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Maternal Mental Health and Child Allostatic Load in Rural Nicaragua

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Maternal Mental Health and Child Allostatic Load in Rural Nicaragua University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2018-09-10 Maternal mental health and child allostatic load in rural Nicaragua Hoehn, Natasha Christine Hoehn, N. C. (2018). Maternal mental health and child allostatic load in rural Nicaragua (Unpublished master's thesis). University of Calgary, Calgary, AB doi:10.11575/PRISM/32962 http://hdl.handle.net/1880/107799 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Maternal mental health and child allostatic load in rural Nicaragua by Natasha Christine Hoehn A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF ARTS GRADUATE PROGRAM IN ANTHROPOLOGY CALGARY, ALBERTA SEPTEMBER, 2018 © Natasha Christine Hoehn 2018 Abstract Approximately 25% of individuals worldwide will experience a common mental disorder (CMD) in their lifetime, and previous studies have suggested that poor maternal mental health (MMH) is associated with negative child health and development outcomes. However, these studies use individual markers to represent overall child health status. An allostatic load (AL) index may provide a better understanding of overall health status by pooling together multiple markers of intermediary risk to poor health outcomes. Here, I tested for an association between the following variables in a cross-sectional sample of maternal-child dyads from rural Nicaragua: 1) MMH and individual child health measures. 2) MMH and a child AL index. Multiple regression analyses found no significant relationships between MMH and any of the outcome measures. However, a high prevalence of probable cases of CMDs (30.9%) was documented among mothers, indicating that mental health should be prioritized by local and regional health interventions. Keywords: Allostatic Load, Maternal Mental Health, Global Mental Health. ii Acknowledgements I would like to thank Dr. Warren Wilson for initially bringing me to Nicaragua, and for providing guidance in the field and at home. Your encouragement throughout this process has been central to my academic growth over the past two years. I would also like to thank those who contributed to the overarching project in Los Robles, including Dr. Jason DeCaro, Dr. Barbara Piperata, and Dr. Kammi Schmeer. I am additionally appreciative of the time Dr. DeCaro dedicated to coaching me in his lab at the University of Alabama. Special thanks to Dr. Paul Brown and Dr. Tak Fung for their statistical expertise, and to Ben Arnold for creating the map of Los Robles included in this thesis. To my thesis defense committee, Dr. Warren Wilson, Dr. Sheri Madigan and Dr. Hartmut B. Krentz, thank you for the effort you have invested in reviewing my work and for your thoughtful feedback. Most importantly, this thesis would not be possible without the Nicaraguan women who collected these data, participated in our research, and welcomed me into their homes. I am particularly grateful for time I was able to share with the families of Doña Neña, Doña Albita, and Doña Angela, who showed me immeasurable generosity and kindness. Lastly, my family’s support has been instrumental to this process. Thank you to Chad Neufeld who pushed me to pursue new research opportunities in Nicaragua and elsewhere. I am continually thankful for your support of my academic endeavors. iii Table of Contents Abstract .............................................................................................................................. ii Acknowledgements .......................................................................................................... iii Table of Contents ............................................................................................................. iv List of Tables ................................................................................................................... vii List of Figures and Illustrations ..................................................................................... ix List of Abbreviations ....................................................................................................... xi Chapter I: Introduction .....................................................................................................1 Chapter II: Global Mental Health....................................................................................4 2.1 Mental Health and Mental Disorders ....................................................................4 2.2 Anthropology and Global Mental Health ..............................................................5 2.3 Global Prevalence of Mental Disorders .................................................................9 2.4 Addressing Mental Disorders in LMICs .............................................................12 2.5 Implications of Failing to Address Mental Disorders in LMICs .......................16 2.5.1 Global burden of disease. ..............................................................................16 2.5.2 Interactions with other health conditions. ...................................................20 2.5.3 MMH and child health. .................................................................................22 Child nutritional status. ....................................................................................26 Child cognitive development. ............................................................................28 Childhood diarrhea. ..........................................................................................30 2.6 Chapter Summary .................................................................................................32 Chapter III: Allostatic Load ...........................................................................................33 3.1 Background ............................................................................................................33 3.2 Homeostasis, Stress, Allostasis, and Allostatic Load ..........................................34 3.2.1 Operationalizing allostatic load. ...................................................................39 3.2.2. Testing allostatic load. ..................................................................................44 3.3 Explaining Variation in Allostatic Load ..............................................................47 3.3.1 Genetic factors. ..............................................................................................47 3.3.2 Demographic factors. ....................................................................................48 3.3.3 Environmental factors. ..................................................................................50 3.4 Chapter Summary .................................................................................................55 Chapter IV: Research Setting .........................................................................................57 4.1 Geography and Demographics .............................................................................58 4.2 History .....................................................................................................................60 4.3 Women in Los Robles ............................................................................................69 Chapter V: Methods ........................................................................................................76 5.1 Research Purpose ...................................................................................................76 5.2 Participants .............................................................................................................76 5.3 Data Collection .......................................................................................................78 5.3.1 Initial data collection period: 2015. .............................................................78 Interviews. .........................................................................................................79 iv Anthropometrics. ...............................................................................................79 Dried Blood Spots (DBSs) ................................................................................80 Consent & Confidentiality. ...............................................................................80 5.3.2 Supplementary data collection period: 2017. ..............................................81 5.4 Measures .................................................................................................................83 5.4.1 Outcome measures: AL index and it’s components. ..................................83 Scoring process. ................................................................................................84 Height-for-age z-scores (HAZ). ........................................................................85 Body-mass-for-age z-scores (BMIZ). ...............................................................86 C-Reactive Protein (CRP). ................................................................................87
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