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Gyimah L, Agyepong IA, Owiredu D, Awini E, Yevoo LL, Ashinyo ME, Aye SGEV, Abbas S, Cronin de Chavez A, Mirzoev T, Danso-Appiah A. Tools for screening maternal mental health conditions in primary care settings in sub-Saharan Africa: systematic review. Front Public Health 2024; 12:1321689. [PMID: 39391163 PMCID: PMC11466175 DOI: 10.3389/fpubh.2024.1321689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 08/27/2024] [Indexed: 10/12/2024] Open
Abstract
Introduction In sub-Saharan Africa, pregnant and postpartum women with mental health problems are often missed in healthcare systems. To address this, a practical and simple screening tool for maternal mental health should be available to primary healthcare workers. An important step toward having such a tool is to assess the existing tools and their effectiveness in primary care settings. Methods We systematically searched PubMed, LILAC, CINAHL, Google Scholar, African Index Medicus, HINARI, and African Journals Online from inception to 31 January 2023, without language restriction. Reference lists of retrieved articles were reviewed and experts in the field were contacted for studies not captured by our searches. All retrieved records were collated in Endnote, de-duplicated, and exported to Rayyan for screening. Study selection and data extraction were done by at least two reviewers using a pre-tested flow chart and data extraction form. Disagreements between reviewers were resolved through discussion. We contacted primary authors for missing or insufficient information and conducted a content analysis of the psychometric properties of the tools. Results In total, 1,181 studies were retrieved by our searches, of which 119 studies were included in this review. A total of 74 out of 119 studies (62%) were screened for depression during pregnancy and or the postpartum period. The Edinburg Postpartum Depression Scale (EPDS) and the Patient Health Questionnaire (PHQ-9) were the most commonly used tools. In total, 12 studies reported specificity and sensitivity for tools for measuring depression (EPDS, PHQ-9, and Whooley) and psychological distress [Self Report Questionnaire (SRQ) and Kessler Psychological Distress Scale (KPDS)]. The average sensitivity and specificity of the EPDS reported were 75.5 and 76.5%, respectively, at a cut-off of ≥13. The EPDS appears to be the most acceptable, adaptable, user-friendly, and effective in screening for maternal mental health conditions during pregnancy and postpartum. However, the methodological approach varied for a particular tool, and documentation on the attributes was scanty. Conclusion The EPDS was the most commonly used tool and considered as most acceptable, adaptable, user-friendly, and effective. Information on the performance and psychometric properties of the vast majority of screening tools was limited. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022323558, identifier CRD42022323558 (PROSPERO).
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Affiliation(s)
- Leveana Gyimah
- Pantang Hospital, Accra, Ghana
- Faculty of Psychiatry, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Irene Akua Agyepong
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - David Owiredu
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
- Centre for Evidence Synthesis and Policy, University of Ghana, Accra, Ghana
| | - Elizabeth Awini
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
| | - Linda Lucy Yevoo
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
| | | | - Sorre Grace Emmanuelle Victoire Aye
- Dodowa Health Research Centre, Research and Development Division, Ghana Health Service, Dodowa, Ghana
- Faculty of Public Health, Ghana College of Physicians and Surgeons, Accra, Ghana
| | - Shazra Abbas
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Anna Cronin de Chavez
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Tolib Mirzoev
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Anthony Danso-Appiah
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Legon, Ghana
- Centre for Evidence Synthesis and Policy, University of Ghana, Accra, Ghana
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Faherty LJ, Gwokyalya V, Dickens A, McBain R, Ngo V, Nakigudde J, Nakku J, Mukasa B, Beyeza-Kashesya J, Wanyenze RK, Wagner GJ. Treatment of Perinatal Depression and Correlates of Treatment Response Among Pregnant Women Living with HIV in Uganda. Matern Child Health J 2023; 27:2017-2025. [PMID: 37354364 PMCID: PMC10564822 DOI: 10.1007/s10995-023-03741-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Perinatal depression is common among women living with HIV, but depression care is limited in low-resource settings. We examined (1) characteristics of women receiving Problem Solving Therapy (PST) versus antidepressant therapy (ADT), (2) treatment response by modality, and (3) correlates of treatment response. METHODS This analysis used data from 191 Ugandan women in the intervention arm of a cluster randomized controlled trial of task-shifted, stepped-care depression treatment for pregnant women living with HIV (PWLWH). Treatment response was defined as scoring < 5 on the nine-item Patient Health Questionnaire (PHQ-9). Bivariate analysis and multivariable logistic regression were used to examine characteristics of women by treatment group and correlates of treatment response. RESULTS Of 134 participants with depression, 129 (96%) were treated: 84 (65%) received PST and 45 (35%) received ADT. Severe depression at treatment initiation was more common in those receiving ADT (28.9% versus 4.8%, Fischer's Exact Test < 0.001). Treatment response was higher for PST (70/84; 83.3%) than ADT (30/45; 66.7%; p = .03). ADT side effects were rare and minor; no infants had serious congenital defects. Of 22 participants (19%) who did not respond to treatment, only five received intensified management. Social support and interpersonal violence were associated with treatment response (adjusted odds ratio, [aOR] = 3.06, 95% CI = 1.08-8.66 and aOR = 0.64, 95% CI = 0.44-0.93). DISCUSSION Both depression treatment modalities yielded high response rates in Ugandan PWLWH; ADT was well-tolerated. Our results highlight a need to build capacity to implement the stepped-care protocol for non-responders and screen for social support and interpersonal violence.
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Affiliation(s)
- Laura J Faherty
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02128, USA.
- Department of Pediatrics, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.
