Prevalence and determinants of antenatal depression in Ethiopia: A systematic review and meta-analysis

Social and obstetric risk factors of antenatal depression: A cross-sectional study in China

BACKGROUND

Antenatal depression is a disabling mental disorder among pregnant women and may cause adverse outcomes for both the mother and the offspring. Early identification and intervention of antenatal depression can help to prevent adverse outcomes. However, there have been few population-based studies focusing on the association of social and obstetric risk factors with antenatal depression in China.

AIM

To assess the sociodemographic and obstetric factors of antenatal depression and compare the network structure of depressive symptoms across different risk levels based on a large Chinese population.

METHODS

The cross-sectional survey was conducted in Shenzhen, China from 2020 to 2024. Antenatal depression was assessed using the Chinese version of the Edinburgh Postnatal Depression Scale (EPDS), with a score of ≥ 13 indicating the presence of probable antenatal depression. The χ 2 test and binary logistic regression were used to identify the factors associated with antenatal depression. Network analyses were conducted to investigate the structure of depressive symptoms across groups with different risk levels.

RESULTS

Among the 44220 pregnant women, the prevalence of probable antenatal depression was 4.4%. An age ≤ 24 years, a lower level of education (≤ 12 years), low or moderate economic status, having a history of mental disorders, being in the first trimester, being a primipara, unplanned pregnancy, and pregnancy without pre-pregnancy screening were found to be associated with antenatal depression (all P < 0.05). Depressive symptom networks across groups with different risk levels revealed robust interconnections between symptoms. EPDS8 ("sad or miserable") and EPDS4 ("anxious or worried") showed the highest nodal strength across groups with different risk levels.

CONCLUSION

This study suggested that the prevalence of antenatal depression was 4.4%. Several social and obstetric factors were identified as risk factors for antenatal depression. EPDS8 ("sad or miserable") and EPDS4 ("anxious or worried") are pivotal targets for clinical intervention to alleviate the burden of antenatal depression. Early identification of high-risk groups is crucial for the development and implementation of intervention strategies to improve the overall quality of life for pregnant women.

Experiences of intimate partner violence and antepartum depression among women seeking antenatal care in Addis Ababa, Ethiopia: findings from the MISPOD study

Despite the high prevalence of intimate partner violence (IPV) and antepartum depression, there is limited evidence on the association between the two in Ethiopia. We aimed to investigate the association between experience of IPV during and before pregnancy and depression in the third trimester of pregnancy. We surveyed women attending antenatal care clinics in 22 selected health facilities in Addis Ababa in the third trimester of pregnancy. We used a 12-item tool to measure IPV and the Edinburgh Postnatal Depression Scale (EDPS) to measure antepartum depression. We performed multivariable logistic regression analysis to determine the association between IPV and antepartum depression. Of the 399 women included, 14.5% (95% CI: 11.3-18.5%) had symptoms suggestive of antepartum depression (EDPS score ≥ 11) and 31.6% (95% CI: 27.1-36.4%) had recently experienced some form of IPV. The adjusted odds of antepartum depression was 2.24 higher among women who had experienced IPV compared to those who had not (95% CI: 1.11-4.54). Antepartum depression was higher among women aged 15-24 compared to those aged 25-34 (AOR = 2.76, 95% CI: 1.05, 7.23), women with low maternal social support compared to those with adequate support (AOR = 7.04, 95% CI: 2.07, 23.97), and women who worried very often about feeding their family compared to those who did not worry at all (AOR = 8.95, 95% CI: 3.09, 25.94). The findings highlight the need for integrated and tailored interventions to mitigate IPV and antepartum depression to address the needs of adolescent and young women, and those living in poverty or lacking social support.

Feasibility of Modified Mindfulness Training Program for Antenatal Depression and Perceived Stress Among Expectant Mothers with Male Child Preference

Background/Objectives: Antenatal depression and perceived stress are prevalent mental health challenges faced by pregnant women, and they are associated with male child preference. This study aimed to assess the feasibility of a modified mindfulness training program for reducing antenatal depression and perceived stress levels among expectant mothers with a male child preference at a public sector tertiary care hospital in Karachi, Pakistan. Material and Methods: The present feasibility trial was conducted among expectant mothers with antenatal depression and perceived stress with a male child preference using the ADAPT-ITT framework. Assessments of the needs and experiences of the new target population were carried out through an exploratory and descriptive qualitative study. In-depth interviews were conducted using a semi-structured interview guide and analyzed using a thematic analysis process. Repeated-measures MANOVA was employed to investigate the effect of time on antenatal depression and perceived stress scores in the feasibility of the intervention. Results: Five major themes emerged from the qualitative data. A significant influence of time was established on the antenatal depression scores, with perceived scores of F (2, 326) = 21.244, p < 0.001, and F (2, 326) = 310.748, p < 0.001. The antenatal depression scores significantly decreased from pre-intervention to post-intervention (mean difference = 4.00, p < 0.001), and there was a slightly significant decline from post-intervention to follow-up (mean difference = 1.167, p = 0.001). The perceived stress scores were significantly reduced from pre-intervention to post-intervention (mean difference = 10.214, p < 0.001), and there was a minor but significant decline from post-intervention to follow-up (mean difference = 0.333, p = 0.043). Conclusions: This study concludes that the modified mindfulness training program is a culturally suitable, contextually relevant intervention in the context of Pakistan and it significantly reduced antenatal depression and perceived stress in expectant mothers with a male child preference. The modified mindfulness training program was modified in accordance with the context of Islamic teaching regarding health-promoting lifestyles and religious spirituality.

Antenatal depression among pregnant women in Ethiopia: An umbrella review

INTRODUCTION

Antenatal depression, ranging from mild to severe, is influenced by hormonal changes during pregnancy and childbearing years, making it a significant public health issue. Antenatal depression, with its far-reaching effects on mothers, infants, and children, continues to be a significant public health issue in developing countries such as Ethiopia. Research on antenatal depression in Ethiopia has produced varied results. Although previous systematic reviews and meta-analyses studies have addressed this topic, a comprehensive summary of existing reviews has not been available. Therefore, this umbrella review aims to consolidate the findings on antenatal depression and associated factors among pregnant women in Ethiopia.

METHODS

This review included five systematic reviews and meta-analyses from various databases, including PubMed, PsycINFO, Research4life, CINHALE and Science Direct. Only reviews published between January 1, 2010, and July 30, 2024, were considered. The search, conducted from August 5 to 15, 2024, used CoCoPop questions and included only English-language reviews. Study quality was assessed with the AMSTAR tool, and data extraction and analysis were performed using Microsoft Excel 2016 and STATA 14.0. The I2 and Cochran's Q tests were used to assess heterogeneity. Pooled effect sizes were calculated based on the pooled prevalence of antenatal depression and odds ratios for associated factors, with a 95% confidence interval indicating statistical significance.

RESULTS

This umbrella review encompassed 50 primary studies from five systematic reviews and meta-analyses, involving a total of 25,233 pregnant women. The pooled prevalence of antenatal depression in Ethiopia was found to be 24.60% (95% CI: 22.46-26.73). Significant associations were identified between antenatal depression and several factors: unplanned pregnancy (POR = 2.29; 95% CI: 1.75, 2.82), poor social support (POR = 2.10; 95% CI: 1.37, 2.84), history of abortion (POR = 2.49; 95% CI: 1.64, 3.34), history of depression (POR = 3.57; 95% CI: 2.43, 4.71), and history of obstetric complications (POR = 2.94; 95% CI: 1.61, 4.28).

CONCLUSIONS

The significant prevalence of antenatal depression (24.60%) among pregnant women in Ethiopia is closely linked to factors such as unplanned pregnancy, poor social support, history of abortion, previous depression, and obstetric complications. To tackle this issue, it is recommended to enhance social support networks, increase access to family planning services to minimize unplanned pregnancies, conduct regular mental health screenings, and incorporate mental health services into antenatal care.

