Longitudinal Effects of Individual and Contextual Adversity on Maternal Mental Health and Infant Outcomes in a Low-Income Community in Peru

Research from around the world has found that the perinatal period is a time of particular vulnerability for maternal mental health, which may also affect infant development. In low- and middle-income countries like Peru, less is known about social determinants that influence mental health across the perinatal period, or about how maternal perinatal factors influence infants’ development. In this dissertation, I used longitudinal analytic methods to examine data from a sample of 251 Peruvian mothers. Findings highlight the interplay of social determinants of health, violence exposure, and resilience on maternal mental health and infant temperament. In Chapter 1, I ran two latent growth curve models to examine depression and posttraumatic stress symptoms (PTSS) trajectories over four perinatal time points and how social determinants of health influenced these trajectories. Findings demonstrated low, stable PTSS levels and high but declining depression across the perinatal period. Greater exposure to intimate partner violence (IPV), more education, higher socioeconomic status, less social support, and being a single mother were associated with higher levels of both prenatal PTSS and prenatal depression. No social determinants significantly related to PTSS slope, but single motherhood and more community disorder significantly related to less steep rates of change in maternal depression symptoms across the perinatal period. In Chapter 2, I used longitudinal structural equation modeling to evaluate direct and indirect effects of mothers’ exposure to child maltreatment, past-year IPV, prenatal and postpartum PTSS, and prenatal and postpartum resilience on domains of their 3-month-old infants’ temperament (i.e., surgency, negative affectivity, and regulatory capacity). Results showed that mothers’ exposure to violence is a risk factor for prenatal mental health and resilience, that resilience is protective for mothers’ mental health and infants’ regulatory capacity, and mixed findings on the effects of maternal prenatal and postpartum PTSS on infants’ regulatory capacity. In Chapter 3, I reflect on the state of the literature on perinatal mental health and infant temperament in low- and middle-income settings. I also reflect on key targets for interventions to support violence-exposed Peruvian mothers and the importance of gender-based violence prevention efforts to support both mothers and their infants. .