| | | | - Akena Dickens
- Makerere University, 7062 University Rd, Kampala, Uganda
| | - Ryan McBain
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02128, USA
| | - Vicky Ngo
- Graduate School of Public Health and Health Policy, City University of New York, 205 E 42nd St, New York, NY, 10017, USA
| | | | - Juliet Nakku
- Makerere University, 7062 University Rd, Kampala, Uganda
| | | | | | | | - Glenn J Wagner
- RAND Corporation, 1776 Main St, Santa Monica, CA, 90407, USA
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Psaros C, Stanton AM, Raggio GA, Mosery N, Goodman GR, Briggs ES, Williams M, Bangsberg D, Smit J, Safren SA. Optimizing PMTCT Adherence by Treating Depression in Perinatal Women with HIV in South Africa: A Pilot Randomized Controlled Trial. Int J Behav Med 2023; 30:62-76. [PMID: 35260947 PMCID: PMC9452601 DOI: 10.1007/s12529-022-10071-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND South Africa (SA) has the greatest HIV prevalence in the world, with rates as high as 40% among pregnant women. Depression is a robust predictor of nonadherence to antiretroviral therapy (ART) and engagement in HIV care; perinatal depression may affect upwards of 47% of women in SA. Evidence-based, scalable approaches for depression treatment and ART adherence in this setting are lacking. METHOD Twenty-three pregnant women with HIV (WWH), ages 18-45 and receiving ART, were randomized to a psychosocial depression and adherence intervention or treatment as usual (TAU) to evaluate intervention feasibility, acceptability, and preliminary effect on depressive symptoms and ART adherence. Assessments were conducted pre-, immediately post-, and 3 months post-treatment, and included a qualitative exit interview. RESULTS Most (67.6%) eligible individuals enrolled; 71% completed at least 75% of sessions. Compared to TAU, intervention participants had significantly greater improvements in depressive symptoms at post-treatment, β = - 11.1, t(24) = - 3.1, p < 0.005, 95% CI [- 18.41, - 3.83], and 3 months, β = - 13.8, t(24) = - 3.3, p < 0.005, 95% CI [- 22.50, - 5.17]. No significant differences in ART adherence, social support, or stigma were found. Qualitatively, perceived improvements in social support, self-esteem, and problem-solving adherence barriers emerged as key benefits of the intervention; additional sessions were desired. CONCLUSION A combined depression and ART adherence intervention appears feasible and acceptable, and demonstrated preliminary evidence of efficacy in a high-need population. Additional research is needed to confirm efficacy and identify dissemination strategies to optimize the health of WWH and their children. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03069417. Protocol available at https://clinicaltrials.gov/ct2/show/NCT03069417.
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Affiliation(s)
- Christina Psaros
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA.
- , Boston, USA.
| | - Amelia M Stanton
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA
| | - Greer A Raggio
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA
- National Center for Weight and Wellness, Washington, D.C., USA
| | - Nzwakie Mosery
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Georgia R Goodman
- Department of Psychiatry, Massachusetts General Hospital / Harvard Medical School, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Elsa S Briggs
- Department of Health Systems & Population Health, University of Washington, Seattle, WA, USA
- Department of Community Health Science, Boston University, Boston, MA, USA
| | - Marcel Williams
- Howard University College of Medicine, Washington, D.C., USA
| | | | - Jenni Smit
- MatCH Research Unit (MRU), Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of Witwatersrand, Durban, South Africa
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, USA
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Tredoux A, Phillander N, Williams H, Ward CL, Schrieff-Brown L. Investigating parenting factors, traumatic brain injury and callous and unemotional traits among high school students in a South African setting. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2022. [DOI: 10.1177/00812463221135256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aggressogenic parenting styles are associated with increased rates of callous and unemotional traits, and in turn, with antisocial behaviours. Traumatic brain injury is also associated with antisocial behaviour, but not callous and unemotional traits specifically. No study has previously investigated these three variables, aggressogenic parenting, traumatic brain injury, and callous and unemotional traits, in a single study. The study setting was Cape Town, South Africa. The sample included high school boys ( N = 54), aged 13–21 years in an observational, descriptive study. We hypothesised that boys who reported that they had sustained a traumatic brain injury and who had been exposed to aggressogenic parenting would display increased levels of callous and unemotional traits, and that those with traumatic brain injury but had experienced positive parenting would display lower levels of such traits. The main measures included the Comprehensive Health Assessment Tool, the Inventory of Callous/Unemotional traits, and the Alabama Parenting Questionnaire. Results show that almost 41% (22/54) of participants reported sustaining a traumatic brain injury. Aggressogenic parenting significantly moderated callous and unemotional traits only in participants with traumatic brain injury, F(1.46) = 4.76, p = .03, while positive parenting and substance use did not. In conclusion, traumatic brain injury in the presence of aggressogenic parenting is associated with greater callous and unemotional traits in this sample of adolescent boys.
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Affiliation(s)
- Aimee Tredoux
- Department of Psychology, ACSENT Laboratory, University of Cape Town, South Africa
| | - Nathan Phillander
- Department of Psychology, ACSENT Laboratory, University of Cape Town, South Africa
| | - Huw Williams
- Centre for Clinical Neuropsychology Research, University of Exeter, UK
| | | | - Leigh Schrieff-Brown
- Department of Psychology, ACSENT Laboratory, University of Cape Town, South Africa
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Abenova M, Myssayev A, Kanya L, Turliuc MN, Jamedinova U. Prevalence of postpartum depression and its associated factors within a year after birth in Semey, Kazakhstan: A cross sectional study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Subramoney S, Joshi SH, Wedderburn CJ, Lee D, Roos A, Woods RP, Zar HJ, Narr K, Stein DJ, Donald KA. The impact of prenatal alcohol exposure on gray matter volume and cortical surface area of 2 to 3-year-old children in a South African birth cohort. Alcohol Clin Exp Res 2022; 46:1233-1247. [PMID: 35581528 PMCID: PMC9357164 DOI: 10.1111/acer.14873] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 04/30/2022] [Accepted: 05/07/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND There is a growing literature that demonstrates the effects of prenatal alcohol exposure (PAE) on brain development in school-aged children. Less is known, however, on how PAE impacts the brain early in life. We investigated the effects of PAE and child sex on subcortical gray matter volume, cortical surface area (CSA), cortical volume (CV), and cortical thickness (CT) in children aged 2 to 3 years. METHODS The sample was recruited as a nested cross-sectional substudy of the Drakenstein Child Health Study. Images from T1-weighted magnetic resonance imaging were acquired on 47 alcohol-exposed and 124 control children (i.e., with no or minimal alcohol exposure), aged 2 to 3 years, some of whom were scanned as neonates. Brain images were processed through automated processing pipelines using FreeSurfer version 6.0. Subcortical and a priori selected cortical regions of interest were compared. RESULTS Subcortical volume analyses revealed a PAE by child sex interaction for bilateral putamen volumes (Left: p = 0.02; Right: p = 0.01). There was no PAE by child sex interaction effect on CSA, CV, and CT. Analyses revealed an impact of PAE on CSA (p = 0.04) and CV (p = 0.04), but not CT in this age group. Of note, the inferior parietal gyrus CSA was significantly smaller in children with PAE compared to control children. CONCLUSIONS Findings from this subgroup scanned at age 2 to 3 years build on previously described subcortical volume differences in neonates from this cohort. Findings suggest that PAE persistently affects gray matter development through the critical early years of life. The detectable influence of PAE on brain structure at this early age further highlights the importance of brain imaging studies on the impact of PAE on the young developing brain.
