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Prevalence and associated factors of psychological distress among caregivers of children with malnutrition: a cross鈥憇ectional study

樱花视频 volume听25, Article听number:听505 (2025) Cite this article

Abstract

Background

Malnutrition is a major child health problem in developing countries, contributing to 53% of child deaths annually. Psychological distress is an emotional and behavioral condition that causes significant suffering and interferes with a person鈥檚 daily life. Caregivers鈥� psychological distress can negatively impact a child鈥檚 development. Studies have shown that psychological distress has an impact on infant growth and nutritional status. However, evidence regarding the relationship between psychological distress and child malnutrition is scarce.

Objectives

The aim of this study was to determine the prevalence of psychological distress among caregivers of malnourished children and to identify factors associated with this.

Methods

This was a cross-sectional study was conducted and 409 caregivers participated. Outcome variable was assessed using Kessler Psychological Distress Scale (K-10).The collected data were analyzed using SPSS version 25. Bivariable and multivariable logistic analysis was conducted to identify factors associated with Psychological distress and Variables with P-value鈥�<鈥�0.05 were considered to have significant association with 95% confidence interval.

Results

The prevalence Psychological distress among caregivers of malnourished children was 42.5%. Unemployment (AOR鈥�=鈥�3.39, 95% CI: 2.14鈥�9.11), poor socioeconomic status (AOR鈥�=鈥�3.91, 95% CI: 1.46鈥�9.34), low child feeding practices (AOR鈥�=鈥�2.18, 95% CI: 1.12鈥�4.21), poor social support (AOR鈥�=鈥�4.44, 95% CI: 1.75鈥�11.29), physical and emotional abuse (AOR鈥�=鈥�3.37, 95% CI: 1.36鈥�8.35), and child underweight (AOR鈥�=鈥�4.36, 95% CI: 3.94鈥�8.36) were factors statically significant associated with psychological distress.

Conclusion

Caregivers of malnourished children experienced high psychological distress linked to unemployment, poverty, poor feeding practices, poor social support, both physical and emotional abuse and child underweight. Therefore, strategies should focus on improving employment, strengthening social support, promoting proper child feeding, raising economic status, preventing abuse, and combating underweight to reduce caregiver psychological distress.

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Introduction

Mental disorders, including psychological distress, continue to pose a significant global health challenge and contribute substantially to the worldwide burden of disease. Globally, mental health problems account for 13% of the total disease burden and 31% of all years lived with disability [1]. Psychological distress is a common and disabling condition, affecting approximately 10% of the global population at least once in their lifetime [2]. Psychological distress can be characterized by enduring a negative life experience, depression symptoms, anxiety, or general stress [3]. Studies indicate that primary caregivers鈥� psychological distress have a negative impact on the child鈥檚 development [4, 5].

Psychological distress is a state of emotional suffering characterized by anxiety symptoms (such as restlessness and tension) and depression symptoms (such as lost interest, sadness, and hopelessness). Psychological distress also characterized by physical symptoms such as headaches, insomnia, and low energy [6]. Malnutrition refers to inadequate, excessive, or imbalanced intake of energy and/or nutrients. Under nutrition is a type of malnutrition, includes conditions like stunting, wasting, and underweight [7].

Malnutrition is a major child health problems in developing countries, with 19.4% of children under 5 years old underweight and 29.9% stunted [8]. In Ethiopia, the prevalence of child malnutrition range from 27 to 37% [9], with the highest rates of under nutrition, stunting, and wasting at 49.2%, 57.1%, and 42.3% respectively [10]. Studies in sub-Saharan Africa have reported that 71% of primary caregivers with children suffering from acute severe malnutrition experiencing psychological distress [11].

