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Hoq MI, Hossain MM, Sayeed MA, Jakaria M. Trends in the prevalence of antenatal and postnatal depression in Bangladesh: A systematic review and meta-analysis. Heliyon 2025; 11:e41955. [PMID: 39897802 PMCID: PMC11787471 DOI: 10.1016/j.heliyon.2025.e41955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/03/2025] [Accepted: 01/13/2025] [Indexed: 02/04/2025] Open
Abstract
Background Maternal depression negatively impacts the health of both mothers and their children. Although several studies have reported on the prevalence of antenatal depression (AND) and postnatal depression (PND) in Bangladesh, reliable estimates based on meta-analysis have yet to be established. This study aims to determine the prevalence of "AND" and "PND" among Bangladeshi mothers, as well as the prevalence of "PND" during various phases of a child's development, while also identifying the associated factors for both "AND" and "PND". Methods We conducted a systematic search in PubMed, Scopus, Cochrane, and a national database called Bangla Jol for studies published from the year 2000 until December 31, 2020. From 163 screened studies, eighteen eligible studies on the prevalence of "AND" and "PND" were included for meta-analysis. A random-effects model was used for this analysis. We also performed subgroup analyses considering "PND" at different stages, study quality, and prevalence based on the decade of publication. Results The pooled prevalence rates were found to be 19.5 % for "AND" (95 % CI: 7.7 %-31.28 %, I2: 98.09 %) and 27.75 % for "PND" (95 % CI: 22.38 %-33.16 %, I2: 97.67 %). In the 2000s, the pooled prevalence was 22.78 % (95 % CI: 17.82 %-27.73 %, I2: 96.65 %). However, there was a significant increase in the prevalence of "PND" in the 2010s, which reached 36.00 % (95 % CI: 23.94 %-48.06 %, I2: 95.76 %). The pooled prevalence at an early stage of the child's development was 17.12 %; during exclusive breastfeeding, it was 25.73 %, and during complementary feeding, it peaked at 48.11 %. Factors associated with maternal depression included unplanned pregnancies, various forms of intimate partner violence (including physical, emotional, and sexual violence), a preference for male children, and strained relationships with husbands and mothers-in-law. Conclusion A rising trend in the prevalence of maternal depression has been observed in Bangladesh. Health policymakers need to prioritize addressing maternal depression. The data indicates that the prevalence of postpartum depression was higher in the 2010s compared to the previous decade. It is crucial to raise awareness among mothers about the importance of screening for depression during the perinatal period, and to integrate such screenings into family planning and mental health services.
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Affiliation(s)
- Mohammad Injamul Hoq
- Department of Pharmacy, International Islamic University Chittagong, Kumira, Chittagong, 4318, Bangladesh
- Department of Public Health, University of Creative Technology Chittagong, Chittagong, 4212, Bangladesh
| | - Md Mohotasin Hossain
- Department of Pharmacy, International Islamic University Chittagong, Kumira, Chittagong, 4318, Bangladesh
| | - Mohammad Aktar Sayeed
- Department of Pharmacy, International Islamic University Chittagong, Kumira, Chittagong, 4318, Bangladesh
| | - Md Jakaria
- The Florey Institute, The University of Melbourne, Parkville, VIC, 3052, Australia
- School of Health Sciences & Purdue Institute for Integrative Neurosciences, Purdue University, West Lafayette, IN, 47907, USA
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Pramanik P, Mishra AK. From the womb to the world: a study of pregnancy narratives by celebrity moms in India. MEDICAL HUMANITIES 2024; 50:343-351. [PMID: 38789254 DOI: 10.1136/medhum-2023-012842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/26/2024]
Abstract
This article examines how celebrity moms in India are self-constructing their public persona through their pregnancy narratives. As a form of personal narrative, pregnancy narratives provide important insights into the unnarrated private world of pregnancy and its nuanced experiences. Although pregnancy and motherhood are glorified in India, it is subjected to a regime of cultural control thereby influencing women's disclosure of pregnancy behaviour and their narrative freedom. Despite being a life-altering event for women, pregnancy experiences and their narrativisation in India have largely been confined to the domestic spaces. However, some recent developments suggest the modernisation of maternity in India and point towards the emergence of a new cultural phenomenon as celebrity mothers through their pregnancy narratives are questioning the traditional beliefs and scientific practices which restrict women and their narrative freedom during pregnancy and childbirth. They are also documenting their obstetric violence, postpartum changes and the alternative means adopted by them to give birth. Through a narrative analysis of Kareena Kapoor's Pregnancy Bible (2021), Tahira Kashyap's The 7 Sins of Being a Mother (2021) and Kalki Koechlin's The Elephant in the Womb (2021), this article examines how modern maternity is being constructed in India and how it is entering popular discourse through personal narratives. In the process, it investigates how these celebrity mothers, to make themselves more acceptable, subvert the existing discourse of maternity and modernise it while retaining its necessary traditionalism. Most importantly, the article develops an understanding of the role of these narratives in encouraging the performance of maternity beyond the domestic setup.
