0.013^***	0.016^***	0.010^*
	(0.006)	(0.004)	(0.004)	(0.005)	(0.005)
Husband’s education (years)	0.009	−0.003	0.008	0.031^***	0.012^*
	(0.007)	(0.004)	(0.006)	(0.008)	(0.012)
Observations	881	881	881	881	881
R²	0.404	0.839	0.302	0.311	0.331
Adjusted R²	0.363	0.827	0.253	0.266	0.285

Notes: SE = socio-emotional skills, MH = mental health. Dependent variables are child outcomes and parental investment and maternal mental health factors at 36 months postpartum. Independent variables include an indicator of treatment status (control, treatment, nondepressed), child and maternal factors at 12 months, and parental investment factor at 36 months. Maternal mental health and parental investment are interacted with the treatment status. All estimations control for baseline characteristics including mother’s baseline age, weight, height, waist circumference and blood pressure, family structure, grandmother being resident, total adults in the household, people per room, number of living children (split by gender), whether the index child is the first child, parental education levels, asset based SES index, life events checklist score, interviewer fixed effect, union council fixed effect, days from baseline, and child age in days. Robust and clustered standard errors at the cluster level are reported in parentheses. Significance: ^*p < 0.1, ^**p < 0.05, ^***p < 0.01.