Malnutrition impairs physical growth, increases morbidity and mortality and limits cognitive development and physical ability [12]. Maternal mental health substantial influence the children鈥檚 nutritional status, and interfering primary caregivers鈥� responsibility for child care [13, 14]. Maternal distress and depression can directly impact a child鈥檚 nutritional status by affecting the primary caregiver鈥檚 ability to provide proper care and feeding. Additionally, factors such as poverty and food insecurity can contribute to both maternal distress and childhood under nutrition, creating a cycle of risk factors that can have long-lasting effects on both the caregiver and child [15].

Studies from different countries have shown a high prevalence of psychological distress among caregivers of children with undernutrition. For example, a study conducted in Malawi reported that 71% of caregivers experienced psychological distress at 4 weeks post-discharge assessment [11], while 33.5% of caregivers attending an outpatient child health clinic in rural Malawi experienced psychological distress [16]. In Lesotho, the prevalence of symptoms of psychological distress among caregivers was 46.2%, with depression affecting 25.7%, anxiety affecting 17.1%, and suicidal ideation reported in 27.5% of cases [17]. In Ethiopia, the prevalence of mental distress was reported to be 27.1% [18], with 32.4% of individuals experiencing common mental disorders [19].

Maternal mental health is linked to child undernutrition in low-income countries, with a 40% higher risk of stunting for children of depressed primary caregivers [20, 21]. Malnutrition and poor mental health are linked. Maternal mental disorders contribute to child stunting and underweight status, and stunting and underweight are also associated with maternal mental disorders [22, 23]. Maternal distress can be a risk factor for child stunting and underweight, which can affect care and nutrition, leading to inadequate feeding practices and poor emotional bonding [24]. Poor maternal psychological well-being is a risk factor for childhood undernutrition. It can affect a mother鈥檚 ability to provide proper care and nutrition for her child, leading to neglect of the child鈥檚 nutritional needs and subsequently contributing to undernutrition [24, 25].

The risk factors for psychological distress include caregiver age, child age and gender, food insecurity, child health status, family history of mental illness and chronic physical illness, low socioeconomic status, poorer physical health, low educational status, poor child feeding practices, stressful life events, interpersonal violence, homelessness, unemployment, previous child death, lack of social support [11, 19, 26,27,28,29,30,31,32,33].

Caregivers of children with malnutrition are more prone to psychological distress than general population. However, little attention was paid on psychological distress among caregivers of children with under nutrition particularly in Ethiopia. Therefore, this study aimed to assess the prevalence of psychological distress and its鈥� associated factors among caregivers with malnourished children.

Methods

Study design and study area

A cross-sectional study was conducted from March to April, 2023 at three specialized hospitals in Ethiopia. These hospitals include the University of Gondar Comprehensive Specialized Hospital, Tibebe Ghion Comprehensive Specialized Hospital, and Felege Hiwot Comprehensive Specialized Hospitals in Bahir Dar city, Northwest Ethiopia.

Study participants, sample size and procedures

All caregivers whose malnourished children received nutritional support and treatment at Comprehensive Specialized Hospitals in Northwest Ethiopia presented during the data collection period. Caregivers of malnourished children attending pediatric wards and the OPD during the data collection period were included and Caregivers were excluded from the study if they were critically sick and had communication difficulties. The sample size was determined by using a single population proportion formula with a 95% confidence level and 5% margin of error and considering the prevalence of psychological distress as 50% because no similar study done in Ethiopia among mothers of children with undernutrition. By considering 10% non-response rate, the total sample size was 422 caregivers. Initially, the number of participants to be recruited from each hospital was allocated proportionally based on the total number of caregivers in each hospital. To determine the sampling interval (K), we divided the total number of caregivers in the sampling frame by the proposed sample size. The calculated sampling interval was 2.3. Based on this, participants were selected by including every other caregiver from the sampling frame until the total sample size allocated for each hospital was reached.