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Affiliation(s)
- Pratyusha Pramanik
- Department of Humanistic Studies, Indian Institute of Technology BHU Varanasi, Varanasi, Uttar Pradesh, India
| | - Ajit K Mishra
- Department of Humanistic Studies, Indian Institute of Technology BHU Varanasi, Varanasi, Uttar Pradesh, India
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Roy SK, Majumdar S, Singh R, Paul A. Prevalence and risk factors of depressive symptoms in the postpartum period: An experience from urban West Bengal, India. J Family Med Prim Care 2024; 13:2880-2885. [PMID: 39228561 PMCID: PMC11368309 DOI: 10.4103/jfmpc.jfmpc_1050_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 09/05/2024] Open
Abstract
Introduction Postpartum depression (PPD) is a form of depression that affects new mothers within the first year after childbirth. PPD can negatively impact both the mother's quality of life and the child's development. Untreated PPD can lead to adverse outcomes, such as infant growth retardation, poor child survival, impaired development, and undernutrition. The burden of PPD is a significant public health concern, with a global prevalence increase of 18.4% from 2005 to 2015. Early detection and intervention of PPD can mitigate the severity and chronicity of symptoms. Aims This study aimed to determine the prevalence of PPD among mothers in an urban area of Kolkata and identify any influencing factors. Materials and Methods The study utilized a cross-sectional design, surveying 189 mothers within the postpartum period of 6 weeks to 1 year. Edinburg Postnatal Depression Scale was used to identify possible PPD. Results About 29% of the women had probable PPD, 19% had possible depression, and 15% had no depression. Factors associated with depression included low birth weight and primiparity, while financial independence served as a protective factor. Multinomial regression analysis revealed that low-birth-weight babies, marital conflict, lack of support at home, and primiparity had higher odds of depression, whereas financial independence was a protective factor. Age was not statistically significant. Conclusion A high prevalence of PPD and significant associations with factors emphasized the importance of screening all mothers for PPD, providing medical care and counselling, and ensuring acceptance and support from partners, family, and society.
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Affiliation(s)
- Sunetra K. Roy
- Department of Community Medicine, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Sukanta Majumdar
- Department of Community Medicine, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Rashmi Singh
- Department of Community Medicine, Calcutta National Medical College, Kolkata, West Bengal, India
| | - Avijit Paul
- Department of Community Medicine, Calcutta National Medical College, Kolkata, West Bengal, India
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Rajeev S P, Nair GM, K KK, Maria C. India's Silent Struggle: A Scoping Review on Postpartum Depression in the Land of a Billion Mothers. Indian J Psychol Med 2024:02537176241245773. [PMID: 39564219 PMCID: PMC11572551 DOI: 10.1177/02537176241245773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2024] Open
Abstract
Background Postpartum emotional issues, including postpartum blues, postpartum psychosis, and postpartum depression (PPD), affect many mothers worldwide. The prevalence of postpartum blues ranges from 300 to 750 per 1,000 mothers, while postpartum psychosis has a prevalence of 0.89-2.6 cases per 1,000 births. PPD affects 100-150 new mothers per 1,000 births, and its prevalence can go above 25% globally. Depression in mothers can have long-lasting impacts on children and the next generation, affecting their growth, development, and relationships. However, the condition of PPD is frequently misdiagnosed, and women who suffer from it do not receive treatment. There is a lack of solid systematic evidence that looks at the overall burden of PPD and the risk factors that are associated with it in India. The awareness of PPD is critical in managing the symptoms and seeking professional support, and studies are needed to evaluate and assess the situation in India. Methodology This study is a systematic literature review with a scoping review approach aimed at providing existing evidence on the awareness and prevalence of PPD in India. The search strategy for the electronic bibliographic search included a list of related terms and factors of awareness and prevalence of PPD. The search encompassed six prominent databases. The assessment tools used in studies from 2012 to 2023 study the factors using the Postpartum Depression Literacy Scale (PoDLiS) and the Edinburgh Postpartum Depression Scale, which measure the awareness and prevalence of PPD. Results The study found a significantly low volume of studies conducted in India to determine the prevalence of PPD. The materials or studies accessible are hospital-based research with a minimal number of samples. The reported prevalence rate of postpartum depression (PPD) in India varies across different studies, ranging from 4% to 48.5%. Among mothers who gave birth either naturally or by cesarean section in a hospital setting, one study reported the lowest prevalence rate (4%). The prevalence of PPD among women in India is estimated to be 18% based on the average score across all research. A study that evaluated the moms in the community found that PPD was prevalent in new mothers at a rate of 21.5%. There are three studies, in particular, that focus on how aware people are of PPD. Two studies found that 54% of the family members of postpartum moms and women undergoing tertiary pediatric care are aware of PPD. Discussion Many studies point to the lack of social support as a significant risk factor for mental health complications after delivery. History of depression, anxiety, adverse life events, partner abuse, low economic status, complications at childbirth, and a traumatic childbirth experience are some of the associated factors identified in the studies. Studies have also shown that women who undergo a cesarean section have a higher risk of developing PPD than those with a vaginal delivery.
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Affiliation(s)
- Rajeev S P
- Dept. of Social Work, Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India
| | - Gokul M Nair
- Dept. of Languages, Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India
| | - Krishna K K
- Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India
| | - Chris Maria
- Rajagiri College of Social Sciences (Autonomous), Cochin, Kerala, India
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Wildali D, Nazzal S, Hamshari S, Belkebir S. Prevalence and risk factors of postpartum depression among women attending primary healthcare centers in northern of West Bank/ Palestine: a cross-sectional study, 2022. BMC Womens Health 2024; 24:43. [PMID: 38225590 PMCID: PMC10789035 DOI: 10.1186/s12905-024-02887-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/04/2024] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Postpartum depression (PPD) has a huge negative impact on the health of the mother and the family, both physically and mentally. Few postpartum depression studies have been done in Palestine. This study aimed to examine the prevalence and the most probable risk factor of PDD among Palestinian women in the northern West Bank. METHODS This is a cross-sectional study of 380 mothers, ages 18 and 44 years, visiting vaccination clinics with their infants after 7-12 weeks of delivery between 1 May 2022 and 30 June 2022. Postpartum women seeking care at the seven largest primary health care centers of the Ministry of Health in four cities in the Northern West Bank in Palestine were asked to complete a self-administered questionnaire that included the Edinburgh Postnatal Depression Scale and demographic and birth details. A score of 13 or higher was used to indicate PPD risk. Descriptive and analytical analyses were performed using SPSS version 20. The level of significance was set at 5%. RESULTS The median age of the participants was 27 years with a range of 26 years. A total of 129 women had an EPDS score of 13 or more, giving a prevalence rate of post-partum depression of 33.9%. The predictors of postpartum depression were stressful life events during pregnancy (p-value 0.003, OR: 2.1, 95% CI [1.27-3.4]), vacuum use during delivery p-values 0.002, OR: 4, 95% CI: [1.64-9.91]), low social support (p-value less than 0.001, OR: 2.5, 95%CI: [1.7-4.2]) and husband's low level of education (p-value less than 0.001, OR: 5.2, 95%CI: [2.7-10]). CONCLUSION The study showed a high prevalence of PPD among Palestinian mothers in the northern West Bank. Our study found that PPD risk factors include lack of social support, the husband's low education, and stressful events during pregnancy. This will emphasize the importance of PPD screening and early intervention, especially among vulnerable women.
