Impact of maternal depression on malnutrition treatment outcomes in older children with sickle cell anemia
Claire Ritter,
Shehu U. Abdullahi,
Safiya Gambo,
Hassan Adam Murtala,
Halima Kabir,
Khadija A. Shamsu,
Garba Gwarzo,
Yasmin Banaei,
Sari A. Acra,
Virginia A. Stallings,
Mark Rodeghier,
Michael R. DeBaun,
Lauren J. Klein
Affiliations
Claire Ritter
Meharry Medical College
Shehu U. Abdullahi
Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital
Safiya Gambo
Department of Pediatrics, Murtala Mohammed Specialist Hospital
Hassan Adam Murtala
Department of Pediatrics, Murtala Mohammed Specialist Hospital
Halima Kabir
Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital
Khadija A. Shamsu
Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital
Garba Gwarzo
Department of Pediatrics, Bayero University/Aminu Kano Teaching Hospital
Yasmin Banaei
Yasmin Banaei MD LLC
Sari A. Acra
Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children’s Hospital at Vanderbilt
Virginia A. Stallings
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, The Children’s Hospital of Philadelphia and University of Pennsylvania
Mark Rodeghier
Rodeghier Consultants
Michael R. DeBaun
Department of Pediatrics, Vanderbilt-Meharry Center of Excellence in Sickle Cell Disease, Vanderbilt University Medical Center
Lauren J. Klein
Department of Pediatrics, D. Brent Polk Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Monroe Carell Jr. Children’s Hospital at Vanderbilt
Abstract Background Malnutrition and sickle cell anemia (SCA) result in high childhood mortality rates. Although maternal depression is an established risk factor for malnutrition in younger children, little is known about its impact on treatment response in children with malnutrition. We aimed to determine the relationship, if any, between maternal depression scores and malnutrition treatment outcomes in older children with SCA. Methods We conducted a planned ancillary study to our randomized controlled feasibility trial for managing severe acute malnutrition in children aged 5–12 with SCA in northern Nigeria (NCT03634488). Mothers of participants completed a depression screen using the Patient Health Questionnaire (PHQ-9).We used a multivariable linear regression model to describe the relationship between the baseline maternal PHQ-9 score and the trial participant’s final body mass index (BMI) z-score. Results Out of 108 mother-child dyads, 101 with maternal baseline PHQ-9 scores were eligible for inclusion in this analysis. At baseline, 25.7% of mothers (26 of 101) screened positive for at least mild depression (PHQ-9 score of 5 or above). The baseline maternal PHQ-9 score was negatively associated with the child’s BMI z-score after 12 weeks of malnutrition treatment (β=-0.045, p = 0.041). Conclusions Maternal depressive symptoms has an impact on malnutrition treatment outcomes. Treatment of malnutrition in older children with sickle cell anemia should include screening for maternal depression and, if indicated, appropriate maternal referral for depression evaluation and treatment. Trial Registration The trial was registered at clinicaltrials.gov (#NCT03634488) on January 30, 2018, https://clinicaltrials.gov/study/NCT03634488 .