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Affiliation(s)
- Sivenesi Subramoney
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
| | - Shantanu H. Joshi
- Department of NeurologyUniversity of California Los AngelesLos AngelesCaliforniaUSA
- Department of BioengineeringUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Catherine J. Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Department of Clinical ResearchLondon School of Hygiene and Tropical MedicineLondonUK
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
| | - David Lee
- Department of BioengineeringUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Annerine Roos
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- SA MRC Unit on Risk and Resilience in Mental Disorders, Department of PsychiatryStellenbosch UniversityStellenboschSouth Africa
| | - Roger P. Woods
- Departments of Neurology, Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- Unit on Child & Adolescent Health, South African Medical Research Council (SAMRC)University of Cape TownCape TownSouth Africa
| | - Katherine L. Narr
- Departments of Neurology, Psychiatry and Biobehavioral SciencesUniversity of California Los AngelesLos AngelesCaliforniaUSA
| | - Dan J. Stein
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
- SU/UCT MRC Unit on Risk and Resilience in Mental DisordersUniversity of Cape TownCape TownSouth Africa
| | - Kirsten A. Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's HospitalUniversity of Cape TownCape TownSouth Africa
- The Neuroscience InstituteUniversity of Cape TownCape TownSouth Africa
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Khan S, Scorza P, Lovero KL, dos Santos P, Fumo W, Camara B, Oquendo MA, Wainberg ML, Fejo M, Duarte CS. Women's mental health in Mozambique: is maternity a protective factor? Glob Ment Health (Camb) 2022; 9:38-44. [PMID: 36618727 PMCID: PMC9806954 DOI: 10.1017/gmh.2022.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 12/16/2021] [Accepted: 01/02/2022] [Indexed: 01/11/2023] Open
Abstract
Backgroud Globally, women have been shown to have high rates of common mental disorders (CMDs). In low and middle-income countries (LMICs), women face significant challenges related to maternity. However, no study has compared mental health problems among pregnant/post-partum women, childless women of childbearing age, and women with children in a low-income country. We sought to compare the frequency of CMD and suicide risk in a sample of women presenting or accompanying patients in primary care in two Mozambican semi-urban settings. Methods We administered the MINI International Neuropsychiatric Interview to 853 women, of whom 220 (25.8%) were pregnant/post-partum, 177 (20.8%) were non-pregnant and childless, and 456 (53.5%) were non-pregnant and with children more than 1-year-old. Logistic regression models compared the likelihood of a psychiatric disorder across groups, adjusting for sociodemographic and chronic-illness covariates. Results We found a high frequency of CMD and suicide risk among all women in this low-income context sample. In adjusted models, no differences in rates of depression, anxiety, or panic disorder were observed among groups. However, suicide risk was higher in women without children than pregnant/post-partum women. Conclusion The frequency of CMD among women of childbearing age in our study was higher than documented rates in high-income countries and other LMIC. Additionally, we found that motherhood was not protective and that pregnancy and the postpartum period were not stages of increased risk for most disorders. This highlights the need to expand mental health services not only for perinatal women but all women of childbearing age in this and possibly similar settings.
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Affiliation(s)
- Saida Khan
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Pamela Scorza
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Kathryn L. Lovero
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Palmira dos Santos
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
| | - Wilza Fumo
- Department of Mental Health, Ministry of Health, Av. Eduardo Mondlane/Av. Salvador Allende P.O. Box 1613, Maputo, Mozambique
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Barbara Camara
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Maria A. Oquendo
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street Suite 200, Philadelphia, Pennsylvania, USA
| | - Milton L. Wainberg
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
| | - Marcelo Fejo
- Department of Psychiatry, Universidade Federal de São Paulo, Rua Major Marrigliano, 241, São Paulo, São Paulo, Brazil
| | - Cristiane S. Duarte
- Department of Psychiatry, New York State Psychiatric Institute and Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Dr. Unit #24, New York, New York, USA
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Nweke M, Ukwuoma M, Adiuku-Brown AC, Ugwu P, Nseka E. Characterization and stratification of the correlates of postpartum depression in sub-Saharan Africa: A systematic review with meta-analysis. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455057221118773. [PMID: 36039898 PMCID: PMC9434669 DOI: 10.1177/17455057221118773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/30/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022]
Abstract
Postpartum depression (PPD) is a common mental health challenge in resource-constrained sub-Saharan Africa (SSA). Characterizing its correlates will aid prediction, early detection, and pre-emptive interventions. This review aimed to systematically synthesize and stratify PPD correlates in sub-Saharan Africa. The review was structured as per the Preferred Reporting Item for Systematic Reviews and Meta-Analyses. We included studies that reported the correlates of PPD in SSA. We searched PubMed, Medline, CINAHL, Academic Search Complete, and PsycINFO for relevant peer-reviewed literature. The correlates of PPD constituted the primary outcome. A random effect model was fitted to estimate the pooled correlation coefficient per correlate. The clinical relevance of correlates was stratified based on strength of correlation (r) and recurrence (f). The mean age of the participants was 27.0 ± 6.0 years, and 68.6% of participants had completed at least secondary education. The correlates of PPD in SSA were intimate partner violence (IPV) ((risk weight (rw) = 2.8; r = 0.212 (confidence interval (CI): 0.11-0.31), poor social support (PSS) (rw = 1.9; r = 0.250 (0.133-0.361)), unwanted pregnancy (UP) (rw = 1.6; r = 0.279 (CI: 0.14-0.41); I2 = 95.89), and maternal age (MA) (rw = 0.96; r = 0.27 (CI: 0.154-0.37)), among others. A cumulative risk weight of ⩾0.95 was predictive of PPD and marks the critical point at which preemptive interventions should be instituted. The stratification of risk PPD factors and computation of risk stability index are useful in identifying the clinical significant risk factors. The provision of critical risk point will simplify early detection thus facilitating cost-effectiveness. Of the correlates of PPD in SSA, IPV, PSS, UP, and MA are the most important. Targeted screening and pre-emptive interventions for women with high risk weight may be a reasonable strategy both in the short and long term.