Data collection

Data were collected reviewing patients鈥� charts and using structured questionnaire.The questionnaire was initially prepared in English and then translated into Amharic, the commonly spoken language in the data collection area. A back translation to English was conducted to ensure linguistic consistency. The questionnaires included socio-demographic factors, clinical factors of caregivers, (including a history of chronic medical conditions and family history of mental illness), Factors related to substance use, psychosocial factors (including social support, intimate partner violence), and satisfaction levels in marital relationships were considered, Child-related factors (included age, gender, childhood medical history, nutritional status (undernutrition and overweight) conditions measured by mid-upper arm circumferences (MUAC, MBI), and measurements of height and weight. To assess the clarity and suitability of the survey questions, we performed a pre-test involving 21 caregivers who were not included in the actual data collection. Prior to data collection, a two-day training session was conducted for both data collectors and supervisors on the study鈥檚 objectives, sampling methods, structured questionnaires, and ethical considerations. The collected data were handled, reviewed, and carefully checked for completeness and consistency. We subsequently made minor modifications to the wording of some questions and their response options to enhance the clarity and applicability of the questionnaire. The internal consistency of the Kessler Psychological Distress Scale (K-10) was assessed using Cronbach鈥檚 alpha鈥�=鈥�0.74.

Measurements

Kessler Psychological Distress Scale (K10) was used to measure the primary outcomes of this study such as Psychological distress. The Kessler Psychological Distress Scale (K10) is a psychological screening tool designed to identify adults with significant levels of psychological distress [34]. (K10) consist 10 questions asking about the frequency of non-specific psychological distress in the past 4weeks. Each 10 item is scored from 1 鈥榥one of the time鈥� to 5 鈥榓ll of the time鈥�. The Scores of the 10 items are then summed, yielding a minimum score of 10 and a maximum score of 50 [34].The measure can screen for distress levels. The Kessler Psychological Distress Scale (K10) scores less than 20 indicate no psychological distress, while 20 and above is classified as has psychological distress. K10 is used to grade psychological distress severity as well [10,11,12,13,14,15,16,17,18,19], mild disorder [20,21,22,23,24], moderate disorder [25,26,27,28,29] and severe disorder [30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]. K10 tool was validated by WHO for use in developing countries [35]. The Amharic version shows good psychometric properties in urban and rural Ethiopia [36, 37]. In a validation study conducted in Ethiopia, the sensitivity and specificity were 84.2% and 77.8%, respectively, with an internal consistency (Cronbach鈥檚 伪鈥�=鈥�0.90) [36].

Social support: was assessed using Oslo Social Support Scale (OSSS-3). This scale consists of three items, with a total score ranging from 3 to 14 [38]. The Oslo 3-item social support scal categorizes individuals into three levels based on their scores: poor social support (3鈥�8 points), moderate social support (9鈥�11 points), and good social support (12鈥�14 points). The reliability of the Oslo 3-Test was adopted in Nigerian adult depression patients, as indicated by strong internal consistency (Cronbach鈥檚 alpha鈥�=鈥�0.91) [39].

Perceived stigma: The level of perceived stigma among caregivers is determined by their scores on a three-item stigma scale. This scale used a four-point Likert scale (ranging from 0 to 3) to assess perceived stigma. A score of 0 indicates no perceived stigma, while a score of 1 or higher signifies the presence of perceived stigma [40].

Intimate partner violence (IPV) refers to instances where caregivers currently or previously in such relationships have experienced sexual, psychological, or physical abuse within the past 12 months [41].

Physical abuse involves responses to survey questions related to various violent acts such as pushing, slapping, punching, and using weapons.

Sexual abuse is experienced when caregivers are forced or pressured into sexual activity without their consent within the last 12 months.

Emotional abuse includes responses to questions about public humiliation, threats towards loved ones, and insults within the last 12 months.

