Depressive Symptoms and Care Demands Among Primary Caregivers of Young Children with Evidence of Congenital Zika Virus Infection in Brazil.

The study did not confirm temporal or causal relationships, so it cannot show that child developmental delay or difficulty covering basic expenses caused caregiver depression. The PHQ-9 and ASQ-3 are screening tools, not diagnostic assessments, so a score does not confirm depression or developmental delay. A caregiver with depressive symptoms may have more negative perceptions about the child, which could lower ASQ-3 scores. The ASQ-3 used a nonstandard administration protocol based on child functioning rather than chronological age, and this protocol has not yet been validated. The PHQ-9 was read aloud, which included caregivers with varied literacy but could increase social desirability bias. The sample was limited to families in two northeastern Brazilian states, mostly mothers, with low household income, and response rates were 44.7% in Paraíba and 55.8% in Ceará. Some children had probable or clinical evidence of congenital Zika rather than confirmed laboratory infection. The delay group combined all five ASQ-3 domains, so children with fine motor, communication, problem-solving, personal-social, or gross motor delay were not separated. The path analysis model only explained part of the variation in depression scores.

The authors declared no conflict of interest. The investigation was a collaboration between the Brazilian Ministry of Health, the State Health Secretariats of Paraíba and Ceará, and the US Centers for Disease Control and Prevention.

Do not conclude that respite care or financial support will reduce caregiver depression. The study did not test these supports, the PHQ-9 and ASQ-3 were screening tools rather than diagnostic assessments, and the direct association between developmental delay and depression was not significant.