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Affiliation(s)
- Martins Nweke
- Department of Physiotherapy, Evangel
University Akaeze, Ebonyi State, Nigeria
| | - Maryjane Ukwuoma
- Department of Physiotherapy, University
of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ada C. Adiuku-Brown
- Department of Obstetrics and
Gynaecology, College of medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu,
Nigeria
| | - Princewill Ugwu
- Department of Physiology, University of
Nigeria Enugu Campus, Enugu, Nigeria
| | - Elizabeth Nseka
- Department of Medical Rehabilitation,
University of Nigeria Enugu Campus, Enugu, Nigeria
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Mohamuud SA, Abukar MI, Ahmed MY, Ali MA, Abdurahman IA, Mohamed MH, Ali MA. Postpartum Depression and Associated Factors among Mothers Who Gave Birth in the Last 12 Months in Mogadishu Somalia, Community Based Cross-Sectional Study. Health (London) 2022. [DOI: 10.4236/health.2022.1410076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Brown S, Sprague C. Health care providers' perceptions of barriers to perinatal mental healthcare in South Africa. BMC Public Health 2021; 21:1905. [PMID: 34670531 PMCID: PMC8528557 DOI: 10.1186/s12889-021-11954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 09/27/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Perinatal mental disorders are a leading contributor to morbidity and mortality during pregnancy and postpartum, and are highly treatable when identified early. However, many women, especially in low and middle-income countries, lack access to routine identification and treatment of mental illness in public health settings. The prevalence of perinatal depression and anxiety disorders, common mental disorders, is three times higher for South African women relative to women in high-income countries. The public health system has begun to integrate mental health into maternal care, making South Africa a relevant case study of perinatal mental healthcare. Yet studies are few. We sought to investigate healthcare providers' perceptions of the barriers to early identification and screening of common perinatal mental disorders in public health facilities in South Africa. METHODS Employing qualitative methods, we used purposive sampling to identify study participants, supplemented by snowball sampling. From September 2019-June 2020, we conducted in-depth interviews with 24 key informants in South Africa. All interviews were recorded and transcribed verbatim. We used a thematic approach to generate initial analytical themes and then conducted iterative coding to refine them. We adapted a delivery systems' framework to organise the findings, depicted in a conceptual map. RESULTS Reported barriers to early identification and treatment of mental illness in the perinatal period encompassed four levels: (1) structural factors related to policies, systems and resources; (2) socio-cultural factors, including language and cultural barriers; (3) organisational factors, such as lack of provider preparation and training and overburdened clinics; and (4) individual patient and healthcare provider factors. CONCLUSION Barriers act across multiple levels to reduce quality mental health promotion and care, thereby creating an environment where inequitable access to identification of mental disorders and quality mental health services was embedded into systems and everyday practice. Integrated interventions across multiple levels are essential to improve the early identification and treatment of mental illness in perinatal women in South Africa. We provide recommendations derived from our findings to overcome barriers at each of the four identified levels.
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Affiliation(s)
- Shelley Brown
- Department of Health Sciences, Sargent College of Health and Rehabilitation Sciences, Boston University, Boston, MA USA
- Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA USA
- Center for Peace, Democracy and Development, Department of Conflict Resolution, Human Security and Global Governance, University of Massachusetts Boston, Boston, MA USA
| | - Courtenay Sprague
- Department of Conflict Resolution, Human Security and Global Governance, McCormack Graduate School of Policy and Global Studies, University of Massachusetts Boston, Boston, MA USA
- Center for Peace, Democracy and Development, Department of Conflict Resolution, Human Security and Global Governance, University of Massachusetts Boston, Boston, MA USA
- Department of Nursing, College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA USA
- Faculty of Health Sciences, University of the Witwatersrand (Wits), Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
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Silverman DT, Killion JP, Evans D, Coetzee L, Rockers PC, Hamer DH. Postpartum Mental Health in Rural South Africa: Socioeconomic Stressors and Worsening Mental Health. Matern Child Health J 2021; 26:434-440. [PMID: 34665355 DOI: 10.1007/s10995-021-03268-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study aimed to characterize patterns of worsening mental health during the postpartum period among women in rural areas of Limpopo Province, South Africa, and to identify correlates with household demographic factors. METHODS We collected data on maternal mental health symptoms shortly after birth and then again 7 months postpartum using the World Health Organization self-reporting questionnaire (SRQ-20) from December 2017 to November 2018. The absolute change in SRQ-20 symptom score was calculated to determine worsening mental health over the postpartum period. Linear regressions were performed to investigate factors associated with mental health symptom scores at varying postpartum time points. RESULTS We found increased reporting of poor mental health symptoms at 7 months postpartum as compared to shortly after birth (n = 224). Worsening maternal mental health over the postpartum period was associated with higher SRQ-20 symptom score shortly after birth (p < 0.001) and reported food insecurity at 7 months (p < 0.001). SRQ-20 symptom scores in the postpartum period were not associated with breastfeeding in the past 24 h reported at 7 months postpartum (p = 0.08). CONCLUSIONS FOR PRACTICE Women in rural South Africa, like women in many settings, may be vulnerable to worsening postpartum mental health when they lack sufficient socioeconomic resources and when they have pre-existing depressive/anxiety symptoms.
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Affiliation(s)
| | | | - Denise Evans
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lezanie Coetzee
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter C Rockers
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Infectious Disease Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Mokwena KE. Neglecting Maternal Depression Compromises Child Health and Development Outcomes, and Violates Children's Rights in South Africa. CHILDREN-BASEL 2021; 8:children8070609. [PMID: 34356588 PMCID: PMC8303702 DOI: 10.3390/children8070609] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/12/2021] [Accepted: 07/14/2021] [Indexed: 11/16/2022]
Abstract
The intention of the South African Children’s Act 38 of 2005 is to provide guarantees for the protection and promotion of optimum health and social outcomes for all children. These guarantees are the provision of basic nutrition, basic health care and social services, optimal family or parental care, as well as protection from maltreatment, neglect and abuse services. However, despite these guarantees, child and maternal mortality remain high in South Africa. The literature identifies maternal depression as a common factor that contributes to negative health and social outcomes for both mothers and their children. Despite the availability of easy-to-use tools, routine screening for maternal depression is not carried out in public health services, which is the source of services for the majority of women in South Africa. The results are that the mothers miss out on being diagnosed and treated for maternal depression, which results in negative child outcomes, such as malnutrition, as well as impacts on mental, social and physical health, and even death. The long-term impacts of untreated maternal depression include compromised child cognitive development, language acquisition and deviant behaviors and economic disadvantage in later life. The author concludes that the neglect of screening for, and treatment of maternal depression therefore violates the constitutional rights of the affected children, and goes against the spirit of the Constitution. The author recommends that maternal and child health services integrate routine screening for maternal depression, which will not only satisfy the Constitutional mandate, but also improve the health and developmental outcomes of the children and reduce child mortality.