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Affiliation(s)
- Dina Wildali
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Saja Nazzal
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Suha Hamshari
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Souad Belkebir
- Department of Family and Community Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Zhang GR, Li PS, Jia YB. Relationship between family cohesion/adaptability and postpartum depressive symptoms: A single-center retrospective study. World J Psychiatry 2023; 13:50-59. [PMID: 36925950 PMCID: PMC10011945 DOI: 10.5498/wjp.v13.i2.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/30/2022] [Accepted: 01/19/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Depression is the most common mental illness in postpartum mothers, and the etiology of postpartum depression remains poorly understood. Over the past several decades, studies have reported that postpartum depression is caused by multiple factors, such as genetic, psychological, pregnancy, and environmental factors, with the family environment being an important environmental factor. The theory of family cohesion and adaptability put forward by Olson is a classic model that describes the level of family function. However, to date, this model has not been examined regarding its applicability to patients with postpartum depression.
AIM To investigate the relationship between family cohesion and adaptability and the risk of postpartum depressive symptoms.
METHODS We retrospectively analyzed 1446 patients admitted to the postpartum healthcare clinic of the Affiliated Foshan Maternity and Child Healthcare Hospital from April 2021 to December 2021. Patients were grouped according to whether postpartum depression symptoms were reported (symptoms, n = 454; no symptoms, n = 992). All patients completed the Edinburgh Postpartum Depression Scale and the Chinese version of the Family Cohesion and Adapt-ability Assessment Scale II. Baseline and clinical data were compared between groups. Univariate regression analysis was used to investigate the association between different types of family cohesion and postpartum depressive symptoms and the association between different family adaptability types and postpartum depressive symptoms.
RESULTS After adjusting for age, education, occupation, gravidity, parity, and mode of delivery, disengaged [adjusted odds ratio (AOR) = 3.36, 95%CI: 1.91–5.91], and separated (AOR = 1.97, 95%CI: 1.34–2.90) family cohesion types showed a higher risk of postpartum depression than the connection type, whereas the enmeshed type (AOR = 0.38, 95%CI: 0.28–0.51) protected against postpartum depressive symptoms. Rigid (AOR = 4.41, 95%CI: 3.02–6.43) and structured families (AOR = 1.88, 95%CI: 1.34–2.63) had a higher risk of postpartum depressive symptoms than flexible families, whereas chaotic families (AOR = 0.35, 95%CI: 0.24–0.51) protected against postpartum depressive symptoms.
CONCLUSION Family cohesion and adaptability are influencing factors for postpartum depressive symptoms, with higher family cohesion and adaptability being associated with a lower risk of postpartum depressive symptoms.
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Affiliation(s)
- Guo-Rong Zhang
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510630, Guangdong Province, China
| | - Peng-Sheng Li
- Department of Women’s Healthcare, Affiliated Foshan Maternity & Child Healthcare Hospital, Southern Medical University, Foshan 528000, Guangdong Province, China
| | - Yan-Bin Jia
- Department of Psychiatry, The First Affiliated Hospital of Jinan University, Jinan University, Guangzhou 510630, Guangdong Province, China
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Dosani A, Yim IS, Shaikh K, Lalani S, Alcantara J, Letourneau N, Premji SS. Psychometric analysis of the Edinburgh Postnatal Depression Scale and Pregnancy Related Anxiety Questionnaire in Pakistani pregnant women. Asian J Psychiatr 2022; 72:103066. [PMID: 35334284 DOI: 10.1016/j.ajp.2022.103066] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Edinburgh Postnatal Depression Scale (EPDS) and the Pregnancy-Related Anxiety Scale (PRAQ) are frequently used perinatal mental health scales. OBJECTIVE To identify the factor structure of the Urdu language versions of EPDS and PRAQ in 280 Pakistani pregnant women. METHOD The tools were administered at 12-19 weeks' and 22-29 weeks' gestational age (GA). Exploratory factor analyses were undertaken on data collected at 12-19 weeks' GA, to assess both scales. Results obtained at the second time point were used to examine test-retest reliability. The correlation between the scales was computed. RESULTS A two-factor model yielded the best fit for both scales, which is consistent with findings from previous studies. For the EPDS, acceptable reliability was attained for the overall score (α = 0.77) and for the factor related to depressive symptoms (α = 0.73), but not for the factor related to anhedonia/suicide (α = 0.64). For the PRAQ, acceptable reliability was attained for the overall score (α = 0.83) and for the factor related to pregnancy concerns (α = 0.84), but not for the factor related to childbirth (α = 0.64). Test-retest reliability was acceptable for both overall scales EPDS: r = 0.50; PRAQ: r = 0.45; both p < .001). The Pearson correlation between the EPDS and PRAQ were r = 0.145, p < .05. CONCLUSION Analysis of the tools confirmed a two-factor structure for both depression and anxiety among Pakistani pregnant women. A weak correlation was found between the EPDS and PRAQ. Further research is required to develop screening instruments for perinatal mental disorders that are applicable to cultural contexts.