Infant and Young Child Feeding practices were assessed using the IYCF score, a composite measure based on four key indicators: breastfeeding, avoidance of bottle feeding, Diet Diversity Score, and Minimum Feeding Frequency. These indicators were assessed separately for children aged 6鈥�8 months, 9鈥�11 months, and 12鈥�23 months, aligning with WHO recommendations and previous study [42]. Breastfeeding: Infants who were not breastfed at any age received a score of zero (0). Diet diversity was assessed based on consumption of seven food groups within the past 24听h (0鈥�=鈥塶o, 1鈥�=鈥墆es), following WHO鈥檚 IYCF guidelines [42, 43]. Diet Diversity: DDS was calculated based on consumption of seven food groups within 24听h (0鈥�=鈥塶o, 1鈥�=鈥墆es), which ranges from 0 to 7 with a higher score indicating better diet diversity [42, 43]. Feeding frequency was determined by the number of times a child consumed solid, semi-solid, or soft foods in the previous day. This scoring varied based on the child鈥檚 age and breastfeeding status [44].For 6-8-month-old infants and 9-11-month-old children, feeding frequency focused solely on complementary foods, excluding breast milk and formula. A score of +鈥�1 was assigned to infants meeting the lower end of the recommended feeding frequency, while鈥�+鈥�2 was given to those meeting or exceeding the higher end [44]. The scoring system for feeding frequency is as follows: 0鈥�1 feeding per day receives a score of 0, 2 feedings per day receives a score of +鈥�1, and 3 or more feedings per day receives a score of +鈥�2. The final index was calculated by summing the individual scores. Avoidance of Bottle Feeding: A score of +鈥�1 was given if caregivers did not use bottle feeding and 0 for used bottle feeding [45]. The combined IYCF score ranged from 0 to 6 for each age category. Scores were categorized as low (0鈥�2), medium (3鈥�4), and high (4+) based on median values [46].

Anthropometric measurements

Child clinical characteristics and Anthropometric data, including age, weight, height, and mid-upper arm circumference, were collected from the medical records of hospitalized children, specifically those with longer hospital stays who were already receiving nutritional support. But for newly admitted children data were collected using standard measurements. Child length or height was measured to the nearest 0.1听cm using a portable length or stature measuring board. Weight was measured with an electronic balance (UNICEF Seca 770). Children鈥檚 recumbent length (for those under 24 months of age) or standing height (for those 24 months and older) and weight were each measured twice using calibrated equipment and standardized techniques [47]. The measurements were taken to the nearest 0.1听cm or 0.01听kg, with children wearing light clothing and no shoes. A third measurement was taken if the difference between the first two measurements exceeded the allowable difference (100听g for weight, 5听mm for length or height). Children鈥檚 ages were recorded, and their MUAC, BMI, weight, and height were measured using standard anthropometric methods [48]. Malnutrition was assessed using standardized z-scores: Weight-for-height (WHZ) for wasting, height-for-age (HAZ) for stunting, and weight-for-age (WAZ) for underweight. Children with z-scores 鈮� -2 were normal. Those with z-scores between 鈭掆��2 and 鈭掆��3 were mildly underweight, stunted, or wasted. Z-scores below 鈭掆��3 indicated moderate or severe underweight, stunting, or wasting [49, 50]. Children with a BMI-for-age z-score (BAZ) between +鈥�1 and +鈥�2 were classified as risk of overweight, while those with a BAZ greater than +鈥�2 were considered obese [51]. Children with BAZ between +鈥�2 and +鈥�3 were classified as overweight, and those with BAZ greater than +鈥�3 were categorized as obese [52].

Wealth index: The household wealth index is determined using Principal Component Analysis (PCA) [53]. This index is calculated by taking into account a selection of household assets (such as radios, mobile phones, beds, mattresses, kerosene lamps, watches, electric or solar panels, chairs, tables, wooden boxes, and carts), construction materials used in the house (like the uppermost cover, interior roof, floor, and walls categorized by interviewer observations), and the size of agricultural land. The national wealth quintiles are then established. This process includes assigning a score to each household, ranking all individuals in the population based on their scores, and ultimately categorizing households into five wealth quintiles: Poorest (20th percentile), Poor (40th percentile), Medium (60th percentile), Rich (80th percentile), and Richest (>鈥�80th percentile) [54].

