Factors affecting mental health of mothers and children in Ethiopia

Summary

This blog by Markos Tesfaye, Ethiopian psychiatrist and an Alliance for Accelerating Excellence in Science in Africa (AESA) grantee under the African Postdoctoral Training Initiative (APTI), addresses how maternal mental well-being during pregnancy affects the placenta and potentially impacts foetal brain development, which leads to mental disorders. This study indirectly benefits mothers through a detailed assessment of their mental health, substance abuse, and domestic violence, calling for policies to address mental and psychosocial issues during pregnancy.

Defining what causes mental disorders halts symptom development and eases suffering

Most individuals with mental disorders living in Ethiopia do not receive mental health care. Lack of knowledge as to what exactly causes mental disorders presents a huge challenge to the development and implementation of preventive measures. Also, no tests reliably predict who will develop mental disorders before symptoms emerge. The study of epigenetics (chemical changes to DNA) resulting from an adverse environment during critical stages of brain development in the uterus may help scientists understand some of the causes of mental disorders. Scientific advances in the field will help in the discovery of novel diagnostic and therapeutic approaches benefitting millions of people around the world.

In my work as a general psychiatrist in Ethiopia, I helped individuals with mental and substance use disorders. It is sad to see not only the patients whose conditions become chronic, but also the suffering and burden of relatives who care for them. This clinical experience motivated me to reach beyond caring for individuals to search for why people develop mental disorders in the first place. Moreover, the ability to reliably predict the risk for individuals to develop mental disorders before symptoms emerge can often ease suffering. My interest in adverse environmental factors in early life such as stress, nutritional deficiencies, exposure to alcohol, etc. grew out of the desire to find a way to prevent mental disorders and thus the suffering of individuals and their caregivers.

How adverse environments impacts foetal brain development & risk to mental health

Mental disorders including depression, schizophrenia, bipolar disorder and attention deficit hyperactivity disorder affect an estimated 112 million individuals living in sub-Saharan Africa¹. Emerging evidence from high-income countries suggests that exposure to adverse environmental factors during foetal life or early childhood puts individuals at risk of non-communicable disease, including mental disorders, at a later age. These include malnutrition, infection, stress, trauma and maternal depression, which are common in Africa. Changes arising from an adverse environment during foetal life or infancy may negatively affect brain development and add to the risk of suffering from mental disorders starting in adolescence or adulthood. The study of these changes in communities where adverse environmental factors are common can shed light on the underlying molecular mechanisms that make a person vulnerable to mental disorders and can lead to the development of diagnostic tests to use before symptoms emerge.

In my ongoing research, I investigate the relationship between epigenetic changes in the placenta and maternal mental well-being during pregnancy. It uses data from the Eunice Kennedy Shriver National Institute of Child Health and Human Development Foetal Growth Studies, conducted on racially diverse pregnant women in the US. The purpose of the work is to identify possible evidence of changes relevant to foetal brain development, in order to better understand molecular changes in the placenta which might signal foetal exposure to adversity or may functionally result in abnormal development. Prior studies have already reported the crucial role of the placenta in foetal brain development and the changes that occur in response to stress during pregnancy using animal models. Human studies also suggest that brain development that mainly occurs during human foetal life could be affected by functional changes in the placenta. I intend to focus on the synergistic effect of several environmental factors common in Africa to improve early diagnosis and treatment of mental disorders.

Through APTI, I have enhanced my training in biological research and gained a new perspective for my research approach in psychiatry. I’ve also built skills in bioinformatics, an interdisciplinary field that develops methods and software tools for understanding biological data, which are in great demand in Africa, as well as developed collaborations with African scientists and improved grant writing skills. Overall, APTI has equipped me with the most important tools and resources needed for building the research program that I envisage in Ethiopia.

Footnotes

1 Institute of Health Metrics and Evaluation (IHME) 2019 [http://ghdx.healthdata.org/]

About Markos Tesfaye Woldeyohannes

Markos Tesfaye Woldeyohannes is an Ethiopian psychiatrist at St. Paul’s Hospital Millennium Medical College in Ethiopia and an African Postdoctoral Training Initiative (APTI) Fellow based at the United States National Institutes of Health (NIH). APTI is implemented through the Alliance for Accelerating Excellence in Science in Africa (AESA), a funding, agenda setting and programme management platform of the African Academy of Sciences (AAS) and the African Union Development Agency (AUDA-NEPAD), supported by the NIH and the Bill & Melinda Gates Foundation. APTI trains African researchers in global health and develops their skills in clinical and translational research.