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Affiliation(s)
- Aliyah Dosani
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, T3E 6K6 Canada; Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6 Canada; O'Brien Institute for Public Health, University of Calgary, 3rd Floor TRW Building, 3280 Hospital Drive N.W., Calgary, Alberta, T2N 4Z6 Canada.
| | - Ilona S Yim
- Department of Psychological Science, University of California, Irvine, 4562 Social and Behavioral Sciences Gateway, Irvine, CA, USA
| | - Kiran Shaikh
- School of Nursing and Midwifery, Aga Khan University, Stadium Road, P/O Box 3500, Karachi 74800, Pakistan
| | - Sharifa Lalani
- School of Nursing and Midwifery, Aga Khan University, Stadium Road, P/O Box 3500, Karachi 74800, Pakistan
| | - Jade Alcantara
- School of Nursing and Midwifery, Mount Royal University, 4825 Mount Royal Gate S.W., Calgary, Alberta, T3E 6K6 Canada
| | - Nicole Letourneau
- Department of Community Health Sciences, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta, T2N 4Z6 Canada; Faculty of Nursing, University of Calgary, 2500 University Drive N.W., Calgary, Alberta, T2N 1N4 Canada; Departments of Pediatrics and Psychiatry, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta,T2N 4N1 Canada
| | - Shahirose S Premji
- School of Nursing, Faculty of Health, York University, Health, Nursing & Environmental Studies Building, Room 313, 4700 Keele St, Toronto, M3J 1P3 Canada
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Mapping global prevalence of depression among postpartum women. Transl Psychiatry 2021; 11:543. [PMID: 34671011 PMCID: PMC8528847 DOI: 10.1038/s41398-021-01663-6] [Citation(s) in RCA: 216] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/16/2021] [Accepted: 09/27/2021] [Indexed: 02/05/2023] Open
Abstract
Postpartum depression (PPD) is the most common psychological condition following childbirth, and may have a detrimental effect on the social and cognitive health of spouses, infants, and children. The aim of this study was to complete a comprehensive overview of the current literature on the global epidemiology of PPD. A total of 565 studies from 80 different countries or regions were included in the final analysis. Postpartum depression was found in 17.22% (95% CI 16.00-18.51) of the world's population. Meta-regression analysis showed that study size, country or region development, and country or region income were the causes of heterogeneity. Multivariable meta-regression analysis found that study size and country or area development were the most important predictors. Varied prevalence rates were noted in geographic regions with the highest rate found in Southern Africa (39.96%). Of interested was a significantly lower rate of PPD in developed countries or high-income countries or areas. Furthermore, the findings showed that there was a substantial difference in rates of PPD when marital status, educational level, social support, spouse care, violence, gestational age, breast feeding, child mortality, pregnancy plan, financial difficulties, partnership, life stress, smoking, alcohol intake, and living conditions were considered in the pooled estimates. Our results indicated that one out of every five women experiences PPD which is linked to income and geographic development. It is triggered by a variety of causes that necessitate the attention and committed intervention of primary care providers, clinicians, health authorities, and the general population.
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Zeleke TA, Getinet W, Tadesse Tessema Z, Gebeyehu K. Prevalence and associated factors of post-partum depression in Ethiopia. A systematic review and meta-analysis. PLoS One 2021; 16:e0247005. [PMID: 33606768 PMCID: PMC7894900 DOI: 10.1371/journal.pone.0247005] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/29/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Globally, post-partum depression is a major public health problem and is associated with a harmful effect on the infant, child, and mothers' mental, physical, and social health. Although a few post-partum depression studies have been published, we still lack an accurate estimated pooled prevalence of national PPD and associated factors. OBJECTIVES This study aims to show the estimated pooled prevalence of PPD and associated factors in Ethiopia. METHODS We conduct the extensive search of articles as indicated in the guideline (PRISMA), reporting systematic review and meta-analysis. Databases like MEDLINE, PubMed, psych INFO, Web of Science, EMBASE, CINAHL, Scopus, and The Cochrane Library. All publications and grey literature were addressed by using MeSH terms and keywords. The pooled estimated effect of post-partum depression and associated factors was analyzed using the random effect model meta-analysis, and 95% CI was also considered. PROTOCOL AND REGISTRATION PROSPERO 2020 CRD42020176769 Available from https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020176769. RESULT A total of 11 studies with 7,582 participants were included in this meta-analysis. The estimated pooled prevalence of post-partum depression (PPD) was 22.08%, with a 95% CI (17.66%, 26.49). For factors associated with post-partum depression, a random effect size model was used during meta-analysis; unplanned pregnancy [(OR = 2.84; 95% CI (2.04, 3.97)], domestic violence [OR = 3.14; 95% CI (2.59, 3.80)], and poor social support [OR = 3.57;95% CI (2.29,5.54) were positively associated factors with post-partum depression. CONCLUSION AND RECOMMENDATION The estimated pooled prevalence of post-partum depression was high in Ethiopia. Unplanned pregnancy, poor social support, and domestic violence were factors affecting PPD. Therefore, the Ethiopian policymakers and health personnel better give more emphasis to mothers who had a history of unplanned pregnancy, domestic violence, and poor social support.
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Affiliation(s)
- Tadele Amare Zeleke
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Wondale Getinet
- Department of Psychiatry College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Zemenu Tadesse Tessema
- Department of Epidemiology and Biostatics, Institute of Public Health College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Kassahun Gebeyehu
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
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Duko B, Wolde D, Alemayehu Y. The epidemiology of postnatal depression in Ethiopia: a systematic review and meta-analysis. Reprod Health 2020; 17:180. [PMID: 33213434 PMCID: PMC7678214 DOI: 10.1186/s12978-020-01035-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 11/01/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Postnatal depression is among the common mental health problems that occur during the postnatal period. However, it is left undiagnosed in low- and middle-income countries including Ethiopia. Therefore, this systematic review and meta-analysis aimed to systematically summarize the available evidence on the epidemiology of postnatal depression in Ethiopia and suggest recommendations for future clinical practice. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline was followed to conduct this systematic review and meta-analysis. We searched PubMed, SCOPUS, EMBASE and Google Scholar databases for the relevant articles that assessed the prevalence of postnatal depression in Ethiopia. We used a random-effect model to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis to explore the source of heterogeneity. Cochrane Q- and the I2-test were used to check the heterogeneity of the included studies. The presence of publication bias was also checked by visual inspection of symmetry and Egger's test. RESULTS The pooled estimated prevalence of postnatal depression in Ethiopia was 20.1% (95% CI 12.7-30.2). The pooled prevalence of postnatal depression in the studies that were conducted in community settings and used the Patient Health Questionnaire to assess postnatal depression [16.6% (95% CI 8.90-28.99)] was lower than the prevalence in studies based in institutions and that used the Edinburgh Postnatal Depression Scale [23.2% (95% CI 14.50-28.5)]. Further, in a leave-one-out sensitivity analysis the prevalence of postnatal depression ranges between 15.4% and 25.4%. Unplanned pregnancy [AOR = 3.46, 95% CI (2.37-5.04)], age between 15-24 years [AOR = 1.72, 95% CI (1.11-2.68)], marital problems [AOR = 3.07, 95% CI (2.36-3.99)], experiencing the death of infant [AOR = 3.41, 95% CI (1.91-6.09)] and history of substance use [AOR = 3.47, 95% CI (2.17-5.56)] were associated with the increased odds of postnatal depression in Ethiopia. CONCLUSION The prevalence of postnatal depression in Ethiopia was high. Therefore, the concerned body should give due attention to improve reproductive health services through early detection of risk factors of postnatal depression.
