Antenatal depressive symptoms and perinatal complications: a prospective study in rural Ethiopia

BACKGROUND

Antenatal depressive symptoms affect around 12.3% of women in in low and middle income countries (LMICs) and data are accumulating about associations with adverse outcomes for mother and child. Studies from rural, low-income country community samples are limited. This paper aims to investigate whether antenatal depressive symptoms predict perinatal complications in a rural Ethiopia setting.

METHODS

A population-based prospective study was conducted in Sodo district, southern Ethiopia. A total of 1240 women recruited in the second and third trimesters of pregnancy were followed up until 4 to 12 weeks postpartum. Antenatal depressive symptoms were assessed using a locally validated version of the Patient Health Questionnaire (PHQ-9) that at a cut-off score of five or more indicates probable depression. Self-report of perinatal complications, categorised as maternal and neonatal were collected by using structured interviewer administered questionnaires at a median of eight weeks post-partum. Multivariate analysis was conducted to examine the association between antenatal depressive symptoms and self-reported perinatal complications.

RESULT

A total of 28.7% of women had antenatal depressive symptoms (PHQ-9 score ≥ 5). Women with antenatal depressive symptoms had more than twice the odds of self-reported complications in pregnancy (OR=2.44, 95% CI: 1.84, 3.23), labour (OR= 1.84 95% CI: 1.34, 2.53) and the postpartum period (OR=1.70, 95% CI: 1.23, 2.35) compared to women without these symptoms. There was no association between antenatal depressive symptoms and pregnancy loss or neonatal death.

CONCLUSION

Antenatal depressive symptoms are associated prospectively with self-reports of perinatal complications. Further research is necessary to further confirm these findings in a rural and poor context using objective measures of complications and investigating whether early detection and treatment of depressive symptoms reduces these complications.

Indigenous Categories of Distress and Dysfunction in South African Xhosa Children and Adolescents as Described by Indigenous Healers

There is a paucity of information on indigenous idioms and categories of distress in children and adolescents in South Af rica. Indigenous healers were asked to provide descriptions of indigenous idioms and categories of distress in children and adolescents in a predominantly Xhosa speaking community. The healers identified five indigenous categories of distress, namely ukuphaphazela, isimnyama esikolweni ukuthwasa, ukuphambana, amafufunyana. These are compared with available descriptions in the literature and differences in presentation and understanding are discussed. The study confirmed that indig enous categories of distress not only affect adults, but also children and adolescents, and that 'brain fag' also occurs in South Africa. The results of this study indicate that indigenous categories of distress such as amafufunyana, ukuthwasa and ukuphambana require an emic approach and may be best un derstood at the individual level. Etic approaches, such as inclusion in psychiatric epidemiological studies are not suit able for these categories because symptoms are not prioritized. Categories such as isimnyama esikolweni and ukuphaphazela, which are associated with more discrete symptoms, could fea sibly be included in epidemiological investigations.

Conceptualizing psychosis in Uganda: the perspective of indigenous and religious healers

A qualitative study, investigating the representations and explanatory models of ;madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood ;madness' as spiritual or physiological, whereas religious healers also held psychological models. Healers' understandings of ;madness' are inextricably linked with the historical and sociopolitical context and may be useful to individuals with psychotic experiences, however, it is likely that these models are dynamic and continually changing.

Somatic symptoms in depression: evaluation of their diagnostic weight in an African setting

BACKGROUND

Somatic symptoms are extremely common features of depression and other mental disorders in African countries such as Nigeria, but their weight in the diagnosis of depression is not certain.

AIM

To determine what weight should be assigned to these symptoms in comparison with other well-known symptoms in the diagnosis of depression.

METHOD

A sample of 829 persons completed the Patient Health Questionnaire which was earlier modified by the inclusion of the somatic symptoms being studied. Using principal component analysis and a logistic regression model, the contributions of these symptoms in comparison with others were determined.

RESULTS

Core depressive symptoms accounted for most of the total variance for depression. The somatic symptoms studied loaded separately from the core depressive symptoms and were not as good predictors of depression. A cognitive factor emerged as well as some somatic factors.

CONCLUSIONS

Although somatic symptoms may be florid among patients with depression, they have considerably less weight than core depressive symptoms in the diagnosis of depression. The emerging cognitive factor could be similar to that described by previous authors.

Cross-cultural Similarities in ADHD-Like Behaviour Amongst South African Primary School Children

This study investigates whether the Disruptive Behaviour Disorders (DBDs) rating scale measures the same constructs in South African as in Western cultures, and explores the differences in scale scores as a function of language, gender and age. Teacher ratings between 1997 and 1999 of the 18 DSM-IV symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in 6 094 primary school children of six language groups in the Limpopo Province of South Africa were collected and analysed. For all language groups, the results were consistent with a two-factor model of ADHD with correlated factors. There were gender and age effects on both scales. The prevalence rates for ADHD sub-types were in line with rates in the United States of America (US) and Europe. Similarities across language groups, as well as to results reported in the US and Europe, were striking. Despite the limitations discussed, teacher ratings of ADHD symptoms on the DBD scale can be used as a screening instrument in South Africa. Separate norms for different language groups are not indicated.

Effect of culture and environment on the phenomenology of delusions and hallucinations

BACKGROUND

The present study was conducted to compare the influence of culture and immediate environment on the phenomenology of schizophrenic symptoms by examining the actual content of delusions and hallucinations in three groups of schizophrenic patients.

METHOD

Pakistanis living in Britain (BP; N = 53), Pakistanis in Pakistan (PP; N = 98) and British White (BW; N = 50). The content of the patients' delusions and hallucinations was obtained from medical records and key-workers' reports from All-Saints Hospital, Birmingham and two psychiatric units in Lahore. All references to delusions and hallucinations were coded in accordance with the classification scheme developed for the Present State Examination (Wing et al., 1974).

RESULTS

Comparisons indicated greater differences in phenomenology of delusions and hallucinations between the Pakistani pair (BP vs. PP) than between the British groups (BP vs. BW). The findings suggested a stronger influence of the immediate environment on the pathogenesis of delusions and hallucinations.

CONCLUSIONS

The results are discussed with reference to the cultural and religious values of the ethnic groups.

The illusion of reality or the reality of illusion. Hallucinations and culture

BACKGROUND

The aim of this review is to integrate research findings on the role of sociocultural factors in hallucinations and to relate these factors to current psychological theory and research.

METHOD

The literature was surveyed by manual search, and the more reliable studies selected for the review.

RESULTS

One hundred and thirteen publications were scrutinised and 30 of them were included in this review.

CONCLUSIONS

Cross-cultural concepts of reality are related to the development and the threshold of hallucinations. Attitudes toward hallucinations tend to affect the emotional reaction to, and the degree of control of, these experiences. Awareness of these attitudes may help the diagnostician to distinguish between pathological and culturally sanctioned hallucinations. It is important that therapists consider the functional significance and meaning of hallucinations as well as the social context and the stimuli associated with them.