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Affiliation(s)
- Kebogile Elizabeth Mokwena
- Department of Public Health, Sefako Makgatho Health Sciences University, Molotlegi Drive, Ga-Rankuwa, Pretoria 0204, South Africa
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Atuhaire C, Rukundo GZ, Nambozi G, Ngonzi J, Atwine D, Cumber SN, Brennaman L. Prevalence of postpartum depression and associated factors among women in Mbarara and Rwampara districts of south-western Uganda. BMC Pregnancy Childbirth 2021; 21:503. [PMID: 34247576 PMCID: PMC8272966 DOI: 10.1186/s12884-021-03967-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 06/25/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a significant cause of maternal morbidity and has severe consequences on the well-being of mothers, new-borns, families, and communities. PPD reduces the mother's response to the child's needs. In severe cases, mothers suffering from PPD are prone to postpartum psychosis, commit suicide and, in rare cases, infanticide. We aimed to determine the prevalence and understand the factors associated with PPD among mothers in southwestern Uganda. METHODS This was a cross-sectional study between November 2019 and June 2020 among 292 mothers, 6 to 8 weeks' postpartum. Mothers were selected from three health facilities in southwestern Uganda and enrolled using stratified consecutive sampling. Postpartum depression was clinically diagnosed using the Diagnostic and Statistical Manual of Mental Disorders V. The factors associated with PPD were assessed by using a structured interviewer administered questionnaire. The factors were analyzed using bivariate chi square analyses and multivariate logistic regression. RESULTS Overall prevalence of PPD was 27.1% (95% CI: 22.2-32.5). This did not vary by the number of previous births or mode of birth. Five factors associated with PPD were low perceived social support, HIV positive status, rural residence, obstetrical complications and the baby crying excessively. CONCLUSION AND RECOMMENDATIONS Prevalence of PPD in Mbarara and Rwampara districts is higher than what has previously been reported in Uganda indicating an urgent need to identify pregnant women who are at increased risk of PPD to mitigate their risk or implement therapies to manage the condition. Midwives who attend to these mothers need to be empowered with available methods of mitigating prevalence and consequences of PPD. Women who are HIV positive, residing in rural settings, whose babies cry excessively, having low social support systems and who have birth complications may be a particularly important focus for Ugandan intervention strategies to prevent and reduce the prevalence of PPD.
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Affiliation(s)
- Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda.
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Grace Nambozi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Joseph Ngonzi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Daniel Atwine
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Samuel Nambile Cumber
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
| | - Laura Brennaman
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology (MUST), Mbarara, Uganda
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Ashenafi W, Mengistie B, Egata G, Berhane Y. The role of intimate partner violence victimization during pregnancy on maternal postpartum depression in Eastern Ethiopia. SAGE Open Med 2021; 9:2050312121989493. [PMID: 33552514 PMCID: PMC7841856 DOI: 10.1177/2050312121989493] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Intimate partner violence during pregnancy is a strong predictor of maternal postpartum depression. In Ethiopia, evidence on the association of intimate partner violence during pregnancy with postpartum depression is very limited. To design appropriate intervention, it is thus important to understand how postpartum depression varies as a function of the type and severity of intimate partner violence victimization during pregnancy. The aim of this study is to explore the association of different types of intimate partner violence during pregnancy and its severity with postpartum depression in Eastern Ethiopia. Method: A community-based cross-sectional study was conducted from January to October 2018. The study included a sample of 3015 postpartum women residing in Eastern Ethiopia. The cutoff point for postpartum depression was defined as ⩾13 points according to the Edinburgh Postnatal Depression Scale. The prevalence ratio with 95% confidence intervals was calculated, and the association between the main predictor (i.e. intimate partner violence during pregnancy) and the outcome variable (postpartum depression) was determined using log binomial regression model. Results: 16.3% (95% confidence interval: 14.9–17.7) of women experienced postpartum depression. After controlling potential confounding factors, the prevalence of postpartum depression among women exposed to severe physical intimate partner violence during pregnancy was 1.98 times higher as compared to those not exposed to physical intimate partner violence during pregnancy (adjusted prevalence ratio = 1.98; 95% confidence interval: 1.53–2.54). Exposure to psychological intimate partner violence during pregnancy was found to increase the prevalence of postpartum depression by 1.79 as compared to non-exposure to psychological intimate partner violence during pregnancy (adjusted prevalence ratio = 1.79; 95% confidence interval: 1.48–2.18). Conclusion: The study provides evidence that psychological and severe physical intimate partner violence during pregnancy were significantly associated with maternal postpartum depression. Screening of pregnant women for intimate partner violence and providing them the necessary support can minimize the risk to postpartum depression.
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Affiliation(s)
- Wondimye Ashenafi
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Bezatu Mengistie
- Department of Environmental Health Science, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gudina Egata
- Addis Ababa University College of Health Sciences, Public Health Nutrition Department, Addis Ababa, Ethiopia
| | - Yemane Berhane
- Department of Epidemiology, Addis Continental Institute of Public Health, Addis Ababa, Ethiopia
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15
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Woldeyohannes D, Tekalegn Y, Sahiledengle B, Ermias D, Ejajo T, Mwanri L. Effect of postpartum depression on exclusive breast-feeding practices in sub-Saharan Africa countries: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:113. [PMID: 33557766 PMCID: PMC7869485 DOI: 10.1186/s12884-020-03535-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/29/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Postpartum depression (PPD) is a serious mood disorder that affects behavioural, physical and mental health of women and newborn after childbirth. Although a wide range of research have been conducted on maternal and infant health outcomes, the effect of postpartum depression on exclusive breastfeeding practices remains ambiguous, and needs addressing. The aim of this study was to assess the effect of postpartum depression on exclusive breast feeding practices in sub-Saharan African countries. METHODS PubMed, Google Scholar, Science Direct and Cochrane Library were systematically searched for relevant articles published between 2001 and 2020. STATA version 14 was used to calculate the pooled odd ratio with 95% confidence intervals (95% CI). The DerSimonian and Laird random effects meta-analysis was used to measure the effect of postpartum depression on exclusive breast feeding practices. The heterogeneity and publication bias were assessed by using I2 test statistics and Egger's test, respectively. This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. RESULT A total of 1482 published articles and gray literatures were retrieved from different databases. Additional articles were identified from the reference list of identified reports and articles. After assessment of obtained articles, studies not meeting the inclusion criteria were excluded. Twenty six studies involving 30,021 population met the inclusion criteria were included in this review. In sub Saharan Africa the overall estimated level of postpartum depression was 18.6% (95% CI: 13.8, 23.4). This review found that postpartum depression had no significant effect on exclusive breast feeding practices (OR = 0.46, 95% CI: 0.18, 1.14). CONCLUSION In Sub Saharan Africa, the prevalence of postpartum depression was lower than the report of World Health Organization for developing Country in 2020. This review reveled that maternal postpartum depression has no significant effect on exclusive breast feeding practices. Thus, the investigators strongly recommend the researchers to conduct primary studies using strong study design in sub-Saharan Africa.