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Affiliation(s)
- Bereket Duko
- Faculty of Heath Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia. .,School of Public Health, Curtin University, Perth, Australia.
| | - Dereje Wolde
- Department of Medical Laboratory, Sodo Christian General Hospital, Wolaita Sodo, Ethiopia
| | - Yonas Alemayehu
- Faculty of Heath Sciences, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Dosani A, Arora H, Mazmudar S. mHealth and Perinatal Depression in Low-and Middle-Income Countries: A Scoping Review of the Literature. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7679. [PMID: 33096738 PMCID: PMC7589927 DOI: 10.3390/ijerph17207679] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 10/19/2020] [Indexed: 02/07/2023]
Abstract
Women in low- and middle-income countries have high rates of perinatal depression. As smartphones become increasingly accessible around the world, there is an opportunity to explore innovative mHealth tools for the prevention, screening, and management of perinatal depression. We completed a scoping review of the literature pertaining to the use of mobile phone technologies for perinatal depression in low-and middle-income countries. PubMed CINHAL, and Google Scholar databases were searched, generating 423 results. 12 articles met our inclusion criteria. Two of the 12 articles reviewed mobile phone applications. The remaining 9 articles were study protocols or descriptive/intervention studies. Our results reveal that minimal literature is currently available on the use of mobile health for perinatal depression in low- and middle-income countries. We found four articles that present the results of an intervention that were delivered through mobile phones for the treatment of perinatal depressive symptoms and an additional qualitative study describing the perceptions of mothers receiving cognitive behavioral therapy via telephones. These studies demonstrated that depressive symptoms improved after the interventions. There is potential to improve the quality of mHealth interventions, specifically mobile phone applications for perinatal depressive symptoms and depression, through meaningful collaborative work between healthcare professionals and application developers.
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Affiliation(s)
- Aliyah Dosani
- School of Nursing and Midwifery, Faculty of Health, Community and Education, Mount Royal University, Calgary, AB T3E 6K6, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Harshmeet Arora
- Department of Computer and Electrical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (H.A.); (S.M.)
| | - Sahil Mazmudar
- Department of Computer and Electrical Engineering, Faculty of Applied Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada; (H.A.); (S.M.)
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12
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Bhushan NL, Krupp K, Jaykrishna P, Ravi K, Khan A, Shidhaye R, Kiplagat S, Srinivas V, Madhivanan P. The association between social support through contacts with Accredited Social Health Activists (ASHAs) and antenatal anxiety among women in Mysore, India: a cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2020; 55:1323-1333. [PMID: 32146484 PMCID: PMC7483323 DOI: 10.1007/s00127-020-01854-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/28/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE In India, antenatal anxiety prevalence estimates range from 6 to 48%. Social support is strongly associated with mental wellbeing, yet most studies have examined the impact of support from partners and family members rather than peers, community members, or health care providers. This study explores the supportive role of Accredited Social Health Activists (ASHA) contacts for antenatal anxiety. METHODS Data were analyzed from the Saving Children, Improving Lives project, a quasi-experimental study conducted among rural, pregnant women in India. Regression models were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals for the relationship frequency of ASHA contacts and antenatal anxiety. Antenatal anxiety was measured using a subscale of the Edinburgh Postnatal Depression Scale. RESULTS The sample consisted of 480 pregnant women. Reported antenatal anxiety prevalence was 27% (95% CI 23%, 31%). Participants who were more frequently visited by ASHAs at home (aPR: 0.90; 95% CI 0.76, 0.98) and more frequently accompanied by ASHAs to their antenatal care visits (aPR: 0.86, 95% CI 0.78, 0.95) were less likely to report antenatal anxiety. ASHA home visits were protective for the most vulnerable women (primigravida and those experiencing domestic violence) and ASHA accompaniment to antenatal care visits was equally protective for all women. CONCLUSIONS ASHAs are valued for their contribution towards maternal health education and linking women of reproductive age to healthcare services. Our findings additionally suggest the important role ASHAs play in providing social support to pregnant women, particularly those who are most vulnerable to experiencing antenatal anxiety.