Depression and anxiety among pregnant women during COVID 19 pandemic in Ethiopia: a systematic review and meta-analysis

Background

Coronavirus Disease-19 pandemic had an adverse impact on the mental health of the public worldwide, but the problem is worst among pregnant women due to social distancing policies and mandatory lockdown, including prenatal care services. As a result, the prevalence of depression and anxiety could increase during the pandemic, particularly among pregnant women. Thus, the purpose of this review is to determine the magnitude of depression and anxiety and contributing factors among pregnant women during the pandemic in Ethiopia.

Methods

Web of Science, Since Direct, PubMed, Google Scholar, and African Journals Online were the electronic databases searched, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines were followed in this review. The Newcastle-Ottawa Critical Appraisal Checklist was used to assess the quality of the included studies. A predefined data extraction sheet developed in Excel was used to extract the data. The pooled prevalence of anxiety and depression was determined by a random effect model meta-analysis.

Results

4,269 and 1,672 pregnant women were involved in depression and anxiety studies, respectively. The pooled prevalence of depression and anxiety among pregnant women during the COVID-19 pandemic in Ethiopia was 24.7% (95% CI: 18.52-30.87) and 35.19% (95% CI: 26.83-43.55), respectively. Single marital status (AOR = 2.22, 95% CI: 1.07-3.37), poor social support (AOR = 2.7, 95% CI: 1.06-4.35), unplanned pregnancies (AOR = 2.17, 95% CI: 1.34-3.0), and unsatisfied marital status (AOR = 2.16, 95% CI: 1.17-3.14) were risk factors for depression. Violence against intimate partners (AOR = 2.87, 95% CI: 1.97-3.77) and poor social support (AOR = 1.98, 95% CI: 1.24-2.71) were risk factors for anxiety.

Conclusion

One-fourth and nearly one-third of pregnant women had depression and anxiety, respectively, during COVID-19 pandemic in Ethiopia. Single or unsatisfied marital status and unplanned pregnancies were risk factors for depression. Poor social support was significantly associated with depression and anxiety. Pregnant women who experienced violence against intimate partners had higher anxiety. After COVID-19 pandemic, mental health interventions are essential for reducing depression and anxiety.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=527148, PROSPERO (CRD42024527148).

Effectiveness of group-based psycho-education on preventing postpartum depression among pregnant women by primary healthcare provider in primary healthcare institution: a cluster-randomized controlled trial

Background

In Ethiopia, one in five mothers suffers from postpartum depression, which needs to be prevented through interventions. According to the World Health Organization, maternal healthcare providers have a unique opportunity to provide psychosocial interventions to prevent the damaging effects of perinatal depression. Hence, this study assessed the effectiveness of prenatal group-based psycho-education in preventing postpartum depression (PPD) in primary healthcare units.

Methods

We conducted a two-arm cluster-randomized controlled trial, enrolling 550 pregnant women at 12-20 weeks of gestation with a normal score (0-4) and a mild score (5-9) on the Patient Health Questionnaire-9 (PHQ-9). The study utilized simple randomization techniques to assign clusters between arms in a 1:1 ratio. The data was collected through face-to-face interviews conducted at 12-20 weeks of gestation and 6 weeks postpartum. The intervention group received usual care plus five prenatal group-based psycho-education (PGBPE) classes, while the control group received only usual care. The PPD status between arms was compared using the chi-square test of association. A mixed-effects multilevel logistic regression model was also used to examine the predictors of the outcome variables.

Results

The overall response rate at the end line was 92.9%. Thus, compared to that in controls, the PPD in the intervention clusters was considerably lower (20 (7.6%) vs. 74 (28.9%)), P = 0.001)/65% (AOR = 0.35, 95% CI = 0.13-0.99), although no difference was detected at baseline. Social support (AOR = 0.04, 95% CI = 0.01-0.15), partner emotional support (AOR = 0.24, 95% CI = 0.12-0.51), PPD literacy (AOR = 0.25, 95% CI = 0.11-0.62), and self-esteem (AOR = 0.22, 95% CI = 0.11-0.47) were more likely to protect mothers from PPD. On the contrary, domestic work (AOR = 9.75, 95% CI = 3.37-28.16), neonates with complications (AOR = 5.79, 95% CI = 2.04-16.45), and unhealthy coping (AOR = 2.39, 95% CI = 1.06-5.42) exposed mothers to PPD.

Conclusion

The implementation of a PGBPE in primary healthcare units (PHCUs) was effective at preventing PPD. Therefore, this intervention method has to be promoted and used in PHCUs to prevent PPD.

Clinical Trial Registration

[Pan African Clinical Trial Registry], identifier [PACTR 202203616584913].

The prevalence of depression in women with pregnancy-related pelvic girdle pain: A systematic review and meta-analysis

Background and Aims

Pregnancy-related pelvic girdle pain (PPGP) is estimated to affect between 20% and 70% of pregnant women with 10% experiencing it for more than 3 months postpartum. Women may also experience depression during this period. Understanding the prevalence of depression in women with PPGP is important to inform clinical management. This systematic review aimed to examine the prevalence of depression in women with PPGP in the antepartum and postpartum periods.

Methods

A systematic review and meta-analysis. Seven databases were searched from inception until May 24, 2023, combining keywords relating to pelvic girdle pain (PGP), depression, and pregnancy. Two investigators independently screened study titles and abstracts against the eligibility criteria, extracting data characteristics of all included studies. Included articles were assessed for risk of bias. Summary estimates of the prevalence of depression were calculated with a random effects meta-analysis (stratified by antepartum and postpartum periods).

Results

Eleven studies (3172 participants) were included with nine suitable for meta-analysis. The overall summary estimate of prevalence of depression among women with PPGP was 24% (95% confidence interval [CI] = 15%-37%), with significant heterogeneity between studies (I 2 = 97%, p < 0.01). Among individual studies, the estimates ranged from 18% to 48% in the antepartum PGP population and from 5% to 39% in the postpartum PGP population. The summary estimate in the antepartum group was 37% (95% CI = 19%-59%; prediction interval 8%-81%) and 15% (95% CI = 7%-30%; prediction interval 3%-56%) in the postpartum group, although time (antepartum vs. postpartum) did not have a statistically significant moderating effect (p = 0.06). Two thirds of the studies were undertaken with Scandinavian populations, limiting the generalizability of these findings.

Conclusion

Summary estimates for the prevalence of depression in women with PPGP are similar to previous studies investigating depression in the general peri-natal population.

Food insecurity and perinatal depression among pregnant women in BUNMAP cohort in Ethiopia: a structural equation modelling

OBJECTIVE

To assess the effect of food insecurity on perinatal depression in rural Ethiopia.

DESIGN

We used a prospective cohort in which food insecurity was considered as primary exposure and perinatal depression as an outcome. Food insecurity at baseline (in the period of 8-24 weeks of pregnancy) was measured using the Household Food Insecurity Access Scale (HFIAS), and perinatal depression at follow-up (in 32-36 weeks of pregnancy) was measured using a Patient Health Questionnaire (PHQ-9). We used multivariable regression to assess the effect of food insecurity on the prevalence of perinatal depression. We explored food insecurity's direct and indirect impacts on perinatal depression using structural equation modelling (SEM).

SETTING

This paper used data from the Butajira Nutrition, Mental Health and Pregnancy (BUNMAP) cohort established under the Butajira Health and Demographic Surveillance Site (BHDSS).

PARTICIPANTS

Seven hundred and fifty-five pregnant women.

RESULTS

Among the study participants, 50 % were food-insecure, and about one-third were depressed at 32-36 follow-up. In SEM, higher values of baseline food insecurity, depressive symptoms and state-trait anxiety (STA) were positively and significantly associated with perinatal depression. The direct impact of food insecurity on perinatal depression accounts for 42 % of the total effect, and the rest accounted for the indirect effect through baseline depression (42 %) and STA (16 %).

