PROJECT SUMMARY
Background. Among social factors affecting vulnerability to mental illness, family is key, and the quality of care
that parents provide for their children perhaps being the most strategic. However, it is still unclear whether the
early childhood parenting support programs offer later mental health benefits for the child; and if they do, which
mechanisms explain the association between early parenting support programs and mental health at school age.
Specifically, it is not well understood how family social factors (e.g., parent sense of self-efficacy, family
dynamics, quality of caregiving environment, school attendance) are associated with mental health outcomes in
childhood. Therefore, in this project we will evaluate the long-term effect of a parenting support program on child
mental health outcomes at school age, and test the impacts of social family, maternal mental health, and child
growth factors as predictors of longer-term child mental health. We will conduct a 3-year observational
longitudinal follow-up assessment (once each year) of 100 children whose mothers previously completed the
year-long biweekly mediational intervention for sensitizing caregivers (MISC), and 114 children whose mothers
were randomized to the No MISC (treatment as usual) arm. Specific Aims for this study are: Aim 1: To evaluate
long-term mental health outcomes (e.g., executive functioning/self-regulation, emotional responses, social
communication, emotion regulation behaviors in caregiver-child interactions) of the MISC intervention among
school-age children living in the DR Congo 5 years after their mothers received MISC or no MISC training. Child
mental health outcomes will be evaluated annually for 3 consecutive years with a range of validated and direct
measures (video recordings of parent/child interactions, psychopathology checklists, eye tracking measures of
child response to short video vignettes of child caregiving interactions). We hypothesize that children of mothers
who received MISC intervention will have more positive psychosocial and eye tracking based emotional
outcomes at school age compared to children of mothers who did not receive MISC. Aim 2: To examine the
family social, child growth, and maternal mental health factors gathered both in early childhood during the MISC
trial, and again in the proposed follow-up study, as simultaneous or consecutive mediators of the MISC effects
on child mental health. We will also evaluate these factors as independent predictors of child mental health
outcomes at 5-12 years of age. Findings on indirect effects of MISC through these factors or their effects
independent of MISC will help guide future efforts on how to best enhance the trajectory of mental health from
early to middle childhood. Aim 3: Controlling for the receipt of the MISC intervention, assess longitudinal dyadic
interdependence of maternal and child mental health outcomes to determine if there are reciprocating effects
between mother and child mental health over time. Overall Impact. Establishing how early childhood parenting
support reduces psychopathology -- along with the family social, child growth, and maternal mental health factors
driving this process -- will sustainably enhance child mental health in low- and middle-income countries (LMICs).