Depressive symptoms among mothers with hospitalized children in South Asia and sub-Saharan Africa

Background: Poor maternal mental health during childhood hospitalization is associated with post-discharge child mortality. We aimed to establish if maternal PHQ-9 scores during hospitalization are associated with acute stressors or longer trends in mental health status. Method: Mothers of children admitted to nine hospitals in six countries completed a PHQ-9 assessment during hospitalization and 45-days post-discharge. Community participants were recruited from homes near the hos-pitalized children. The prevalence and correlates of high PHQ-9 scores among hospitalized and community mothers were compared. Outcomes: Among 2762 mothers of hospitalized children, 514 (19 %) had PHQ-9 scores >= 10, significantly more than the 116 (10 %, p < 0.001) of 1159 community participants. Recruitment site and food insecurity were PHQ-9 correlates in both groups. Correlates of higher mean PHQ-9 scores among the hospitalized cohort included maternal illness (mean difference [MD]: 1.27, 95%CI: 0.77, 1.77), pregnancy (MD: 0.77, 95%CI: 0.27, 1.28), child HIV-infection (MD: 2.51. 95%CI: 1.55, 3.52), and lower child weight-for-height (MD: 0.21, 95%CI: 0.32, 0.11). Marriage (MD-0.92, 95%CI:-1.36,-0.48) and a positive malaria test (MD:-0.63, 95%CI:-1.15,-0.10) were associated with lower PHQ-9 scores among mothers of hospitalized children. Among mothers with PHQ-9 >= 10 during admission, 410 had repeat assessments 45-days after their child's discharge, and 108 (26 %) continued to meet the high PHQ-9 criterion. Interpretation: Among mothers of hospitalized children, there are subgroups with transient and persistent depressive symptoms. Interventions tailored to address acute stressors may improve post-discharge pediatric and maternal health outcomes. Funding: Bill & Melinda Gates Foundation OPP1131320.