CONCLUSION

The significant effect of food insecurity at baseline on perinatal depression and the indirect effect of baseline food insecurity through baseline anxiety and depression in the current study implies the importance of tailored interventions for pregnant women that consider food insecurity and psychosocial problems.

Association between dietary intake and symptoms of depression and anxiety in pregnant women: Evidence from a community-based observational study

Dietary intake is considered as a crucial factor affecting mental health symptoms, particularly depression and anxiety symptoms, especially in the case of pregnant women. This study explored the role of dietary intake in depression and anxiety symptoms of pregnant women and provided evidence for primary care interventions. We enrolled 806 pregnant women in their third trimester from 14 communities in Hengyang City, Hunan Province, China, from July 2019 to September 2019. The Chinese version of the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder questionnaire-7 (GAD-7) were used to assess depression and anxiety symptoms. Dietary intake, demographic characteristics, BMI, and pregnancy characteristics were collected using a self-designed, structural questionnaire. A covariate-adjusted logistic regression was conducted to examine the relationship between mental health symptoms and dietary intake. The prevalence of anxiety and depression symptoms in our population were 7.7% (95% CI: 5.9%-9.5%) and 9.2% (95% CI: 7.2%-11.2%), respectively. Women consuming eggs and egg products once a week (OR: 3.688, 95% CI: 1.476-9.215) were more likely to have depression symptom than consumed eggs and egg products once or more per day. Consuming green leafy vegetable <2-3 times per month had a significantly greater risk for depression symptoms than consuming the same once or more per day (OR: 3.450, 95% CI: 1.145-10.393). Women who consumed eggs and egg products 2-3 times a week had an increased likelihood of experiencing anxiety symptoms (OR: 2.253, 95% CI: 1.049-4.837). Anxiety symptoms in women consuming green leafy vegetables <2-3 times per month probably increased by 3.988 times (95% CI: 1.327-11.985) compared with women consuming the same once or more per day. Consuming salted and smoked food <2-3 times per month was protective against anxiety symptoms (OR: 0.181, 95% CI: 0.040-0.828) than consuming the same every day. Implementing interventions to promote healthy dietary among pregnant women is crucial due to its association with mental health. However, future researches are warranted to confirm the reliability and causal association obtained in this study.

Women's experiences of social support during pregnancy: a qualitative systematic review

BACKGROUND

Social support during pregnancy can alleviate emotional and physical pressures, improving the well-being of mother and child. Understanding women's lived experiences and perceptions of social support during pregnancy is imperative to better support women. This systematic review explores and synthesises the qualitative research on women's experiences of social support during pregnancy.

METHODS

Databases PubMed, CINAHL, MEDLINE, APA PsycInfo and Scopus were searched with no year limit. Eligible studies included pregnant women or women who were up to one year postpartum and were assessed on their experiences of social support during pregnancy. The data were synthesised using the thematic synthesis approach.

RESULTS

Fourteen studies were included with data from 571 participating women across ten countries; two studies used focus groups, and 12 used interviews to collect their data. Four main themes were developed ('a variety of emotional support', 'tangible and intangible instrumental support', 'traditional rituals and spiritual support', and 'the all-encompassing natal home'), and six sub-themes ('female network connections', 'care and affection from the husband', 'dissatisfaction with relationships', 'financial support from the husband and family', 'practical support from family and friends', 'health information support').

CONCLUSIONS

This systematic review sheds light on women's experiences of social support during pregnancy. The results indicate a broad variety of emotional support experienced and valued by pregnant women from different sources. Additionally, women expressed satisfaction and dissatisfaction with tangible and intangible support forms. It was also highlighted that spirituality played an essential role in reducing stress and offering coping mechanisms for some, whereas spirituality increased stress levels for others.

Prevalence and correlates of perinatal depression

PURPOSE

This systematic review of systematic reviews aims to provide the first global picture of the prevalence and correlates of perinatal depression, and to explore the commonalities and discrepancies of the literature.

METHODS

Seven databases were searched from inception until April 2022. Full-text screening and data extraction were performed independently by two researchers and the AMSTAR tool was used to assess the methodological quality.

RESULTS

128 systematic reviews were included in the analysis. Mean overall prevalence of perinatal depression, antenatal depression and postnatal depression was 26.3%, 28.5% and 27.6%, respectively. Mean prevalence was significantly higher (27.4%; SD = 12.6) in studies using self-reported measures compared with structured interviews (17.0%, SD = 4.5; d = 1.0) and among potentially vulnerable populations (32.5%; SD = 16.7, e.g. HIV-infected African women) compared to the general population (24.5%; SD = 8.1; d = 0.6). Personal history of mental illness, experiencing stressful life events, lack of social support, lifetime history of abuse, marital conflicts, maternity blues, child care stress, chronic physical health conditions, preeclampsia, gestational diabetes mellitus, being exposed to second-hand smoke and sleep disturbance were among the major correlates of perinatal depression.

CONCLUSION

Although the included systematic reviews were all of medium-high quality, improvements in the quality of primary research in this area should be encouraged. The standardisation of perinatal depression assessment, diagnosis and measurement, the implementation of longitudinal designs in studies, inclusions of samples that better represent the population and better control of potentially confounding variables are encouraged.

Examining maternal depression, birthweight and linear growth: Findings from the South African National Income Dynamics Study

Background. Literature is inconclusive regarding an association between maternal depression, low birthweight (LBW) and stunting in early childhood. While some studies have found an association, others have not. Maternal food insecurity is a risk factor for both maternal depression and reduced linear growth in early childhood.  Objective. This study examined the relationship between maternal depression, food insecurity, LBW and stunting in the first five years of life. The study employed longitudinal data of South African women and children from the National Income Dynamics Study (NIDS).  Methods. Mothers were classified into four groups: food insecure and depressed; food insecure only; depressed only; and neither food insecure nor depressed. During data collection, 22% of women were pregnant and the remaining 78% were pre-conception. The primary outcomes were low birthweight and height-for-age (HAZ) scores. Generalised Linear Mixed Effects (GLME) models were used to account for women having more than one child. GLME models with a Gaussian link function were used to compare mean differences in birthweight and HAZ scores. Multivariable regression models were used to examine factors associated with depression.  Results. Food insecurity was significantly associated with depression among pre-conceptional and pregnant women. There was no statistically significant difference in birthweight or linear growth across groups, but this may be influenced by proximity of depression measurement in relation to outcomes.  Conclusion. Food insecurity is a potentially modifiable risk factor for depression and may be a confounding factor in studies that have found associations between depression and child health outcomes. 

Understanding Healthcare Professionals' Knowledge on Perinatal Depression among Women in a Tertiary Hospital in Ghana: A Qualitative Study

Health conditions affecting women in the perinatal period still account for a major contribution to disease burden in Sub-Saharan Africa, yet there is a dearth of empirical research to understanding health professionals' perspective on their experiences and how they care for perinatal women in depression. We used a qualitative exploratory descriptive approach through a face- to face-interview to explore the knowledge of 11 health professionals of Komfo Anokye Teaching Hospital, Kumasi- Ghana. Interviews were taped recorded and transcribed verbatim. The study adopted Haase's modification of Colaizzi's method for the analysis. Four main themes emerged: ineffective communication (Referral lapses among care providers, long waiting time, lack of confidentiality), workload (Inefficient staff to meet perinatal women's need, no screening tools and time constraints), Reaction to patients symptoms (Identifying patient's symptoms, assessment through patient's centeredness and Education and counselling). Our results emerged that time constraints, stigmatization and lack of awareness delayed the care and management of perinatal depression among healthcare professionals in the hospital setting. There is the need to improve healthcare professionals' knowledge on perinatal depression and it is imperative for the hospital administrators to invest in continuous training and professional development for healthcare professionals.