Data processing and analysis

The collected data were checked for completeness and consistency. The collected data were entered into Epi Data Version 4.6. Nutritional status of children such as anthropometric data were computed using WHO Anthro version 3.2 and categorized as follows: wasted (Weight-for-height z-score < -3 SD), stunted (height-for-age z-score < -3 SD), and underweight (weight-for-age z-score < -3 SD). Subsequently, the data were exported to SPSS Version 25 for analysis. Descriptive statistics, including frequency tables, percentages, and counts, were used to summarize the characteristics of the study participants and to illustrate the distribution of various variables.

We performed both bi-variable and multivariable analyses to identify factors significantly associated with the primary outcomes of psychological distress. In the Bi-variable analysis, variables with p-values less than 0.25 were considered for candidates for inclusion in the multivariable analysis to control potential confounding factors and variables with p-values less than 0.05 were considered to have a statistically significant association, with a 95% confidence interval. The strength of these associations was assessed and explained by using an adjusted odds ratio. The model鈥檚 fitness was assessed; Hosmer and Lemeshow test value was 0.72. Tolerance and variance inflation factors (VIFs) were also examined to evaluate multicollinearity. This assessment confirmed that the tolerance was 鈮モ��0.263, while the VIF was 鈮も��4.972.

Results

Socio-demographic characteristics of the study participants

In the study, a total of 409 caregivers participated, and the response rate was 96.9%. The mean age of the caregivers was 31鈥壜扁��5.5 years, ranging from 19 to 49 years. Nearly half (47.9%) of the caregivers were aged between 25 and 34 years. More than half (84.4%) of caregivers were female. More than three fourth (77.5%) of caregivers were married. Nearly half (47.2%) of caregivers had formal primary education. More than half (72.6%) of caregivers were unemployed. Nearly half (48.2%) of caregivers had poor socioeconomically status (Table听1).

Table 1 Socio-demographic characteristics of participants among caregivers of children with malnutrition (n鈥�=鈥�409)
Full size table

Psychosocial and clinical characteristics of the participants

Regarding psychosocial aspects of caregivers, nearly half (43.3%) of caregivers had faced intimate partner violence. Nearly half (46%) of the caregivers reported feeling stigmatized due to having undernourished children. About 42.3% of caregivers had Poor social support. A majority (45.5%) of caregivers dissatisfied with their marital relationships. In terms of mental health, about 21.8% of caregivers had a history of mental illness (Table听2).

Table 2 Psychosocial and clinical characteristics of the participants among caregivers of children with malnutrition (n鈥�=鈥�409)
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Anthropometric measurements of children

Regarding child nutritional status, more than three fourth (75.3%) of children were underweight, more than half (62.3%) of children were stunted, and 40.8% of children were wasted and about 68(16.6%) of children were at risk of overweight. About 15.2% of children had acute respiratory infection, and 18.1% had diarrhea. Nearly half (41%) of caregivers had low child feeding practice (Table听3).

Table 3 Anthropometric measurements, child clinical characteristics and child feeding practice among caregivers of children with malnutrition (n鈥�=鈥�409)
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Prevalence and associated factors of psychological distress among caregivers of children with malnutrition

In this study, the prevalence of psychological distress among caregivers of children with malnutrition was 42.5% with (95% CI: 38鈥�47%).

In the multivariable logistic regression analysis, Factors included unemployed, poor economic status, Low child feeding practice, poor social support, child underweight were significantly associated with psychological distress.