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Affiliation(s)
- Demelash Woldeyohannes
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia.
| | - Yohannes Tekalegn
- Department of Public Health, College Health Science, Madda Walabu University, Bale Robe, Ethiopia
| | - Biniyam Sahiledengle
- Department of Public Health, College Health Science, Madda Walabu University, Bale Robe, Ethiopia
| | - Dejene Ermias
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Tekele Ejajo
- Department of Public Health, College of Medicine and Health Science, Wachemo University, Hossana, Ethiopia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5001, Australia
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Social and Demographic Factors Associated with Postnatal Depression Symptoms among HIV-Positive Women in Primary Healthcare Facilities, South Africa. Healthcare (Basel) 2021; 9:healthcare9010065. [PMID: 33445414 PMCID: PMC7826739 DOI: 10.3390/healthcare9010065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 12/31/2020] [Accepted: 01/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Mothers living with HIV are at risk for mental health problems, which may have a negative impact on the management of their HIV condition and care of their children. Although South Africa has a high prevalence of HIV, there is a dearth of studies on sociodemographic predictors of postnatal depression (PND) among HIV-positive women in South Africa, even in KwaZulu Natal, a province with the highest prevalence of HIV in the country. Objective: The objective of the study was to determine sociodemographic factors associated with the prevalence of postnatal depression symptoms among a sample of HIV-positive women attending health services from primary healthcare facilities in Umhlathuze District, KwaZulu Natal. Methods: A quantitative cross-sectional survey was used to collect data from 386 HIV-positive women who had infants aged between 1 and 12 weeks. The Edinburgh Postnatal Depression Scale (EPNDS), to which sociodemographic questions were added, was used to collect data. Results: The prevalence of PND symptoms among this sample of 386 HIV-positive women was 42.5%. The age of the mothers ranged from 16 to 42 years, with a mean of 29 years. The majority of the mothers were single or never married (85.5%; n = 330), living in a rural setting (81.9%; n = 316%), with a household income of less than R 2000 (estimated 125 USD) per month (64.9%; n = 120). The government child support grant was the main source of income for most of the mothers (53%; n = 183). PND symptoms were significantly associated with the participant’s partner having other sexual partners (p-value < 0.001), adverse life events (p-value = 0.001), low monthly income (p-value = 0.015), and being financially dependent on others (p-value = 0.023). Conclusion: The prevalence of PND symptoms among the sample is high, with a number of social and demographic factors found to be significantly associated with PND. This requires the consideration of sociodemographic information in the overall management of both HIV and postnatal depression. Addressing the impact of these factors can positively influence the health outcomes of both the mother and the baby.
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Phukuta NSJ, Omole OB. Prevalence and risk factors associated with postnatal depression in a South African primary care facility. Afr J Prim Health Care Fam Med 2020; 12:e1-e6. [PMID: 33354984 PMCID: PMC7736693 DOI: 10.4102/phcfm.v12i1.2538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/08/2020] [Accepted: 08/13/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The prevalence and factors that influence postnatal depression (PND) vary according to context. AIM To determine the prevalence and factors associated with PND in the postnatal clinic of a large community health centre. SETTING This study was conducted at Levai Mbatha Community healthcare centre, in Evaton, South of Gauteng. METHOD In a cross-sectional study, the Edinburg Postnatal Depression Scale (EPDS) was administered on 227 consecutive mothers during postnatal clinic visits. In addition, sociodemographic and clinical information were collected. Analysis included descriptive statistics, chi-square test and logistic regression. A score of greater than 13 on the EPDS screened positive for PND. RESULTS Participants' mean age was 27 years, and most completed less than grade 12 education (52.4%), were single (55.5%), were employed or had a working partner (60%) and had no previous PND (97%). The proportion of participants screening positive was 38.8%. In the adjusted logistic regression, completing only primary school education (odds ratio [OR]: 9.11; 95% confidence interval [CI]: 1.03-80.22; p = 0.047), using contraceptive prior to index pregnancy (OR: 2.05; 95% CI: 1.12-3.72; p = 0.019) and reporting a thought of self-harm or infanticide (OR: 7.08; 95% CI: 5.79-22.21; p = 0.000) significantly increased the risk of PND. In contrast, having a relationship with the father of the index child (OR: 0.42; 95% CI: 0.18-0.94; p = 0.037) mitigated this risk. CONCLUSION The proportion of women screening positive for PND was high in the study setting and was concomitant with significant risk of suicide or infanticide. This highlights the need to screen and consider PND as a vital sign during postnatal visits, especially in the face of low educational attainment, failed contraception and poor or no relationship with the father of the index child.
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Affiliation(s)
- Nyundu S J Phukuta
- Division of Family Medicine, Department of Family Medicine, Faculty of Sciences, University of The Witwatersrand, Johannesburg.
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18
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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: 0.8] [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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Clinical and Obstetric Risk Factors for Postnatal Depression in HIV Positive Women: A Cross Sectional Study in Health Facilities in Rural KwaZulu-Natal. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228425. [PMID: 33202528 PMCID: PMC7697934 DOI: 10.3390/ijerph17228425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
Postnatal depression (PND) remains underdiagnosed and undertreated in different socio-economic backgrounds in South Africa. This study determined the prevalence of and clinical and obstetric risk factors for PND symptoms among HIV positive women in health facilities in a rural health district in South Africa. The Edinburgh Postnatal Depression Scale was used to measure PND from 386 women who had delivered a live infant. More than half (58.5%) tested HIV positive during the current pregnancy. The prevalence of PND symptoms was 42.5%. Logistic regression analysis yielded significant associations between clinical and obstetric variables of pre-term baby (p-value < 0.01), baby health status p-value < 0.01), baby hospitalization, (p-value < 0.01), and knowing the baby’s HIV status (p-value = 0.047). Maternal variables associated with PND were level of education (p-value < 0.01), monthly income (p-value < 0.01), and source of income (p-value = 0.05). At multivariate analysis, none of the clinical and obstetrical risk factors were independently associated with the PND. The high prevalence of PND symptoms underscore the need to integrate routine screening for PND in prevention of mother to child transmission of HIV programmes to enable early diagnosing and treatment of PND.