Antenatal depression and its associated factors among women of Godawari Municipality, Lalitpur, Nepal: a cross-sectional study

OBJECTIVES

To estimate the prevalence of antenatal depression and identify its associated factors among pregnant women of Godawari Municipality, Lalitpur, Nepal.

DESIGN

Community-based cross-sectional study.

SETTING

Godawari Municipality, Lalitpur, Nepal, between September and November 2021.

PARTICIPANTS

250 randomly selected pregnant women of Godawari Municipality, Lalitpur, Nepal.

MAIN OUTCOME MEASURES

The level of antenatal depression was assessed using Edinburgh Postnatal Depression Scale. χ² test and multivariate logistic regression analysis were applied to determine the association between antenatal depression and related variables at 95% level of confidence.

RESULTS

The prevalence of antenatal depression was found to be 24.8% (95% CI: 19.2 to 30.7). Multigravida (AOR: 2.219, 95% CI: 1.113 to 4.423), unintended pregnancy (AOR: 2.547, 95% CI: 1.204 to 5.388), male sex preference of child by family (AOR: 2.531, 95% CI: 1.204 to 5.321) and intimate partner violence (AOR: 2.276, 95% CI: 1.116 to 4.640) were found to be the positive predictors of antenatal depression.

CONCLUSION

This study showed a high prevalence of depression among pregnant women. The results suggest a need for mental health assessment during pregnancy. Screening for depression should be part of routine antenatal checkups for early detection and management of mental health concerns during this vulnerable period.

Altered activities of CYP1A1 and CYP19A1 enzymes in women using SSRI medication during pregnancy

INTRODUCTION

Selective serotonin reuptake inhibitors (SSRIs) are commonly used medication for the treatment of depression during pregnancy. Their use may affect various biological molecules such as enzymes which regulate placental hormonal production and xenobiotic metabolism. Our aim was to investigate the effect of maternal SSRI use on activities of three placental enzymes.

METHODS

We analyzed activities of xenobiotic metabolism enzymes cytochrome P450 1A1 (CYP1A1), aromatase (CYP19A1), and glutathione-S-transferase (GST) from placental microsomal and cytosolic subcellular fractions. Term placentas were collected from 47 SSRI users and 49 control women participating Kuopio Birth cohort (KuBiCo) during the years 2013-2015. Among SSRI users, escitalopram was the most widely used SSRI medication.

RESULTS

The mean enzyme activities of all studied enzymes were lower in SSRI users compared to controls. A statistically significant difference was observed in the enzyme activities of CYP19A1 (p = 0.001) and CYP1A1 (p = 0.002) between the study groups after adjusting for use of additional medication, gestational diabetes, sex of the newborn and gestational weeks at delivery. SSRI use had no significant effect on placental GST enzyme activity.

DISCUSSION

Our results indicate that SSRI medication alters placental enzyme activities. This may lead disturbances in maternal steroid hormone balance as well as in xenobiotic metabolism and may provide risk for both developing fetus and pregnant women.

Trimester-specific association of perceived indoor air quality with antenatal depression: China Medical University Birth Cohort Study

Antenatal depression is associated with adverse birth and long-term outcomes for mothers and children. Pregnant women spend 90% of time indoors; however, the association between indoor air quality and risk of antenatal depression has not been established. In this study, we aim to determine the total and trimester-specific association of perceived indoor air quality (PIAQ) with antenatal depression. A total of 2166 pregnant women were enrolled during the first trimester and evaluated during the second and third trimesters in the China Medical University Birth Cohort Study, a prospective pre-birth cohort study in northeastern China. PIAQ scores were obtained during each of three trimesters, which a higher score indicated a worse indoor air quality. Antenatal depression was screened using an Edinburgh Postnatal Depression Scale (EPDS) and defined as an EPDS score ≥ 9. Prevalence of antenatal depression was 26.7%, 20.6%, and 20.9% during the first, second, and third trimesters, respectively. A higher PIAQ score was positively associated with a depression score throughout pregnancy (β = 0.27, 95% CI = 0.15-0.39). Trimester-specific adverse PIAQ exposure was associated with a higher depression score in the same trimester, but not with a higher score in a subsequent trimester. A dose-response pattern and incremental increases in risk of depression were observed with calculated adverse PIAQ exposures across all three trimesters, with the highest risk (OR = 3.24; 95% CI = 2.28-4.78) among women with adverse PIAQ across all three trimesters. The hazardous association between adverse PIAQ exposure and risk of depression were less pronounced among women with higher physical activity levels (P for interaction < 0.001). The results of present study provided important evidence that pregnant women's mental health was linked to indoor air quality during pregnancy. These findings could be helpful in the development of guidelines to prevent antenatal depression by improving indoor air quality.

Effects of the Covid-19 Pandemic on the Prevalence of Insomnia, Anxiety, and Depression During Pregnancy: A Systematic Review and Meta-Analysis

This systematic review and meta-analysis study aims to determine the effects of the Covid-19 pandemic on the prevalence of insomnia, anxiety, and depression symptoms during pregnancy. Reviews were done through PubMed, EBSCO (Medline, CINAHL), Embase (OVID), Web of Science, PsycINFO, TR Index, Turkish Thesis Center databases using (pregnancy OR pregnant) and (sleep OR sleep disorders OR insomnia), and (anxiety OR depression) keywords between April and May 2021. The meta-analysis included 48 articles (sample: 77,299). It was found that the Covid-19 pandemic did not affect the prevalence of depression symptoms and anxiety during pregnancy, but it increased insomnia. While insomnia ratio was reported 39.6% (95% CI: 0.253-0.560) in the studies conducted before the pandemic, it was reported 88.8% (95% CI: 0.821-0.921) in the studies conducted during the pandemic. This study found that the Covid-19 pandemic did not have effects on depression symptoms and anxiety, but it increased insomnia complaints.

Sleep quality and associated factors among pregnant women attending antenatal care unit at Gondar, Ethiopia: a cross-sectional study

OBJECTIVE

This study aimed to determine the prevalence and associated factors of poor sleep quality among pregnant women in Ethiopia.

METHOD

Institutional based cross-sectional study.

SETTING

University of Gondar Comprehensive Specialized Hospital, Gondar, Ethiopia.

PARTICIPANTS

A total of 415 pregnant women were recruited by using a systematic random sampling technique from 28 April 2020 to 12 June 2020.

MEASUREMENT

The desired data were collected through face-to-face interview technique by using validated questionnaires such as the Pittsburgh Sleep Quality Index, Edinburgh Postnatal Depression Scale, Perceived Stress Scale, Oslo-3 and Abuse Assessment Screen. The data were analysed by using SPSS V.20. Logistic regression analysis was used to identify associated factors with poor sleep quality. Variables having a p value of less than 0.2 in the bivariate analysis were entered to the multivariable logistic regression. A p value of less than 0.05 was considered statistically significant, at 95% CI.

RESULT

In this study, 175 (42.2%) pregnant women had poor sleep quality. According to multivariable logistic regression, being first and third trimesters of gestational age (adjusted OR (aOR) 2.31, 95% CI 1.16 to 4.61 and aOR 3.45, 95% CI 2.05 to 5.79, respectively), consumption of caffeinated substances (aOR 2.96, 95% CI 1.68 to 5.52), having depression (aOR 2.12, 95% CI 1.19 to 3.76), having high perceived stress (aOR 5.39, 95% CI 1.96 to 14.79) and experience of intimate partner violence (aOR 5.57, 95% CI 2.19 to 14.68) were positive significant associated factors with poor sleep quality.

CONCLUSION AND RECOMMENDATION

The prevalence of poor sleep quality among pregnant women was relatively high. First and third trimesters, consumption of caffeinated substances, antenatal depression, high perceived stress and intimate partner violence were factors significantly associated with poor sleep quality. This result suggests that all pregnant women should be screened and treated for poor sleep quality during the first and third trimesters.

