<div class="Abstracts u-font-serif" id="abstracts" style="margin: 0px; padding: 0px; font-size: 18px; line-height: 26px; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif !important;"><div class="abstract author" id="abs0010" lang="en" style="margin: 0px 0px 8px; padding: 0px;"><div id="abssec0010" style="margin: 0px; padding: 0px;"><p id="abspara0010" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Good mental health is a critical resource for mothers and caregivers of young children, given the central role of mental health in enabling responsive caregiving. However, fulfilling caregiving responsibilities under challenging circumstances such as extreme poverty, food insecurity, and gender&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/inequality" title="Learn more about inequality from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">inequality</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;intensifies vulnerability to poor mental health. </span></p><p id="abspara0010" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Previous research focuses on the mental health of mothers, while in many LMICs children are cared for by other caregivers, such as grandparents. We examined the prevalence of mental health problems among primary caregivers of young children in rural Lesotho, and investigated factors associated with these mental health problems.&nbsp;</span><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">It analyzed baseline data from a cluster randomized controlled trial, where all caregivers with children between 1 and 5 years old across 34 villages were invited to participate. The analysis included mental health data from 781 caregivers of 998 children. We assessed the caregiver's mental health using three self-report screening instruments. Univariate and&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/multivariate-regression" title="Learn more about multivariate regression from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">multivariate regression</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;modeling tested associations between caregiver, child, and household variables and (1) depression symptoms (PHQ-9), (2) anxiety symptoms (GAD-7), (3)&nbsp;</span></span><a href="https://www.sciencedirect.com/topics/psychology/psychological-distress" title="Learn more about psychological distress from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="background-color: rgb(255, 255, 255); margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">psychological distress</span></a><span style="margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;(SRQ-20), (4)&nbsp;</span><a href="https://www.sciencedirect.com/topics/psychology/suicidal-ideation" title="Learn more about suicidal ideation from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="margin: 0px; padding: 0px; text-decoration-line: underline; text-decoration-thickness: 1px; text-decoration-color: rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">suicidal ideation</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;and (5) help-seeking for mental health.</span></span><img src="/media/django-summernote/2022-11-08/2dc9c93d-24ef-4744-a40d-b2236d304ca1.png" style="width: 100%;"></p><p id="abspara0020" style="margin-bottom: 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">This study has reported a high prevalence of symptoms of psychological distress (46.2%), depression (25.7%), anxiety (17.1%), and suicidal ideation (27.5%) among caregivers. Greater prevalence was associated with food insecurity, parenting stress, or recent death in the family/household. Older caregivers reported higher rates of psychological distress and depression, while younger caregivers reported higher rates of anxiety. Suicidal ideation was associated with greater food insecurity and parenting stress, and lower caregiver education.</span><span style="font-family: Helvetica;">﻿</span></p><section id="sec2" style="margin: 0px 0px 8px; padding: 0px;"></section><p id="abspara0025" style="margin-bottom: 16px; padding: 0px;"></p><section id="sec2" style="box-sizing: border-box; margin: 0px 0px 8px; padding: 0px; display: block; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"></section><p></p><section id="sec1" style="box-sizing: border-box; margin: 0px 0px 8px; padding: 0px; display: block; color: rgb(46, 46, 46); font-family: NexusSerif, Georgia, &quot;Times New Roman&quot;, Times, STIXGeneral, &quot;Cambria Math&quot;, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, &quot;Arial Unicode MS&quot;, serif; font-size: 18px; font-style: normal; font-variant-ligatures: normal; font-variant-caps: normal; font-weight: 400; letter-spacing: normal; orphans: 2; text-align: start; text-indent: 0px; text-transform: none; white-space: normal; widows: 2; word-spacing: 0px; -webkit-text-stroke-width: 0px; text-decoration-thickness: initial; text-decoration-style: initial; text-decoration-color: initial;"><p id="p0010" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Compromised mental health has far-reaching implications for the functioning of individuals, communities, and countries, contributing to increased years lived with disability</span><span style="font-family: Helvetica; font-size: 14px;">, greater healthcare expenditures, and reduced economic opportunities</span><span style="font-family: Helvetica; font-size: 14px;">. Recognizing these costs, mental health and well-being are specifically