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Affiliation(s)
- Nivedita L. Bhushan
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Karl Krupp
- Public Health Research Institute of India, Mysore, Karnataka, India,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Kavitha Ravi
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Anisa Khan
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Rahul Shidhaye
- Pravara Institute of Medical Sciences, Loni, Maharashtra, India
| | | | - Vijaya Srinivas
- Public Health Research Institute of India, Mysore, Karnataka, India
| | - Purnima Madhivanan
- Public Health Research Institute of India, Mysore, Karnataka, India,Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA,Division of Infectious Diseases & Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson, Arizona, USA
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Koirala P, Chuemchit M. Depression and Domestic Violence Experiences Among Asian Women: A Systematic Review. Int J Womens Health 2020; 12:21-33. [PMID: 32021490 PMCID: PMC6970613 DOI: 10.2147/ijwh.s235864] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/03/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To determine the association of postpartum depression with domestic violence experiences among women in Asia. Background Postpartum depression (PPD) is an important cause of maternal morbidity as well as mortality. There is increasing evidence that domestic violence (DV) increases the risk of PPD. Methods We performed literature searches using the databases PUBMED, SCOPUS, Web of Science and Google Scholar, for studies published between January 2010 and May 2019. The keywords “postpartum”, “postnatal”, “depression”, and “violence” were used. Observational studies conducted within Asia, and written in the English language, were included. Results In the 38 studies included in this review (with 37,087 participants), the prevalence of PPD ranged between 8.2% to 70% and that of DV between 6.1% to 67.4%. There were 1.6 to 7.1 higher odds of PPD among sufferers of DV. Intimate partner violence (IPV) was the most relevant factor that women experiencing psychological abuse (which was the most prevalent form of IPV) were more at risk for, and violence/intimidation by other family members was also associated with PPD. Domestic violence increased the risk of suicidal ideation in PPD. Discussion The findings of the review unequivocally shows the association between domestic violence and PPD. Maternal mental health is a neglected area of healthcare in many parts of Asia. Likewise, domestic violence is a readily recognized, but inadequately addressed social issue. We recommend that healthcare workers be trained to recognize and support the women who are vulnerable to violence and depression during pregnancy and postpartum. Policies need to be developed at national and global levels to tackle these issues with utmost urgency.
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Affiliation(s)
- Pallavi Koirala
- College of Public Health Sciences, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
| | - Montakarn Chuemchit
- College of Public Health Sciences, Chulalongkorn University, Patumwan, Bangkok 10330, Thailand
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Shitu S, Geda B, Dheresa M. Postpartum depression and associated factors among mothers who gave birth in the last twelve months in Ankesha district, Awi zone, North West Ethiopia. BMC Pregnancy Childbirth 2019; 19:435. [PMID: 31752760 PMCID: PMC6873414 DOI: 10.1186/s12884-019-2594-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 11/12/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Postpartum depression is the most common complication of childbearing age women and is a considerable public health problem. The transition into motherhood is a difficult period that involves significant changes in the psychological, social and physiological aspects, and has increased vulnerability for the development of mental illness. More than 1 in 10 pregnant women and 1 in 20 postnatal women in Ethiopia suffer from undetected depression. METHODS Community based cross sectional study was conducted among 596 postpartum mothers in Ankesha District, North West Ethiopia, from February 01 to March 2, 2018. One stage cluster sampling technique was employed to get the study participants. The objective was to assess the prevalence and associated factors of postpartum depression among mothers who gave birth in the last Twelve months in Ankesha District, Awi Zone, North West Ethiopia, 2018. The interviewer-administered questionnaire was used to collect data and Eden Burg Postpartum Depression Scale was used to assess postpartum depression with cutoff point ≥8. The data were entered into Epi data version 3.1 and exported to SPSS version 24 for analysis. All variables with P < 0.25 in the bivariate analysis were included in the final model and statistical significance was declared at P < 0.05. RESULT In this study, a total of 596 study participants were involved making a response rate of 97.4%, the prevalence of postpartum depression was 23.7% with 95%CI: 20.3-27.2. From the participant mothers who are divorced/widowed/unmarried (AOR = 3.45 95%CI: 1.35-8.82), unwanted pregnancy (AOR = 1.95 95%CI: 1.14-3.33), unpreferred infant sex (AOR = 1.79 95%CI: 1.13-2.86), infant illness (AOR = 2.08 95%CI: 1.30-3.34) and low social support (AOR = 3.16 95% CI: 1.55-6.43) was independent predictors of postpartum depression. CONCLUSION Almost a quarter (23.7%) of women suffers from postpartum depression. Marital status, unwanted pregnancy, unwanted infant sex, infant illness, and low social support were independent predictors of postpartum depression. Therefore, integration of mental illness with maternal and child health care is important, information communication education and behavioral change communications on postpartum depression are better been given attention.
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Affiliation(s)
- Solomon Shitu
- Wolkite University College of Health and Medical Sciences, Wolkite, Ethiopia.
| | - Biftu Geda
- College of Health and Medical Sciences, School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- College of Health and Medical Sciences, School of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
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Sidhu GS, Sidhu TK, Kaur P, Lal D, Sangha NK. Evaluation of Peripartum Depression in Females. Int J Appl Basic Med Res 2019; 9:201-205. [PMID: 31681543 PMCID: PMC6822329 DOI: 10.4103/ijabmr.ijabmr_23_19] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 05/15/2019] [Accepted: 06/29/2019] [Indexed: 11/04/2022] Open
Abstract
Background Depression is the most common mental health condition affecting perinatal women and mothers worldwide. Worldwide, about 10% of pregnant women and 13% of women who have given birth experience a mental disorder, primarily depression. In developing countries like India, this is even higher, i.e., 15.6% during pregnancy and 19.8% after childbirth. The present study was initiated with the objective of studying the prevalence of depression among women in the peripartum period and to find the association of peripartum depression and its risk factors. Materials and Methods This was a hospital-based cross-sectional study, including mothers in antenatal and postnatal period. A sample size of 200 was calculated using Daniels' formula. A questionnaire was administered by the investigator in vernacular language by an interview technique for assessing awareness and behavior of all participants. The Edinburgh Postnatal Depression Scale was used to identify the patients at the risk of depression. Written informed consent was taken from every participant. Results The prevalence of peripartum depression was 14%. Younger age group (not <18 years), working female, joint family, first pregnancy, social support from in-laws, and not having desire/pressure for a male child were found to be associated with a lower prevalence of peripartum depression. Other variables which were not significantly associated with peripartum depression were education of the participants and their husbands and urban/rural locality. Conclusion The prevalence of peripartum depression is quite high and is negatively associated with first pregnancy, joint family, and working status.