Prevalence and factors associated with maternal loneliness during the postpartum period in Gondar city

Background

Mental health problems have increased worldwide, particularly in developing countries. Currently, loneliness is widely understood as a painful subjective experience when the social connections a person has do not meet their interpersonal needs in respect to the quality or quantity of friendship or social interaction. It has been linked to unpleasant health consequences for both the mother and child. Therefore, this study aimed to assess maternal loneliness during the postpartum period and associated factors in Gondar city.

Methods

A community-based cross-sectional study was conducted from July 1^st to August 30^th, 2021 in Gondar city. A cluster sampling technique was employed to select 858 postpartum women. Data were entered into epidemiological data (EPI data) version 4.6 and exported to SPSS 25 for further cleaning and analysis. The multivariable logistic regression analysis was fitted to identify factors associated with maternal loneliness during the postpartum period. The adjusted odds ratio (AOR) with its 95 % confidence interval (CI) was performed and the level of significance was claimed based on a p-value of ≤0.05.

Results

A total of 858 women were included in the analysis, giving a response rate of 98.4%. Two-fifths (40.9%) of the study participants have experienced loneliness during the postpartum period (95% CI: 37.6, 44.2). Low household decision-making power (AOR = 11.2; 95% CI: 7.59, 16.4) and poor social support (AOR = 2.44; 95 CI: 1.58, 3.76) were significantly associated with maternal loneliness.

Conclusion

In this study, 4 out of 10 women have experienced loneliness during the postpartum period. Thus, it highlights the potential risks of the mother’s loneliness on her postnatal well-being, particularly if the woman has poor social support and low household decision-making power. Encouraging women to be involved in all aspects of the household decision-making and promoting the need for social support for all women during the postpartum period may be optimal initial targets to reduce the impact of loneliness.

The magnitude and determinants of depressive symptoms amongst women in early pregnancy in Southern Nigeria: A cross-sectional study

Background

Antenatal depression (AD) is prevalent and associated with adverse pregnancy, maternal and child outcomes, yet no study has addressed its magnitude and predictors in early pregnancy in Nigeria.

Aim

To determine the prevalence and factors associated with AD in first half of pregnancy.

Setting

Multicentric health facilities in Southern Nigeria.

Methods

A multicentric health-facilities-based cross-sectional study was conducted from January to July 2018. Using pretested structure interviewer-administered questionnaires, antenatal depressive symptoms were assessed amongst 511 pregnant mothers with the Edinburg Postnatal Depressive Scale tool. Socio-demographic, socio-economic, clinical, family and social factors were also measured. Descriptive statistics, bivariate and multivariable logistic regression analyses were employed to describe and identify factors associated with AD.

Results

The prevalence of antenatal depressive symptoms in early pregnancy in this study was 29.4% (95% confidence interval [CI] 26.6–32.9). Factors independently associated with AD were intimate partner violence (adjusted odds ratios [AOR] = 8.10, 95% CI 5.00–13.14), marital dissatisfaction (AOR 5.48, 95% CI 3.48–8.38), poor social support (AOR 4.70; 95% CI 2.99–7.38), past history of depression (AOR 4.67; 95% CI 2.47–8.80), previous pregnancy complication (AOR 2.50, 95% CI 1.57–3.89), low socio-economic status (AOR 2.41, 95% CI 1.61–3.66) and unplanned pregnancy (AOR 2.35, 95% CI 1.47–3.64).

Conclusions

The prevalence of antenatal depression is high with modifiable risk factors requiring context-specific policies such as provision of family, social and economic support for mothers at the earliest possible contact in the antenatal period.

Prevalence and associated factors of suicidal behavior among pregnant mothers in southern Ethiopia: a cross-sectional study

Background

Suicidal behavior among pregnant mothers is one of the most common psychiatric emergencies that require a major public health concern by researchers and mental health task forces. Pregnant mothers experience suicidal attempt, which is a fatal problem to end life. Therefore, there was a need to assess the prevalence and associated factors of suicidal behavior among pregnant mothers to integrate mental health care, particularly suicide, with maternal management.

Methods

A cross-sectional study was conducted among 504 pregnant mothers in the Gedeo zone, southern Ethiopia. Suicidal behavior was assessed using revised suicidal behavior questionnaire (SBQ-R) with a total score of 3-18; those scoring ≥7 were considered as having Suicidal behavior. Data were entered into Epi-data 3.1 and analyzed using SPSS version 20. Bivariate and multivariate binary logistic regression analysis was performed to identify associated factors of suicidal behavior. Variables with a P-value less than 0.05 with 95% CI were considered statistically significant.

Results

In this study, the overall prevalence of suicidal behavior among pregnant mothers was 47(9.3%) with 95% CI (7.1- 11.9). Regarding the factors; being unmarried [AOR = 5.69, 95% CI, (1.19, 27.23)], gestation age greater than 27 weeks, [AOR = 4.92, 95% CI (1.67, 14.53)], history of having chronic medical illness [AOR = 4.47, 95% CI (1.35, 14.85)], depression [AOR = 4.20, 95% CI (1.90, 9.28], and intimate partner violence [AOR = 7.60, 95% CI (3.27, 17.67)] were significantly associated with suicidal behavior at P value less than 0.05 and corresponding 95% CI.

Conclusion

Pregnant mothers in the community had a high prevalence of suicidal behavior compared to studies conducted among general populations. It is better to include and implement the assessment of suicidal risk factors as a primary treatment package for pregnant mothers, training of health extension workers and other primary health workers on how to assess the risk of suicide among pregnant mothers is warranted.

Depression and anxiety among quarantined population during the COVID-19 outbreak in central Ethiopia

Evidence suggests that quarantine might have a wide-ranging, substantial, and long-lasting negative psychological impact especially when the necessary preventive measures are not taken. This study assessed the prevalence and associated factors of depression and anxiety among quarantined population during the COVID-19 outbreak in central Ethiopia. A community-based cross-section study was conducted among individuals under quarantine from June 5 to July 5, 2020, in Addis Ababa, Ethiopia. The hospital Anxiety and Depression Scale (HADS) was used to assess depression and anxiety. Binary logistic regression analysis (multivariate analysis) was used to identify the potential determinants of depression and anxiety. A total of 297 participants were included in the study which makes the response rate 90.8%. The prevalence of anxiety, depression, and co-morbid anxiety and depression were 21.5%, 70.7%, and 15.8% respectively. In our multivariable analyses, stressful life events (AOR 2.61, 95%CI (1.46, 4.67)), spent time on sleeping (AOR 1.97, 95% CI (1.08, 3.62)), and believing that COVID-19 could be prevented by wearing a glove (AOR 0.30, 95% CI (0.11, 0.81)) showed a statistically significant association with anxiety, whereas being married (AOR 2.67, 95% CI (1.37, 5.22)), had stressful life event in the last six months (AOR 1.44, 95% CI (1.44, 5.25)) and spending of time by sleeping during the quarantine (AOR 1.97, 95% CI (1.42, 6.19)) predicted depression. In conclusion, the current study result indicated that a considerable proportion of individuals who were under quarantine during the COVID-19 pandemic have experienced psychological disturbances, such as anxiety and depression. The results suggest that attention needs to be given to mitigate mental health problems in the quarantined population during the COVID-19 outbreak.

Prevalence and Associated Risk Factors of Antenatal Depression among Pregnant Women Attending Tertiary Care Hospitals in South India

BACKGROUND

Antenatal depression (AND) is a common mood disorder that affects both the mother and the child.

OBJECTIVE

The current study is aimed at identifying the prevalence of antenatal depression and the risk factors associated with it in South Indian pregnant women.

MATERIALS AND METHODS

The current study was carried out in a tertiary care teaching hospital where pregnancy and postnatal care are offered. In the study, 314 pregnant women who visited the antenatal clinic for their prenatal checkups were included. To diagnose possible depression, Edinburgh Postnatal Depression Scale (EPDS) was used. The chi-square test was applied to determine the association between antenatal depression and various socioeconomic, obstetric, and medical factors. A logistic regression analysis was performed to identify significant confounding variables.

