Video Abstract for "Depressive symptoms and care demands among primary caregivers of young children with evidence of congenital Zika virus infection in Brazil"

A: Hello, my name is Kim Kotzky, and I'm a research fellow in the Division of Human Development and Disability at the Centers for Disease Control and Prevention, also known as CDC.

B: And I'm Georgina Peacock, a Developmental Behavioral Pediatrician and Director of CDC's Division of Human Development and Disability. Together with our colleagues at the Brazilian Ministry of Health, we conducted the Zika Outcomes and Development in Infants and Children, or ZODIAC, investigation.

A: ZODIAC investigators followed-up on children conceived during the 2015-2016 Zika virus outbreak in Brazil, as well as their primary caregivers. Some, but not all children exposed to Zika before birth may have complex health and developmental challenges requiring specialized care throughout their lives. These challenges may include microcephaly, seizures, severe motor impairment, and vision abnormalities. The investigation was designed to document the health and development of children with evidence of congenital Zika virus infection as they approached toddlerhood and the impact on their families.

In this paper, we describe the families' social, economic and mental health challenges.

B: Data were collected in 2017 in two states in northeastern Brazil that were heavily affected by the 2015-2016 Zika outbreak. Our multidisciplinary field team collected data from 150 children conceived during the outbreak who were born with evidence of Zika virus infection. We also collected data from the affected child's primary caregiver, who was most often the child's mother. Children were between the ages of 15 and 26 months old at the time of data collection. Approximately 40% of children screened positive for developmental delay on the Ages and Stages Questionnaire, or ASQ-3. The ASQ-3 is designed to screen the developmental progress of young children in 5 domains: communication, gross motor skills, fine motor skills, problem solving, and personal-social skills. To assess caregivers' depressive symptoms, we used a validated depression screening tool called the Patient Health Questionnaire-9, or PHQ-9. Questions about caregiving demands were based on questions from the National Survey of Children's Health.

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A: We conducted bivariate analyses to describe differences in depressive symptoms and care demands among primary caregivers of children with and without developmental delay. We also used a path analysis model to examine the relationships between developmental delay, depressive symptoms, difficulty covering basic expenses, and amount of time spent providing care, and whether these relationships differed by the availability of childcare support.

B: Our findings revealed significant differences between primary caregivers of children with evidence of Zika, depending on whether the child had developmental delay. Primary caregivers of the children with developmental delay had higher depression scores and were significantly more likely to report employment challenges, difficulty covering basic expenses, spending at least 5 hours per week providing health care at home, and not having received childcare support when compared to primary caregivers of the children without developmental delay. Group differences in caregiver-reported levels of government assistance and emotional support for parenting were not statistically significant.

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A: In addition, we found an indirect relationship between developmental delay and depressive symptoms through difficulty covering basic expenses – however, this was only among primary caregivers who reported not having received childcare support. (In other words, mothers of children with developmental delays tended to report more depressive symptoms, via difficulty covering basic expenses, but only if they did not report having help with childcare.)

These data add to the literature suggesting childcare support is a protective factor for primary caregiver well-being.


B: To summarize, for families impacted by the Zika outbreak in Brazil, economic and child care challenges may be associated with primary caregiver mental health. Based on our findings, we would like to outline four potential strategies that might promote caregiver well-being in this population:

  1. Increase access to child care support and respite care;
  2. Expand opportunities for financial support;
  3. Screen caregivers for mental health concerns and connect them to services when indicated; and
  4. Monitor child health and development to ensure that children's needs are identified early and that families have access to the appropriate supports and services.


A: Thank you for watching this video abstract. To support children impacted by congenital Zika virus infection, it is important that we support their families and caregivers. Our findings can help inform efforts to support families and address Zika's social and economic impacts.

B: For more information on Zika, please visit our website. To learn more about the findings from this paper, please read the full article in the Journal of Developmental and Behavioral Pediatrics.