Unemployed caregivers had a 3.39 times higher likelihood of experiencing psychological distress compared to employed caregivers (AOR鈥�=鈥�3.39, 95% CI鈥�=鈥�2.14鈥�9.11). Caregivers with low socioeconomic status were 3.31 times more likely to experience psychological distress than those with high socioeconomic status (AOR鈥�=鈥�3.91, 95% CI鈥�=鈥�1.46鈥�9.34). Caregivers with poor child feeding practices were 2.18 times more likely to experience psychological distress than those with high socioeconomic status (AOR鈥�=鈥�2.18, 95% CI鈥�=鈥�1.12鈥�4.21). Caregivers had poor social support were 4.44 times had psychological distress as compared to having strong social support (AOR鈥�=鈥�4.44, 95% CI鈥�=鈥�1.75鈥�11.29). Caregivers facing both physical and emotional abuse had a 3.37 times higher likelihood of developing psychological distress compared to those not experiencing intimate partner violence (AOR鈥�=鈥�3.37, 95% CI鈥�=鈥�1.36鈥�8.35). Caregivers of underweight children were 4.36 times more likely to experience psychological distress than caregivers of non-underweight children (AOR鈥�=鈥�4.36, 95% CI鈥�=鈥�3.94鈥�8.36) (Table听4).

Table 4 Bivariate and multivariate logistic regression model predicting depression among caregivers of children with malnutrition (n鈥�=鈥�409)
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Discussion

In this study the prevalence of Psychological distress was 42.5%. This finding was similar with studies done in Bangladesh 46.2% [55],Lesotho 46.2% [17]. In this study the prevalence of Psychological distress was 42.5%. This finding was similar with studies done in Bangladesh 46.2% [55],Lesotho 46.2% [17]. However, it is lower than the prevalence reported from in Bangladesh 49% [56]. The possible variation might be different using of screening tools and study population. The previous study conducted in Bangladesh a used the Reporting Questionnaire-20, whereas the current study used Kessler Psychological Distress Scale (K-10). The Reporting Questionnaire-20 may have resulted in an overestimation of the prevalence of Psychological Distress when compared to the tool employed in the current study.

In contrast, this finding was higher prevalence than previous study done from in Ethiopia 10.1% [57], Malawi 33.5% [11],Malawi 23.3% [58], India 5.3% [59].The possible discrepancies could be attributed to variations in study settings, screening tools, study population, study setting, and study design. The previous study in Ethiopia was community-based, the current study done in hospital setting that concentrated on severely malnourished children and the hospital setting may be causing emotional stress for caregivers. Another potential reason for these discrepancies in Ethiopia, Malawi, and India might be using different screening tools. The prior study used the Self-Reporting Questionnaire (SRQ)-20, whereas the present study used the Kessler Psychological Distress Scale (K-10).Another possible reason for this discrepancy in Malawi attributed to differences in study design, in Malawi used cohort study design. The extended duration of the study in Malawian may have enabled participants to build up resistance to the negative effects of child malnutrition over time. This cross-sectional study, conducted over a shorter timeframe, limited the ability to comprehensively analyze how coping strategies and resilience evolve over time and influence levels of psychological distress. The single-survey design carries the risk of overestimating the prevalence of psychological distress [11].

The second aim of this study was to identify factors associated with psychological distress. Accordingly, uunemployed caregivers had a 3.39 times higher likelihood of experiencing psychological distress than employed. This finding agrees with a previous study in Ethiopia, Sudan, Bangladesh, India [59,60,61,62,63]. Unemployment is a significant socioeconomic factor that can impact the psychological well-being of caregivers, particularly those with malnourished children [59]. This distress can have negative effect on child development and overall family health. The financial burdens and uncertainties associated with unemployment can significantly induce stress and anxiety in caregivers [64]. These psychological stressors can impair their ability to provide adequate care, leading to further neglect or inadequate feeding practices and Unemployment can lead to social isolation, depriving mothers of support networks and coping mechanisms [65]. This isolation can exacerbate feelings of loneliness, depression, and helplessness, further impacting their ability to care for their children [66].