RESULTS

Of the total 314 women, 69 (21.98%) were suffering from possible depression with the mean EPDS score being 10.61 ± 7.48. Women of younger age had greater risks for depression than older women (AOR = 2.01; 95% CI: 0.56-7.20). Maternal age (χ ² = 0.013, p = 0.009) and the presence of health issues during the current pregnancy (χ ² = 5.18, p = 0.023) were the factors significantly associated with antenatal depression.

CONCLUSIONS

Clinical efforts should focus on screening antenatal depression, early identification, and effective care, thus preventing progression to postpartum depression and its detrimental effects.

Fear, anxiety and depression among pregnant women during COVID-19 pandemic: impacts of healthy eating behaviour and health literacy

INTRODUCTION

The COVID-19 pandemic has been influencing people's psychological health, especially in pregnant women. We aimed to examine associated factors of fear of COVID-19, anxiety and depression among pregnant women during the pandemic where the impacts of healthy eating behaviour (HES) and health literacy (HL) were emphasized.

METHODS

A cross-sectional study was conducted between 14 February 2020 and 31 May 2020 in 18 health centres and hospitals across Vietnam. Data of 518 pregnant women were analysed, including socio-demographics, pregnant-related factors, HES, HL, health-related behaviours, fear of COVID-19 scale (FCoV-19S), anxiety (using the generalized anxiety disorder (GAD-7)) and depression (using the patient health questionnaire with 9 items (PHQ-9)). Regression analysis was utilized to explore the associations.

RESULTS

Pregnant women with higher scores of HES and HL had lower likelihood of anxiety (odds ratio, OR, 0.79; 95% confidence interval (95%CI), 0.73, 0.87; p < .001; and OR, 0.94; 95%CI, 0.90, 0.99; p = .018) and depression (OR, 0.84; 95%CI, 0.78, 0.91; p < .001; and OR, 0.96; 95%CI, 0.91, 0.99; p = .044), respectively. Pregnant women being employed had a lower FCoV-19S score (regression coefficient, B, -1.46; 95%CI, -2.51, -0.40; p = .007). Besides, other significant predictors of anxiety were eating healthier during the pandemic, unchanged or more physical activity, elevated gestational age and smoking. Other significant predictors of depression were eating healthier during the pandemic, elevated gestational age and smoking.

CONCLUSIONS

Among others, HES and HL had positive impacts on protecting pregnant women against anxiety and depression. Improving HES and HL should be addressed as a strategic approach to improve reproductive health during the pandemic.KEY MESSAGEThe COVID-19 pandemic influences antenatal mental disorders with the higher level as opposed to that before the pandemic.Healthy eating behaviour and better health literacy (HL) had critical roles in lowering prenatal anxiety and depression during the COVID-19 crisis.Strategic approaches for improving healthy eating and HL should be recommended for protecting pregnant women from mental health problems during the pandemic.

Nutritional Factors Associated With Maternal Depression Among Pregnant Women in Urban Low-Income Settlements in Nairobi, Kenya

BACKGROUND

Nutritional deficiencies are common during pregnancy and a year after childbirth. At the same time, maternal depression affects many women during pregnancy up to 1 year after childbirth. The objectives of this study were to determine the associations between nutrition status, dietary intake, and maternal depression among pregnant women.

METHODS

This was a cross-sectional study that included 262 pregnant women aged 15 to 49 years attending the antenatal clinic in 2 public health facilities in urban low-income settlements in Nairobi, Kenya. Maternal depression was assessed using Edinburgh Postnatal Depression Scale (EPDS). Mid-upper arm circumference (MUAC) was used to determine nutritional status. Dietary intake was assessed using the 24-hour recall, and brain essential nutrients were assessed through a questionnaire. Odds ratio was used to test the associations. All maternal characteristics with P < .001 in the univariable analysis were considered in the multivariable logistic regression, variables with P < .05 were considered significant.

RESULTS

Of the 262 pregnant women, 33.6% (95% CI: 27.9-40.7) had depressive illness as indicated by EPDS >13. About 9.9% of pregnant women had MUAC < 23 cm. The study established statistically significant association between poor nutrition by MUAC and maternal depression (P < .001). Maternal depression was statistically significantly associated with inadequate intake of brain food essential (P = .002). Maternal depression was statistically significantly associated with lower income (P < .001). In multivariable regression analysis, the main predictor of maternal depression was poor nutrition (P < .004).

CONCLUSION

These findings reveal an association between poor nutrition and maternal depression. These results suggest that nutritional deficiencies could be a contributing factor for maternal depression. Study recommends dietary interventions as cost-effective way to reduce deficiencies and improve mental health problems for pregnant women. Assessment of maternal depression and dietary intake be integrated as fundamental components of antenatal care.

Influence of perceived stress on prenatal depression in Surinamese women enrolled in the CCREOH study

BACKGROUND

Prenatal depression may have adverse health effects on mothers and their offspring. Perceived stress is an important risk factor for depression during pregnancy. Studies have shown that both perceived stress and depression may negatively influence birth outcomes. While 20% of pregnancies in Suriname, a middle-income Caribbean country located in northern South America, results in adverse birth outcomes, data on prenatal depression and its risk factors are lacking. This study aimed to assess the influence of perceived stress on depression during pregnancy in Surinamese women.

METHODS

Survey data were used from 1143 pregnant women who participated in the Caribbean Consortium for Research in Environmental and Occupational Health-MeKiTamara prospective cohort study that addresses the impact of chemical and non-chemical environmental exposures in mother/child dyads in Suriname. The Edinburgh Depression Scale and Cohen Perceived Stress Scale were used to screen for probable depression (cut-off ≥ 12) and high stress (cut-off ≥ 20), respectively. The association between perceived stress and depression was examined using bivariate and multiple logistic regression analyses, adjusted for social support (including resilience) and maternal demographics.

RESULTS

The prevalence of high perceived stress during the first two trimesters and the third trimester were 27.2% and 24.7% respectively. 22.4% of the participants had probable depression during first or second trimester and 17.6% during the third trimester. Women experiencing high stress levels during the first two trimesters had 1.92 increased odds (95% CI 1.18-3.11, p = 0.008) of having probable depression during the third trimester of pregnancy than those with low stress levels. Pregnant women with low individual resilience during early pregnancy (52.1%) had 1.65 (95% CI 1.03-2.63, p = 0.038) increased odds of having probable depression during later stages of pregnancy compared to those with high individual resilience. Low educational level (p = 0.004) and age of the mother (20-34 years) (p = 0.023) were significantly associated with probable depression during the third trimester.

CONCLUSIONS

Early detection and management of stress and depression during pregnancy are important. Health education programs, targeting the reduction of stress during pregnancy, may help to reduce depression and its potential adverse health effects on the mother and child.

Common mental disorders and intimate partner violence against pregnant women living with HIV in Cameroon: a cross-sectional analysis

BACKGROUND

Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa.

METHODS

This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD.

RESULTS

Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD.

CONCLUSIONS

Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.

Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care Service in Kochi Health Center, Jimma Town, Ethiopia

BACKGROUND

Antenatal depression has immense public health importance, as it can adversely affect both the mother and child health. The problem contributes to the disease burden in both developed and developing countries. Despite this, it is less investigated and not getting the necessary attention in the study setting.

OBJECTIVE

The aim of the study was to assess the prevalence of antenatal depression and associated factors among women attending antenatal care (ANC) service in Kochi Health Center, Jimma town, southwest Ethiopia, 2019.

METHOD

Institutional based cross-sectional survey was conducted on 314 pregnant women attending Kochi Health Center from February 15 to April 15, 2019. A systematic random sampling technique was used to include the study participants. Antenatal depression was assessed using the Patient Health Questionnaire (PHQ-9) tool. Data was collected through face-to-face interviews using a pretested and structured questionnaire. Descriptive statistics was done to summarize the dependent and independent variables. Moreover, the chi-square test analysis was done to determine the association between the outcome and explanatory variables.