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Affiliation(s)
- Gurkirat S Sidhu
- Department of Community Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Tanvir Kaur Sidhu
- Department of Community Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Prabhjot Kaur
- Department of Community Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
| | - Dhruvendra Lal
- Department of Community Medicine, CMC, Ludhiana, Punjab, India
| | - Navpreet K Sangha
- Department of Community Medicine, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India
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Upadhyay AK, Singh A, Singh A. Association between unintended births and risk of postpartum depression: Evidence from Ethiopia, India, Peru and Vietnam. SSM Popul Health 2019; 9:100495. [PMID: 31650000 PMCID: PMC6804781 DOI: 10.1016/j.ssmph.2019.100495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/05/2019] [Accepted: 10/03/2019] [Indexed: 12/29/2022] Open
Abstract
Previous studies have shown that unintended births adversely affect birth outcomes, child health and cognitive development in developing countries. However, only a few studies have examined the association between unintended births and risk of postpartum depression (PPD) in these countries. The study uses data from the first wave of Young Lives Study (YLS) conducted in 2002 in Ethiopia, India, Peru and Vietnam to examine the association between birth intention and the risk of PPD. Bivariate and multivariable logistic regressions are used to examine the association. Bivariate result indicates that the risk of PPD was substantially higher among mothers who reported an unintended birth as compared to mothers who reported an intended birth in each country. Results from multivariable logistic regression models indicate that unintended births were associated with higher risk of PPD in pooled data (odds ratio: 1.46, 95%CI. 1.29, 1.66), Ethiopia (odds ratio: 1.99, 95% CI. 1.58,2.50), and Peru (odds ratio: 1.29, 95% CI. 1.04, 1.59) compared with mothers having an intended birth. Results suggest that reducing unintended births might help in reducing the incidence of PPD among mothers in these countries. One of the most cost-effective interventions for reducing the incidence of unintended births is the availability of effective family planning programme.
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Affiliation(s)
| | - Abhishek Singh
- International Institute for Population Sciences, Mumbai, India
| | - Ashish Singh
- SJM School of Management, Indian Institute of Technology Bombay, India
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17
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Characteristics of perinatal depression in rural central, India: a cross-sectional study. Int J Ment Health Syst 2018; 12:68. [PMID: 30455730 PMCID: PMC6231264 DOI: 10.1186/s13033-018-0248-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 11/03/2018] [Indexed: 11/13/2022] Open
Abstract
Background Perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth. In India, increased priority accorded to mental health programs mean it is now possible to reduce the population-level burden of perinatal depression. In this secondary analysis of two studies, we aimed to describe the epidemiological features of depression among community- and facility-based samples of perinatal women from rural central India, and to describe the help-seeking behaviours from those women who screened positive for depression. Methods The Community Study was a multi-round population-based cross-sectional survey (n = 6087). The Facility Study was a multi-round facility-based cross-sectional survey (n = 1577). Both studies were conducted in Sehore District, Madhya Pradesh between 2013 and 2017. Field workers conducted structured interviews with perinatal women. The questionnaire had sections relating to sociodemographic characteristics, depression screening using the Patient’s Health Questionnaire (PHQ9), treatment seeking for depression-related symptoms, and disability. Using data pooled from both studies, we tested each characteristic for association with the total screening score and with screening positive for depression. Results We identified 224 perinatal women from the Community Study and 130 perinatal women from the Facility Study, of whom 8.8% and 18.5% screened positive for depression, respectively. For the continuous PHQ9 score, there was evidence of a “U” shaped association with age, and positive associations with pregnancy, disability score, suicidality and being a health facility attendee. For the binary PHQ9 score, there was evidence of positive associations with pregnancy, disability score, suicidality and being a health facility attendee. Conclusions This study highlights where the largest population-level variations in perinatal depression symptoms are present in this Indian sample, for which mental health service provision should be made a priority. Epidemiological evidence generated by this study, as well as new evidence on peer-delivered interventions for perinatal depression, must be utilized by policy-makers to prioritize mental health services for mothers along with maternal and child health services. Electronic supplementary material The online version of this article (10.1186/s13033-018-0248-5) contains supplementary material, which is available to authorized users.
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18
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Azale T, Fekadu A, Hanlon C. Postpartum depressive symptoms in the context of high social adversity and reproductive health threats: a population-based study. Int J Ment Health Syst 2018; 12:42. [PMID: 30069229 PMCID: PMC6064119 DOI: 10.1186/s13033-018-0219-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/14/2018] [Indexed: 01/13/2023] Open
Abstract
Background Postpartum depression is an important but neglected public health issue in low- and middle-income countries. The aim of this study was to assess postpartum depressive (PPD) symptoms and associated factors in a rural Ethiopian setting characterized by high social adversity and reproductive health threats. We hypothesized that infant gender preference would be associated with PPD symptoms. Methods A cross-sectional, population-based study was conducted in Sodo district, southern Ethiopia, between March and June 2014. A total of 3147 postpartum women (one to 12 months after delivery) were recruited and interviewed in their homes. The questionnaire included demographic, reproductive health and psychosocial factors in addition to a culturally validated measure of depressive symptoms, the Patient Health Questionnaire. Scores of 5 or more were indicative of high levels of PPD symptoms. Results The prevalence of high PPD symptoms was 12.2%, with 95% confidence interval (CI) between 11.1 and 13.4. Of these, 12.0% of the study participants had suicidal ideation. Preference of the husband for a boy baby was associated with PPD symptoms in univariate analysis (crude odds ratio 1.43: 95% CI 1.04, 1.91) but became non-significant after adjusting for confounders. In the final multivariable analysis, rural residence [adjusted odds ratio (aOR) 2.56: 95% CI 2.56, 4.19], grand multiparity (aOR 2.00: 1.22, 3.26), perinatal complications (aOR: 2.55: 1.89, 3.44), a past history of abortion (aOR 1.50: 1.07, 2.11), experiencing hunger in the preceding 1 month (aOR 2.38: 1.75, 3.23), lower perceived wealth (aOR 2.11: 1.19, 3.76), poor marital relationship (aOR 2.47: 1.79, 3.42), and one or more stressful events in the preceding 6 months (aOR 2.36: 1.82, 3.06) were associated significantly with high PPD symptoms. Conclusion PPD symptoms affected more than one in 10 women in this Ethiopian community setting. Social adversity and reproductive health threats were associated with poorer mental health. Interventions focusing on poor rural women with low access to care are necessary. This research can serve as an entry point for the adaptation of a psychosocial intervention.
