How to Measure Maternal Mental Health in Early Childhood Development Evaluations

Too few early childhood development (ECD) interventions measure impacts on mothers! For example, even though ECD interventions can clearly impact mothers’ mental wellbeing—providing childcare may reduce stress; organizing parenting groups may reduce depression—only 12 percent of empirical ECD studies in low- and middle-income countries measure those impacts. Why do so few studies measure maternal mental health in the context of ECD interventions? First, researchers focused on early childhood may not have a familiarity with the best instruments for measuring maternal mental health. Second, studies focused on ECD may have so much of their limited survey time dedicated to asking mothers about early childhood outcomes that they may not feel they have time to ask questions about maternal mental wellbeing.

In a new publication—”Tools to measure the impact of early childhood development interventions on maternal mental health in low- and middle-income countries”—we identify the instruments that ECD researchers have used to measure maternal mental wellbeing in low- and middle-income countries. We draw on ECD studies from Latin America, Africa, and Asia (see the figure below). We identify where the instruments have been used, how long they are, which ones are free, and which ones have been validated most extensively outside of the context of ECD studies.

Existing ECD studies report impacts on a number of distinct aspects of maternal mental health:  depression, stress, anxiety, self-efficacy, and social support, as well as general mental health. Depression is by far the most commonly measured aspect of mental wellbeing, most often measured with either the Center for Epidemiological Studies Depression Scale (CES-D) or the Edinburgh Postnatal Depression Scale (EPDS), both freely available instruments. Stress is the next most measured area, usually with the Parenting Stress Index, which is not free. Some studies use the Self-Reporting Questionnaire (SRQ), which is free. Studies also use the Self-Reporting Questionnaire to measure general mental health. Fewer ECD studies measure anxiety, self-efficacy, and social support.

How accurate are these instruments? The best instrument will be one that is validated in the context of the study, since how people talk about depression or other aspects of mental health varies dramatically across contexts. There are many reviews of the validity of instruments to measure mental wellbeing (and we talk about several in our study), but two stand out.

• Ali, Ryan, and De Silva examine “screening tools for common mental disorders in low- and middle-income countries” in a 2016 study. They recommend the SRQ for general mental health screening and the EPDS for maternal depression.
• Sambrook Smith and others carry out a systematic review of systematic reviews (we’re going meta!) of common mental disorders among mothers of very young children. (Here’s an open-access preprint version.) They don’t focus on low- and middle-income countries. The most frequently validated tool is the EPDS, followed by the Beck Depression Inventory and the Patient Health Questionnaire. All were found to be valid across multiple settings. (And all three have been used in the context of ECD evaluations, as our paper shows.)

Maternal outcomes matter in the context of ECD interventions! If you’re not sure how to measure those outcomes, we recommend creating research teams with expertise across focal areas and disciplines. But you don’t have to reinvent the wheel. Many—although not nearly enough—previous ECD researchers have sought to measure maternal mental wellbeing, and you can draw on their experience to understand the full returns to ECD investments.