addressed in the global development goals for 2030</span><span style="font-family: Helvetica; font-size: 14px;">. Despite an increased global focus on mental health in recent years&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">people from low and middle-income countries (LMICs) continue to experience pervasive structural and social challenges that compromise their mental health</span><span style="box-sizing: border-box; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">. Mental health links prominently with other public health issues that persist in LMIC settings such as economic deprivation, HIV/AIDS, and gender</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/inequality" title="Learn more about inequality from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">inequality</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span></span></p><p id="p0015" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">LMICs carry 80% of the disease burden associated with depressive disorders</span><span style="font-family: Helvetica; font-size: 14px;">, and 76% of the world's suicides take place in these countries</span><span style="font-family: Helvetica; font-size: 14px;">. In addition, one in every four women in LMICs experience perinatal anxiety, suggesting higher prevalence rates compared to high-income countries.</span><span style="box-sizing: border-box; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;While studies from LMICs are limited, evidence from</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/psychology/systematic-review" title="Learn more about systematic reviews from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">systematic reviews</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">shows that anxiety and depressive disorders are highly correlated</span></span><span style="font-family: Helvetica; font-size: 14px;">. Despite this substantial burden, efforts to increase and improve service delivery for people affected by poor mental health in these settings remain inadequate</span><span style="font-family: Helvetica; font-size: 14px;">. While the lack of equity around prevention and treatment exists between countries, there is also the issue of equity within countries – especially between urban and rural areas within LMICs (WHO)</span><span style="font-family: Helvetica; font-size: 14px;">. As an example, research from South Africa demonstrated rural-urban and spatial differences (hotspots of mental ill health) in the prevalence of depression status, with those in urban areas showing lower levels of depression compared to those living in rural areas.</span><img src="/media/django-summernote/2022-11-08/4db543b3-8593-479d-be17-36b9793bd36d.png" style="width: 100%;"></p><p id="p0020" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Structural factors such as health infrastructure or social protection policies are important for mental health in that they determine the distribution of resources within a population and who has access to them</span><span style="box-sizing: border-box; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">.</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/governance" title="Learn more about Governance from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">Governance</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">and policies related to education and health, as well as the social environments that shape gender norms and women's status in society,</span></span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;are key drivers that determine why, how, and for whom good mental health is unattainable. Poverty leads to a heightened risk of poor mental health by increasing exposure to risk factors such as adverse life events</span><span style="font-family: Helvetica; font-size: 14px;">, food insecurity,&nbsp;</span><span style="box-sizing: border-box; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">and limited</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/education-and-employment" title="Learn more about education and employment from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">education and employment</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">opportunities</span></span><span style="font-family: Helvetica; font-size: 14px;">. Women may be especially prone to poor mental health in contexts characterized by poverty</span><span style="font-family: Helvetica; font-size: 14px;">, where they are often responsible for the care of young children and the upkeep of their household. Fulfilling caregiving responsibilities under highly challenging circumstances intensifies vulnerability, particularly in gender-unequal societies where women have limited economic agency.</span></p><p id="p0025" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">For mothers and other caregivers who fulfill the primary parenting role, good mental health is a critical resource to support the health and well-being of children in their care</span><span style="font-family: Helvetica; font-size: 14px;">. Caregiver mental health is central to the provision of responsive caregiving</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;which forms the basis of quality caregiver-child interactions and promotes optimal child development</span><span style="font-family: Helvetica; font-size: 14px;">. Mental health problems such as maternal depression can compromise child development across a range of domains</span><span style="font-family: Helvetica; font-size: 14px;">, including physical and cognitive development</span><span style="font-family: Helvetica; font-size: 14px;">, and later mental health outcomes for the child</span><span style="font-family: Helvetica; font-size: 14px;">. Identifying caregivers in need of support is therefore crucial for both parental functioning and child wellbeing</span><span style="font-family: Helvetica; font-size: 14px;">.