Caregivers with a lower socioeconomic status were 3.3 times more likely to experience psychological distress when compared to caregivers with a higher socioeconomic status. This is consistent with previous study in Ethiopia, Sudan, Ghana, Kenya, Vietnam, Bangladesh [56, 60, 61, 67, 68]. One potential explanation is that caregivers with lower socioeconomic status (SES) are more likely to experience psychological distress, which may increase their vulnerability to symptoms of psychopathology compared to those with higher SES [69]. Socioeconomic status (SES) is recognized as a factor influencing the health of both caregivers and babies. Lower SES is linked to increased risks of negative maternal and perinatal health outcomes [70].

Caregivers who experienced both Physical and emotional abuse were 3.37 times more likely to develop psychological distress compared those had not any abuse. This is consistent with previous study in Ethiopia, Bangladesh, Malawi; Tanzania [58, 71,72,73]. Experiencing physical abuse can undermine a caregiver鈥檚 sense of control over their own life and their children鈥檚 safety, leading to feelings of helplessness that may contribute to depression and anxiety [74,75,76]. Emotional abuse, including humiliation and threats, can severely damage primary caregivers鈥� self-esteem, making it difficult for them to feel confident and capable [77].

Caregivers with poor social support were 2.6 times more likely to have psychological distress than caregivers with strong social support. This is consistent with previous study in Ethiopia, Uganda, DR Congo, Ghana [62, 78,79,80]. Lack of social support makes individuals more vulnerable to experiencing psychological distress [81]. Inadequate social support is a significant risk factor for poor mental health. It increases vulnerability to psychological distress, including depression and anxiety, and can even contribute to suicidal ideation [82]. Social isolation impairs brain function 81) and exacerbates feelings of loneliness, creating a vicious cycle that hinders the ability to maintain healthy relationships and further deteriorates mental well-being [83, 84].

Caregivers with low child feeding practices were 2.6 times more likely to experience psychological distress than those with good child feeding practices. This is consistent with previous studies in Vietnam, DR Congo [56, 78].There is a well-established connection between poor child feeding practices and increased maternal psychological distress [78, 85]. Maternal distress, stemming from children鈥檚 feeding challenges, can manifest as stress, anxiety, depression, and feelings of inadequacy [86]. Challenges such as food refusal or poor appetite can be incredibly stressful for caregivers, particularly concerning their child鈥檚 growth and development. This can lead to feelings of helplessness and loss of control, exacerbating existing anxieties. The heavy burden of responsibility for their child鈥檚 well-being often leads caregivers to blame themselves for inadequate nutrition or feeding practices, further increasing psychological distress [87].

Caregivers with underweight children were 2.6 times more likely to experience psychological distress compared to caregivers whose children are not underweight. This is consistent with previous study in Vietnam, Pakistani, Australian [56, 88, 89]. Caregivers naturally experience worry and anxiety regarding their child鈥檚 health and development when the child is underweight [89]. Caregivers may worry about their child鈥檚 health and development. This concern can be compounded by self-doubt regarding their parenting abilities. In some cultures, having an underweight child can be stigmatized [90]. These factors can lead to feelings of shame, isolation, and judgment, significantly increasing the mother鈥檚 emotional burden. The presence of an underweight child can disrupt the daily routine of a household, particularly mealtimes. This can lead to increased stress for caregivers, making it difficult to prioritize their own well-being, potentially creating a cyclical pattern of neglect. Stressed primary caregivers may find it challenging to create a calm and supportive feeding environment, potentially hindering the child鈥檚 intake and subsequent weight gain [91]. Caregivers鈥� psychological distress can create a negative cycle. Caregivers鈥� psychological distress further exacerbates feeding difficulties and the child鈥檚 nutritional status.

Limitation

Data on psychological distress were evaluated by asking caregivers to recall their experiences from the four weeks before the survey. This method may lead to either under-reporting or over-reporting of psychological distress symptoms.

The data was gathered via in-person interviews, potentially leading to biases related to social desirability.