RESULTS

A total of 314 pregnant women participated in the study, making a response rate of 96.7%. The study has revealed a total of 52 (16.6%) of the respondent had antenatal depression. A chi-square test of independence analysis showed a significant association between antenatal depression and marital status, family history of depression, pregnancy planning, history of abortion, social support, and intimate partner violence (P < 0.00001).

CONCLUSION

The study has shown that the prevalence of antenatal depression was high and associated with multiple psychosocial, clinical, and obstetric factors. Therefore, screening pregnant women for depression and the provision of necessary mental health services is recommended to mitigate the adverse health outcome of the problem.

Prevalence of depression among women with obstetric fistula in low-income African countries: a systematic review and meta-analysis

Depression is one of mental health consequences that present in women with obstetric fistula. It is estimated that over 264 million people of all ages suffer from depression globally. The objective of this systematic review and meta-analysis was to synthesize the epidemiologic evidence from previous studies on the prevalence of depression among women with obstetric fistula in low-income African countries. We followed the preferred reporting items for systematic review and meta-analysis (PRISMA) guidelines to conduct this meta-analysis. The common databases (PubMed, SCOPUS, EMBASE, Psych INFO, Google Scholar, African Index Medicus, and African Journals Online (AJOL)) were searched for the relevant literature. We used a random-effect meta-analysis model to estimate the overall prevalence of depression and the Q -and I² -statistics were used to assess the heterogeneity between the studies included in the meta-analysis. Egger's test and visual inspection of the symmetry in funnel plots were used to check for the presence of publication bias. The pooled estimated prevalence of depression among women with obstetric fistula in low-income African countries was 56.2% (95% CI 43.1-68.4). The prevalence of depression among women with obstetric fistula was 74.4% in Ethiopia, 72.9% in Kenya, 46.0% in Malawi, 41.0% in Sudan, 34.8% in Nigeria, and 27.7% in Tanzania. Furthermore, the prevalence of depression was higher (97.0%) when it was measured by using Beck's Depression Inventory (BDI) when compared with Patient Health Questionnaire (PHQ9) (62.7%), General Health Questionnaire (GHQ-28) (36.7%), Hamilton Depression Rating Scale (HDRS) (41.0%), and Center for Epidemiologic Studies Depression Scale (CES-D) (27.7%). Moreover, the pooled estimated prevalence of depression among women with obstetric fistula was ranged from 48.1 to 57.7% in a leave-one-out sensitivity analysis. The prevalence of depression among women with obstetric fistula in low-income African countries was high. Screening and appropriate management of depression among women with obstetric fistula are warranted.

Prevalence and determinants of antenatal common mental disorders among women in India: a systematic review and meta-analysis

To review the available evidence about the prevalence and determinants of antenatal common mental disorders (antenatal CMDs) among women in India. We searched Ovid Medline, Embase and Psyinfo systematically from date of inception to Oct. 31, 2019 for publications in English language on the prevalence of antenatal CMDs and their determinants among women in India. All study designs were included. Quality was assessed with Standard Quality Assessment Criteria for Evaluating Primary Research Papers. We performed a meta-analysis using a random effects model. Twenty-seven studies involving 7780 women were analysed. There was a high degree of heterogeneity ((I² = 97.53%). Publication bias [Egger bias = 0.65 (95% CI: 0.36; .94)] was evident. The overall pooled estimate of the prevalence of antenatal CMDs was 21.87% (95% CI: 17.46; 26.29). Significant risk factors reported in the 18 studies which examined them were negative reaction of husband or in-laws to the dowry, difficult relationship with husband/in-laws, lack of support or experiencing violence perpetrated by an intimate partner and preference for or feeling pressured to have a male child. Protective factors were having more education and being employed, having a supportive husband and opportunities for recreation during pregnancy. Antenatal CMDs are highly prevalent among women in India. There is an urgent need for locally developed policies and programmes for mental health promotion during pregnancy, preventive and early intervention for antenatal CMDs among women to be integrated into maternity care in India.

Prevalence and Associated Factors of Antenatal Depressive Symptoms in Pregnant Women Living in an Urban Area of Thailand

Background

Depression is a major public health problem in middle- and low-income countries. Depression in pregnancy has adverse effects on obstetric outcomes. Maternal depression remains under-recognized, under-diagnosed and undertreated in Thailand. Antenatal screening of depression is an important strategy to improve maternal and neonatal outcomes. This problem has rarely been investigated in Thailand, especially in urban areas.

Objective

To discover the prevalence, associated factors, and predictive factors of depression in pregnant women living in an urban area.

Materials and Methods

This cross-sectional study of 402 pregnant women was conducted during antenatal care at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand, from 10 September to 31 November 2019. The participants were interviewed using a structured questionnaire that included a demographic profile, obstetric conditions, socio-cultural characteristics, and a Thai language version of the Center for Epidemiologic Studies-Depression Scale to assess depressive symptoms.

Results

Among a total 402 pregnant women, the prevalence of depressive symptoms in pregnant women in an urban area was 18.9%. Depressive symptoms in pregnant women were significantly associated with divorce (p < 0.001), low family income (p < 0.03), financial insufficiency (p < 0.001), extended family (p < 0.001), history of previous abortion (p = 0.033), history of previous pregnancy complications (p = 0.044), current alcohol use (p = 0.03), current tobacco use (p = 0.009), current substance abuse (p = 0.002), marital conflict (p < 0.001), and family conflict (p < 0.001). The significant factors predicting depression in pregnant women were extended family (AOR 3.0, 95% CI 1.59–5.51, p=0.001) and marital conflict (AOR 4.7, 95% CI 2.37–9.11, p<0.001).

Conclusion

This study revealed that the prevalence of depressive symptoms in pregnant women living in an urban area in Thailand was 18.9%. The significant associated factors of depressive symptoms were divorce, low family income, financial insufficiency, extended family, previous abortion, previous pregnancy complications, current alcohol use, current tobacco use, current substance abuse, marital conflict, and family conflict. Extended family and marital conflict were significant predictive factors for antenatal depressive symptoms.

Prevalence of depression symptoms and its influencing factors among pregnant women in late pregnancy in urban areas of Hengyang City, Hunan Province, China: a cross-sectional study

OBJECTIVES

To evaluate the prevalence of depressive symptoms and its influencing factors in late pregnancy.

DESIGN

Cross-sectional study.

SETTING

Fourteen community in urban areas of Hengyang City.

PARTICIPANTS

The study conducted from July to October 2019, and surveyed 813 women in late pregnancy who lived in urban areas of Hengyang for more than 6 months, signed an informed consent and were without cognitive disorders, severe mental illnesses or other serious diseases.

MEASURES

Perinatal depression symptoms were evaluated using the Patient Health Questionnaire-9, and perinatal anxiety symptoms were evaluated using the Generalised Anxiety Disorder-7 Scale. Sociodemographic variables, obstetric characteristics, lifestyle behaviours, family factors, social support, sleep quality and self-efficacy were obtained through structured questionnaires.

RESULTS

The prevalence of depression symptoms among pregnant women in late pregnancy was 9.2% (95% CI 7.2%-11.2%). Protective factor: age between 25 and 29 years (OR=0.398; 95% CI 0.16-0.991).

RISK FACTORS

a normal relationship with her mother-in-law (OR=5.309; 95% CI 1.122-4.184), artificial insemination (OR=4.339; 95% CI 1.492-12.623), no exercise during pregnancy (OR=2.666; 95% CI 1.177-6.039), low self-efficacy (OR=4.253; 95% CI 1.518-11.916), low social support (OR=2.371; 95% CI 1.206-4.661), poor sleep quality (OR=2.134; 95% CI 1.131-4.027), existence of anxiety symptoms (OR=17.654; 95% CI 8.494-36.689).

