Psychosocial factors included maternal selfreports
of depressive symptoms, parenting stress,
and social support. Depressive symptoms were
assessed using the Center for Epidemiological
Studies Depression Scale (CES-D), a reliable and
well-validated 20-item scale with standard scoring
widely used in research to assess depressive
symptoms in the general population (31). A
dummy variable was created and coded ‘1’ for
mothers scoring 16 or above, the standard cutoff
for identifying individuals at risk of depression
(32). The Chronbach’s alpha for the CES-D in our
sample was 0.89. Parenting stress was measured by
the average score of six items from the Parenting
Stress Index (PSI), a standard measure of perceived
stress in the caregiver role (33). Mothers responded
on a scale from 1 ¼ ‘never’ to 5 ¼ ‘almost
always’ to items such as ‘having too little time to
spend by yourself’ and ‘child gets on your nerves.’
The alpha reliability for this scale in our sample
was 0.76.