Conclusion and recommendations

Psychological distress constitutes a significant public and mental health concern among caregivers of malnourished children. Unemployment, poverty, inadequate feeding practices, insufficient social support, and child underweight emerged as strong predictors of psychological distress. To address this issue, the following interventions are recommended: Implement targeted employment programs to enhance caregivers鈥� financial stability and mitigate psychological stress, Strengthen social support systems through community initiatives and support groups to provide emotional and practical assistance to caregivers, Promote healthy child feeding practices through educational campaigns, counseling sessions, and readily available nutrition resources to enhance child welfare and lessen the burden on caregivers and Develop and implement comprehensive interventions to address child underweight and its contributing factors, thereby directly impacting caregiver well-being. For Researchers: Conduct in-depth qualitative research to understand the experiences, coping mechanisms, and support needs of caregivers, which will inform the development of targeted interventions and conduct longitudinal studies to assess the long-term effects of malnutrition on caregiver mental health and to evaluate the effectiveness of interventions over time.

Data availability

The information provided in the document is available from the author via email at biazinyenealem21@gmail.com upon reasonable request.

Abbreviations

AOR:

adjusted odds ratio

CI:

confidence interval

COR:

crude odds ratio

EPDS:

Edinburgh Postnatal Depression Scale

Epi-Data:

Epidemiological Data

K-10:

Kessler Psychological Distress Scale

LMIC:

low- and middle-income countries

PCA:

Principal Component Analysis

PHQ:

Patient Health Questionnaire

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Acknowledgements

The individuals behind this research express their gratitude to the study participants, data gatherers, supervisors, and members of the pediatric department.

Funding

Not applicable.

Author information

Authors and Affiliations

  1. Department of Psychiatry, College of Health and Medical Science, Dilla University, P.O.BOX: 419, Dilla, Ethiopia

    Biazin Yenealem Mekuriaw,听Endris Seid,听Tadese Teferi听&听Amare Alemwork

  2. Department of Psychiatry, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia

    Berhanie Getnet

  3. Department of Psychiatry, College of Health and Medical Science, Hawassa University, Hawassa, Ethiopia

    Mastewal Aschale听&听Aklile Tsega

Authors
  1. Biazin Yenealem Mekuriaw

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  2. Berhanie Getnet

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  3. Endris Seid

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  4. Tadese Teferi

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  5. Amare Alemwork

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  6. Mastewal Aschale

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  7. Aklile Tsega

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Contributions

BY: conceived the idea developed the proposal and participated in Writing 鈥� original draft, Methodology, Writing review and editing, Supervision, Data curation, Resources, data analysis, Software, Funding acquisition, Validation, wrote the final paper and final review of the manuscript. BG, ES, TT, AA, MA and AT participated in the Data cu ration, Methodology, Supervision, Writing review and editing and revised the subsequent drafts of the paper and were involved in the writing and final review of the manuscript. All the authors read and approved the final manuscript.

Corresponding author

Correspondence to Biazin Yenealem Mekuriaw.

Ethics declarations

Ethics approval and consent to participate

The Institutional Review Board (IRB) of University of Gondar approved the study with protocol number 4094/2023. A formal permission letter was obtained from Department of Psychiatry. Each participant was given a detailed explanation and signed an informed consent form before interviews. All personal information was kept entirely and secret, Privacy and confidentiality were strictly upheld throughout the data collection process. Participants were not forced to participate and were not offered any incentives; participation was voluntary. The collected data was handled and secured by the principal investigator. Participants were informed that the data would be used only for research purposes.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Mekuriaw, B.Y., Getnet, B., Seid, E. et al. Prevalence and associated factors of psychological distress among caregivers of children with malnutrition: a cross鈥憇ectional study. 樱花视频 25, 505 (2025). https://doi.org/10.1186/s12889-025-21692-w

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  • DOI: https://doi.org/10.1186/s12889-025-21692-w

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樱花视频

ISSN: 1471-2458

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