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Affiliation(s)
- Telake Azale
- 1Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebaw Fekadu
- 3Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia.,4Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Charlotte Hanlon
- 2Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,5Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Hahn-Holbrook J, Cornwell-Hinrichs T, Anaya I. Economic and Health Predictors of National Postpartum Depression Prevalence: A Systematic Review, Meta-analysis, and Meta-Regression of 291 Studies from 56 Countries. Front Psychiatry 2018; 8:248. [PMID: 29449816 PMCID: PMC5799244 DOI: 10.3389/fpsyt.2017.00248] [Citation(s) in RCA: 342] [Impact Index Per Article: 48.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 11/07/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. METHODS We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. FINDINGS 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6-18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I2 = 98%), ranging from 3% (2-5%) in Singapore to 38% (35-41%) in Chile. Nations with significantly higher rates of income inequality (R2 = 41%), maternal mortality (R2 = 19%), infant mortality (R2 = 16%), or women of childbearing age working ≥40 h a week (R2 = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. INTERPRETATION The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Affiliation(s)
- Jennifer Hahn-Holbrook
- Department of Psychology, University of California, Merced, Merced, CA, United States
- Center for Excellence in Biopsychosocial Approaches to Health, Chapman University, Orange, CA, United States
| | | | - Itzel Anaya
- Department of Psychology, Palo Alto University, Palo Alto, CA, United States
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Upadhyay RP, Chowdhury R, Aslyeh Salehi, Sarkar K, Singh SK, Sinha B, Pawar A, Rajalakshmi AK, Kumar A. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ 2017; 95:706-717C. [PMID: 29147043 PMCID: PMC5689195 DOI: 10.2471/blt.17.192237] [Citation(s) in RCA: 161] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To provide an estimate of the burden of postpartum depression in Indian mothers and investigate some risk factors for the condition. METHODS We searched PubMed®, Google Scholar and Embase® databases for articles published from year 2000 up to 31 March 2016 on the prevalence of postpartum depression in Indian mothers. The search used subject headings and keywords with no language restrictions. Quality was assessed via the Newcastle-Ottawa quality assessment scale. We performed the meta-analysis using a random effects model. Subgroup analysis and meta-regression was done for heterogeneity and the Egger test was used to assess publication bias. FINDINGS Thirty-eight studies involving 20 043 women were analysed. Studies had a high degree of heterogeneity (I2 = 96.8%) and there was evidence of publication bias (Egger bias = 2.58; 95% confidence interval, CI: 0.83-4.33). The overall pooled estimate of the prevalence of postpartum depression was 22% (95% CI: 19-25). The pooled prevalence was 19% (95% CI: 17-22) when excluding 8 studies reporting postpartum depression within 2 weeks of delivery. Small, but non-significant differences in pooled prevalence were found by mother's age, geographical location and study setting. Reported risk factors for postpartum depression included financial difficulties, presence of domestic violence, past history of psychiatric illness in mother, marital conflict, lack of support from husband and birth of a female baby. CONCLUSION The review shows a high prevalence of postpartum depression in Indian mothers. More resources need to be allocated for capacity-building in maternal mental health care in India.
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Affiliation(s)
- Ravi Prakash Upadhyay
- Department of Community Medicine, Room 517, 5th floor, College Building, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | | | - Aslyeh Salehi
- School of Health and Human Sciences, Southern Cross University, Queensland, Australia
| | - Kaushik Sarkar
- Directorate of National Vector Borne Disease Control Programme, New Delhi, India
| | - Sunil Kumar Singh
- Department of Community Medicine, Room 517, 5th floor, College Building, Department of Community Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi 110029, India
| | - Bireshwar Sinha
- Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India
| | - Aditya Pawar
- Department of Psychiatry, Drexel University College of Medicine, Philadelphia, United States of America
| | | | - Amardeep Kumar
- Department of Psychiatry, Patna Medical College, Patna, Bihar, India
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Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry 2016; 3:973-982. [PMID: 27650773 PMCID: PMC5155709 DOI: 10.1016/s2215-0366(16)30284-x] [Citation(s) in RCA: 654] [Impact Index Per Article: 72.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 12/11/2022]
Abstract
Maternal depression, a non-psychotic depressive episode of mild to major severity, is one of the major contributors of pregnancy-related morbidity and mortality. Maternal depression (antepartum or post partum) has been linked to negative health-related behaviours and adverse outcomes, including psychological and developmental disturbances in infants, children, and adolescents. Despite its enormous burden, maternal depression in low-income and middle-income countries remains under-recognised and undertreated. In this Series paper, we systematically review studies that focus on the epidemiology of perinatal depression (ie, during antepartum and post-partum periods) among women residing in low-income and middle-income countries. We also summarise evidence for the association of perinatal depression with infant and childhood outcomes. This review is intended to summarise findings from the existing literature, identify important knowledge gaps, and set the research agenda for creating new generalisable knowledge pertinent to increasing our understanding of the prevalence, determinants, and infant and childhood health outcomes associated with perinatal depression. This review is also intended to set the stage for subsequent work aimed at reinforcing and accelerating investments toward providing services to manage maternal depression in low-income and middle-income countries.
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Affiliation(s)
- Bizu Gelaye
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA.
| | - Marta B Rondon
- Department of Medicine, Cayetano Heredia Peruvian University, Lima, Peru
| | - Ricardo Araya
- Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Michelle A Williams
- Department of Epidemiology, Harvard T H Chan School of Public Health, Boston, MA, USA
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