</span></p><p id="p0030" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">While there is a growing body of evidence on perinatal mental health in LMICs, less is known about parent mental health past the first year of childbirth. Most research has studied the mental health of mothers, while in many LMICs young children are cared for by other family members, such as grandparents. This is especially relevant in sub-Saharan Africa, where the HIV epidemic has significantly increased the number of orphans and vulnerable children</span><span style="font-family: Helvetica; font-size: 14px;">. In addition, many parents from rural communities migrate to urban areas for work, leaving their children behind in the care of extended family.</span></p><p id="p0035" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">Lesotho is a small, low-income country in southern Africa, where more than half the population (59.7%) live in extreme poverty</span><span style="font-family: Helvetica; font-size: 14px;">. The country has the second-highest adult HIV prevalence rate globally, at 23.8%</span><span style="font-family: Helvetica; font-size: 14px;">. One in four children are orphans, and over one-third of children do not live with either parent</span><span style="box-sizing: border-box; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">. Lesotho has no stand-alone</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/governmental-policy" title="Learn more about governmental policy from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">governmental policy</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">or policy plan for mental health, and human resources allocated to mental health are scarce</span></span><span style="font-family: Helvetica; font-size: 14px;">. Research about community-level mental health or access to services in the country has been extremely limited. A small lowland town with a sample of 356 adults,</span><span style="box-sizing: border-box; margin: 0px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">reported the prevalence of depression at 12.4% and</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/social-sciences/generalized-anxiety-disorder" title="Learn more about generalized anxiety disorder from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">generalized anxiety disorder</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">at 6.2%, using a structured psychiatric interview. More recently, depression has been studied in Lesotho using the Patient Health Questionnaire-9 (PHQ-9) screening tool among men who have sex with men,</span></span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;adult patients on antiretroviral treatment (69% female;</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;and TB-HIV patients (53% male</span><span style="font-family: Helvetica; font-size: 14px;">). These studies reported moderate-severe depression symptoms at a rate of 16%, 29.8%, and 28.8%, respectively. Using the PHQ-9, depression has also been studied among inmates living with HIV (88.3% male) from three correctional institutions in Lesotho&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">with 53% reporting mild-severe symptoms of depression. To the best of our knowledge, mental health among women and caregivers of young children in Lesotho has not previously been studied.</span></p><p id="p0040" style="box-sizing: border-box; margin: 0px 0px 16px; padding: 0px;"><span style="font-family: Helvetica; font-size: 14px;">In this research paper, we examine the prevalence of depression, anxiety, and</span><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><a href="https://www.sciencedirect.com/topics/psychology/psychological-distress" title="Learn more about psychological distress from ScienceDirect's AI-generated Topic Pages" class="topic-link" style="box-sizing: border-box; margin: 0px; padding: 0px; background-color: transparent; text-decoration: underline 1px rgb(46, 46, 46); color: rgb(46, 46, 46); word-break: break-word; text-underline-offset: 1px;"><span style="font-family: Helvetica; font-size: 14px;">psychological distress</span></a><span style="font-family: Helvetica; font-size: 14px;">&nbsp;</span><span style="font-family: Helvetica; font-size: 14px;">among caregivers of young children (ages 1–5 years) across 34 rural villages in Lesotho, and investigate the covariates of these mental health problems.</span></p></section><div><br></div></div></div></div><ul id="issue-navigation" class="issue-navigation u-margin-s-bottom u-bg-grey1" style="margin-right: 0px; margin-left: 0px; padding: 0px; list-style: none; overflow: hidden; font-size: 16px; line-height: 24px; color: rgb(46, 46, 46); font-family: NexusSans, Arial, Helvetica, &quot;Lucida Sans Unicode&quot;, &quot;Microsoft Sans Serif&quot;, &quot;Segoe UI Symbol&quot;, STIXGeneral, &quot;Cambria Math&quot;, &quot;Arial Unicode MS&quot;, sans-serif; margin-bottom: 16px !important; background-color: rgb(245, 245, 245) !important;"></ul>