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Arach AAO, Nakasujja N, Nankabirwa V, Ndeezi G, Kiguli J, Mukunya D, Odongkara B, Achora V, Tongun JB, Musaba MW, Napyo A, Zalwango V, Tylleskar T, Tumwine JK. Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study. PLoS One 2020; 15:e0240409. [PMID: 33048971 PMCID: PMC7553273 DOI: 10.1371/journal.pone.0240409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Deaths during the perinatal period remain a big challenge in Africa, with 38 deaths per 1000 pregnancies in Uganda. The consequences of these deaths can be detrimental to the women; some ending up with postpartum depression. We examined the association between perinatal death and postpartum depression among women in Lira district, Northern Uganda. METHODS We conducted a community-based cross-sectional study of 1,789 women. Trained research assistants screened women for postpartum depressive symptoms on day 50 postpartum using the Edinburgh postpartum depression scale (EPDS). Socio-demographic, economic, birth and survival status of the neonate were collected during pregnancy and within one week postpartum. We used generalized estimating equation for the Poisson family with a log link using Stata to estimate the prevalence ratio of the association between postpartum depressive symptoms (EPDS scores ≥14) and perinatal death. Mothers who lost their babies between 7-49 days postpartum were excluded. RESULTS Of the 1,789 participants symptomatically screened for postpartum depression, 377 (21.1%) [95% confidence interval (95%CI): 17.2%, 23.0%] had probable depressive symptoms. The prevalence of postpartum depressive symptoms among the 77 women who had experienced perinatal death (37 stillbirths and 40 early neonatal deaths (≤7 days of life)) was 62.3% [95% CI: 50.8%, 72.6%] compared to 19.2% [95% CI: 17.4%, 21.2%], among 1,712 with live infants at day 50 postpartum. Women who had experienced a perinatal death were three times as likely to have postpartum depressive symptoms as those who had a live birth [adjusted prevalence ratio 3.45 (95% CI: 2.67, 4.48)]. CONCLUSIONS The prevalence of postpartum depressive symptoms, assessed by EPDS, was high among women who had had a perinatal death in Northern Uganda. Women experiencing a perinatal death need to be screened for postpartum depressive symptoms in order to intervene and reduce associated morbidity.
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Affiliation(s)
- Anna Agnes Ojok Arach
- Faculty of Health Sciences, Department of Nursing and Midwifery, Lira University, Lira, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Kiguli
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Beatrice Odongkara
- Department of Paediatrics and Child Health, Gulu University, Gulu, Uganda
| | - Vincentina Achora
- Department of Obstetrics and Gynaecology, Gulu University, Gulu, Uganda
| | - Justin Bruno Tongun
- Department of Paediatrics and Child Health, University of Juba, Juba, South Sudan
| | - Milton Wamboko Musaba
- Faculty of Health Sciences, Department of Obstetrics and Gynaecology, Busitema University, Mbale, Uganda
| | - Agnes Napyo
- Faculty of Health Sciences, Department of Public Health, Busitema University, Tororo, Uganda
| | - Vivian Zalwango
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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21
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Atuhaire C, Brennaman L, Cumber SN, Rukundo GZ, Nambozi G. The magnitude of postpartum depression among mothers in Africa: a literature review. Pan Afr Med J 2020; 37:89. [PMID: 33244352 PMCID: PMC7680231 DOI: 10.11604/pamj.2020.37.89.23572] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/21/2020] [Indexed: 11/12/2022] Open
Abstract
Introduction postpartum depression (PPD) continues to become one of the major maternal health challenges across the globe but there is a paucity of recent data on its magnitude in Africa. This study was motivated by the need to update the current magnitude of PPD in Africa based on various assessment tools. Methods a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively. Results a total of 21 articles met the study criteria. Fifteen articles used the EPDS and six used other assessment tools. Postpartum depression among studies that used EPDS tool ranged from 6.9% in Morocco to 43% in Uganda and 6.1% in Uganda to 44% in Burkina Faso among studies that used other depression assessment tools. Sensitivity and specificity results of the EPDS ranged from 75%-100% and 87%-98% respectively. Conclusion despite the limited dearth of literature, the magnitude of PPD in Africa remains high which suggests that PPD is still a neglected illness and calls for immediate interventions. EPDS is an effective tool with high sensitivity and specify in varying study contexts.
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Affiliation(s)
- Catherine Atuhaire
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Laura Brennaman
- Nova Southeastern University College of Nursing, Fort Myers Campus, 3650 Colonial Court, Fort Myers, Florida, United State of America
| | - Samuel Nambile Cumber
- Centre for Health Systems Research and Development, University of the Free State, Bloemfontein, South Africa.,Office of the Dean, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa.,School of Health Systems and Public Health, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Institute of Health and Care Sciences, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Godfrey Zari Rukundo
- Faculty of Medicine, Department of Psychiatry, Mbarara University of Science and Technology, Uganda
| | - Grace Nambozi
- Faculty of Medicine, Department of Nursing, Mbarara University of Science and Technology, Mbarara, Uganda
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The Need for Universal Screening for Postnatal Depression in South Africa: Confirmation from a Sub-District in Pretoria, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17196980. [PMID: 32987674 PMCID: PMC7579387 DOI: 10.3390/ijerph17196980] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/15/2020] [Accepted: 09/19/2020] [Indexed: 12/16/2022]
Abstract
Although postnatal depression (PND) is a worldwide public health problem, it is relatively higher in developing countries, including countries in Sub-Saharan Africa. Postnatal depression is not routinely screened for in primary healthcare facilities in South Africa, despite its reported compromise on mother and child health. The purpose of this study was to determine the prevalence of, as well as factors associated with, postnatal depression in a sample of clinic attendees in a sub district in Tshwane, South Africa. A quantitative and cross-sectional survey was conducted in a sample of 406 women in three healthcare facilities. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data from women who had infants between the ages of 0 and 12 months. The cut-off point for the EPDS for the depressed category was a score of 13 out of a maximum of 30. The majority of the women (57.14%, n = 232) had scores of 13 and above, which is indicative of postnatal depressive symptoms. On logistic regression, postnatal depressive symptoms were significantly associated with lack of support in difficult times (p < 0.001, 95% CI 10.57–546.51), not having the preferred sex of the baby (p = 0.001, 95% CI 0.37–0.58), low household income (p < 0.001, 95% CI 1.23–1.67), and an older baby (p = 0.005, 95% CI 1.21–1.49). The results show the high proportion of women who have postnatal depression but remain undiagnosed and untreated, and therefore confirm the need for routine screening for postnatal depressive symptoms in primary healthcare facilities, which are used by the majority of women in South Africa.