CONCLUSION

The prevalence of depression symptoms is lower than that in developing countries, but due to the large population base of China, the problem should still be taken seriously. To prevent mental disorders of pregnant women, early screening for mental disorders, promotion of healthy lifestyles, mental healthcare during pregnancy and improved family and social support should be implemented during pregnancy nursing.

Association between family functions and antenatal depression symptoms: a cross-sectional study among pregnant women in urban communities of Hengyang city, China

OBJECTIVE

To explore the prevalence of depressive symptoms among women in late pregnancy, and assess mediating effect of self-efficacy in the association between family functions and the antenatal depressive symptoms.

DESIGN

Community-based, cross-sectional study was conducted among women during the third trimester of pregnancy.

SETTING

This study was conducted among pregnant women registered at community health service centres of urban Hengyang City, China from July to October 2019.

PARTICIPANTS

813 people were selected from 14 communities by multi-staged cluster random sampling method.

MAIN OUTCOME MEASURES

The Family Adaptation Partnership Growth Affection and Resolve Index, the General Self-efficacy Scale and Patient Health Questionnaire were used to access family functions, self-efficacy and antenatal depression symptoms, respectively.

RESULTS

In this study, 9.2% pregnant women reported the symptoms of antenatal depression (95 CI% 7.2% to 11.2%). After adjustment, the results showed that severe family dysfunction (adjusted OR, AOR 3.67; 95% CI 1.88 to 7.14) and low level of self-efficacy (AOR 3.16; 95% CI 1.37 to 7.27) were associated with antenatal depressive symptoms (p<0.05). Furthermore, self-efficacy level partially mediated the association between family functions and antenatal depressive symptoms(β=-0.05, 95% CI -0.07 to -0.03, p<0.05) and the mediating effect accounted for 17.09% of the total effect.

CONCLUSIONS

This study reported 9.2% positive rates of antenatal depression symptoms among women in the third trimester of pregnancy in Hengyang city, China. The mediating effect of self-efficacy on the association between family functions and antenatal depression symptoms among women in the third trimester of pregnancy was found in this study, which provide a theoretical basis to maternal and child health personnel to identify high-risk pregnant women and take targeted intervention for them.

Prevalence and Correlates of Depression Among Pregnant Women Enrolled in a Maternal and Newborn Health Program in Rural Northern Ghana: a Cross-sectional Survey

Women in many sub-Saharan African countries are at elevated risk of depression during pregnancy. However, there are still gaps in the estimates of antenatal depression and associated risk factors in very low-resource settings such as Northern Ghana. This study describes the prevalence of depression among rural pregnant women, participating in a maternal and child health program, in Ghana, and examines associated risk factors for depression. Pregnant women who were registered for group-based maternal and child health community programs were recruited for study participation from 32 communities in two rural districts in Northern Ghana (n = 374). Baseline surveys were conducted and depression was assessed using the Patient Health Questionnaire (PHQ-9). Bivariate and multivariable analyses used a modified Poisson and generalized estimating equations (GEE) model. Of the women in our study population, 19.7% reported symptoms indicative of moderate to severe depression (PHQ-9 score ≥ 10), with 14.1% endorsing suicidal ideation in the last 2 weeks. Bivariate analyses revealed that lower hopefulness, moderate and severe hunger, experiences of emotional, physical, and/or sexual intimate partner violence (IPV), and insufficient social support from female relatives were associated with symptoms indicating moderate to severe depression. In the multivariable analyses, low hopefulness, household hunger, emotional IPV, physical and/or sexual IPV, and insufficient female relative support remained significantly associated with depression. Antenatal depression is associated with unmet basic needs and safety. Perinatal mental health programming must take an ecological perspective and address personal, familial, and community-level factors.

Antenatal depression: an examination of prevalence and its associated factors among pregnant women attending Harare polyclinics

Background

Antenatal depression is the most prevalent common mental health disorder affecting pregnant women. Here, we report the prevalence of and associated factors for antenatal depression among pregnant women attending antenatal care services in Harare, Zimbabwe.

Methods

From January–April 2018, 375 pregnant women, aged 16–46 years, residing mostly in Harare’s high-density suburbs were recruited from two randomly-selected polyclinics. Antenatal depression was measured using the Structured Clinical Interview for DSM-IV. Sociodemographic data including; maternal age, education, marital status, economic status, obstetric history and experiences with violence were also collected. Chi-square tests and multivariate logistic regression analysis were used to determine the association between antenatal depression and participants’ characteristics.

Results

The prevalence of antenatal depression was 23.47% (95% CI: 19.27–28.09). Multivariate logistic regression analysis revealed intimate partner violence (IPV) [OR 2.45 (95% CI: 1.47–4.19)] and experiencing negative life events [OR 2.02 (95% CI: 1.19–3.42)] as risk factors for antenatal depression, with being married/cohabiting [OR 0.45 (95% CI: 0.25–0.80)] being a protective factor.

Conclusion

The prevalence of antenatal depression is high with associated factors being interpersonal. Context-specific interventions are therefore needed to address the complexity of the factors associated with antenatal depression.

Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model

BACKGROUND

Various forms of life stressors have been implicated as causes of antenatal depression. However, there is a lack of understanding of which forms of stress lead to antenatal depression and through what mechanisms. Modeling stress processes within a theoretical model framework can enhance an understanding of the mechanisms underlying relationships between stressors and stress outcomes. This study used the stress process model framework to explore the causal mechanisms underlying antenatal depression in Gondar, Ethiopia.

METHODS

Questionnaires, using an Online Data collection Kit (ODK) tool were administered face-to-face in 916 pregnant women in their second and third trimesters. Pregnant women were included from six randomly selected urban districts in Gondar, Ethiopia during June and August 2018. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depression. A Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effect of stressors and mediators of antenatal depression.

RESULT

Sixty-three participants (6.9%) reported symptoms of depression. Of these, 16 (4.7%) and 47 (8.1%) were in their second and third trimesters, respectively. The SEM demonstrated several direct effects on antenatal depression scores including unplanned pregnancy (standardized β = 0.15), having a history of common mental health disorder (standardized β = 0.18) and fear of giving birth to the current pregnancy (standardized β = 0.29), all of which were associated with a higher depression score. Adequate food access for the last 3 months (standardized β = - 0.11) was associated with decreased depression score. Social support (β = - 0.21), marital agreement (β = - 0.28), and partner support (β = -.18) appeared to partially mediate the link between the identified stressors and the risk of antenatal depression.

CONCLUSION

Both direct and indirect effects contributed to higher antenatal depression score in Ethiopian women. The three psychosocial resources namely marital agreement, social and partner support, mediated reduced antenatal depression scores. Early screening of antenatal depression and enhancing the three psychosocial resources would help to improve maternal resilience.

Prevalence and determinants of depression in mothers of children under 5 years in Bole District, Ghana

OBJECTIVE

Depression in mothers is a risk factor for poor health, and pregnancy and child outcomes. The objective of the present study was to determine the prevalence of depression and identify its determinants in mothers of children under 5 years in Bole District, Ghana.

RESULTS

We conducted an analytical cross-sectional study consisting of 244 mothers (mean age 28.7 ± 6.29 years) in Bole District, Ghana. Edinburgh Postnatal Depression Scale was used to screen for depression and the determinants of depression were identified using logistic regression analysis. The prevalence of depression in this study population was 16.8% (95% confidence interval 12.1-22.0%). The independent determinants of depression were marital status, occupation, lighting source and type of cooking fuel. Being currently unmarried (p < 0.001), and using lighting sources other than electricity (p = 0.004) were associated with higher risk of depression while being employed in other occupations (p = 0.001), and not cooking with firewood (p = 0.008) were associated with lower risk of depression. In this study population, the prevalence of depression was relatively high in mothers and was associated with marital status, occupation, lighting source and cooking fuel. Interventions to prevent and treat depression in women should include strategies to improve their socio-economic status and living conditions.