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Dadi AF, Miller ER, Mwanri L. Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2020; 20:416. [PMID: 32698779 PMCID: PMC7374875 DOI: 10.1186/s12884-020-03092-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/03/2020] [Indexed: 02/08/2023] Open
Abstract
Background Postnatal Depression (PND) is a mood disorder that steals motherhood and affects the health and development of a newborn. While the impact of PND on motherhood and newborn in developed countries are well described, its epidemiology and health consequences in infant is not well known in middle-and low-income countries. The objective of this review was to determine the burden and association of PND with adverse infant health outcomes in low-and middle- income countries. Methods We searched observational studies written in the English language and conducted in middle-and low-income countries between December 1st, 2007, and December 31st, 2017. The CINHAL, MEDLINE, Emcare, PubMed, Psych Info, and Scopus databases were searched for the following search terms: PND, acute respiratory infection, pneumonia, diarrhea, exclusive breastfeeding, common infant illnesses, and malnutrition. We excluded studies in which the primary outcomes were not measured following a standardized approach. We have meta-analyzed the estimates from primary studies by adjusting for possible publication bias and heterogeneity. The analysis was conducted in Stata 14. The study was registered in PROSPERO protocol number CRD42017082624. Result Fifty-eight studies on PND prevalence (among 63,293 women) and 17 studies (among 32,454 infants) on infant health outcomes were included. PND prevalence was higher in the low-income countries (Pooled prevalence (PP) = 25.8%; 95%CI: 17.9–33.8%) than in the middle-income countries (PP = 20.8%; 95%CI: 18.4–23.1%) and reached its peak in five to ten weeks after birth. Poor obstetric history and social support, low economic and educational status, and history of exposure to violence were associated with an increased risk of PND. The risk of having adverse infant health outcomes was 31% higher among depressed compared to non-depressed postnatal mothers (Pooled relative risk (PRR) = 1.31; 95%CI: 1.17–1.48). Malnutrition (1.39; 1.21–1.61), non-exclusive breastfeeding (1.55; 1.39–1.74), and common infant illnesses (2.55; 1.41–4.61) were the main adverse health outcomes identified. Conclusions One in four and one in five postnatal mothers were depressed in low and middle-income countries, respectively. Causes of depression could be explained by social, maternal, and psychological constructs. High risk of adverse infant health outcomes was associated with PND. Timely screening of PND and evidence-based interventions were a pressing need in low and middle-income countries.
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Affiliation(s)
- Abel Fekadu Dadi
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. .,College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5001, Australia.
| | - Emma R Miller
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5001, Australia
| | - Lillian Mwanri
- College of Medicine and Public Health, Flinders University, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, SA, 5001, Australia
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Duma N, Madiba T. The prevalence of peripartum depression and its relationship to mode of delivery and other factors among mothers in Ixopo, Kwazulu-Natal, South Africa. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1177/0081246320931355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Peripartum depression is a common mental health condition among mothers, occurring between 4 and 6 weeks post-delivery. This study sought to evaluate the influence that mode of delivery and other related factors have on the development of peripartum depression. The study was carried out in Ixopo, in the KwaZulu-Natal province of South Africa. All women whose infants had been delivered within 4–6 weeks of the study were included until the sample size of 276 was reached. A demographic questionnaire and an Edinburgh postnatal depression scale were administered. Mothers with Edinburgh postnatal depression scale scores of ⩾10 were considered to be suffering from peripartum depression, and peripartum depression was ruled out in those with a score of <10. A total of 110 mothers had Edinburgh postnatal depression scale score ⩾10, thus presenting a prevalence of 39.9%. Of these, 51 (46.4%) had undergone normal vaginal delivery and 59 had a Caesarean section (53.6%). Of the latter group, 23 had elective Caesarean section and 36 had emergency Caesarean section. Logistic regression showed no significant association between peripartum depression and mode of delivery ( p = .074); women who had delivered their child by emergency Caesarean section were three times more likely to develop peripartum depression compared to those who had delivered via normal vaginal delivery (odds ratio: 2.733, confidence interval: 1.002–7.452). Unemployment was found to have a statistically significant association with peripartum depression ( p = .003) and single motherhood was not associated ( p = .425). Emergency Caesarean sections and unemployment were shown to be risk factors for peripartum depression.
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Affiliation(s)
- Noxolo Duma
- Discipline of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, South Africa
| | - Thandinkosi Madiba
- Discipline of Surgery, School of Clinical Medicine, University of KwaZulu-Natal, South Africa
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Dadi AF, Mwanri L, Woodman RJ, Azale T, Miller ER. Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling. Reprod Health 2020; 17:63. [PMID: 32381087 PMCID: PMC7206662 DOI: 10.1186/s12978-020-00912-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 04/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Postnatal depression (PND) is the second most common cause of disability and the most common complication after childbirth. Understanding the potential mechanisms by which the stress process can lead to PND is an important step for planning preventive interventions for PND. This study employed a stress process model to explore the possible pathways leading to PND in Gondar Town, Ethiopia. METHODS A community-based cohort study was conducted in 916 pregnant women, who were assessed for depression in their second or third trimester of pregnancy and re-assessed two to eight weeks after birth. Women with an Edinburgh Postnatal Depression Scale (EPDS) ≥6 were considered to be depressed. Modified Poisson regression was used to identify the independent predictors of PND. A Generalized Structural Equation Modeling (GSEM) was then used to explore the direct and indirect effects of stressors and their mediators on PND. RESULTS The prevalence and incidence proportion of PND were 9.27% (95%CI: 7.45, 11.36) and 7.77% (95%CI: 6.04, 9.79), respectively and 2.1% of the women demonstrated symptoms of depression within the study period. PND was independently predicted by having limited postnatal care services, Antenatal Depression (AND) and a Common Mental Disorders (CMD) before pregnancy, (IRR = 1.8; 95%CI: 1.0, 3.2), 1.6(95%CI: 1.4, 1.7), and 2.4 (95%CI: 1.4, 4.3) respectively). In SEM, AND (standardized total effect = 0.36) and a CMD before pregnancy (standardized total effect = 0.11) had both a direct and an indirect positive effect on PND scores. Low birth weight (standardized β = 0.32) and self-reported labor complications (standardized β = 0.09) had direct effects only on PND scores. CONCLUSION The observed incidence and prevalence of PND in Ethiopia were lower than in previous studies. A CMD before pregnancy and low birth weight (LBW) increased PND scores, and these effects were in part mediated via antenatal depression and labor complications. Early detection and treatment of depression before or during pregnancy could either directly or indirectly reduce the risk of labor complications and PND. Interventions that reduce LBW or improve the uptake of postnatal care might reduce PND incidence.
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Affiliation(s)
- Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
- Flinders University, College of Medicine and Public Health, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, 5001, SA, Australia.
| | - Lillian Mwanri
- Flinders University, College of Medicine and Public Health, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, 5001, SA, Australia
| | - Richard J Woodman
- Flinders University, College of Medicine and Public health, Center for Epidemiology and Biostatistics, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, 5001, SA, Australia
| | - Telake Azale
- Department of Health Promotion and Behavioral Sciences, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Emma R Miller
- Flinders University, College of Medicine and Public Health, Health Sciences Building, Sturt Road, Bedford Park, Adelaide, 5001, SA, Australia
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Dadi AF, Akalu TY, Baraki AG, Wolde HF. Epidemiology of postnatal depression and its associated factors in Africa: A systematic review and meta-analysis. PLoS One 2020; 15:e0231940. [PMID: 32343736 PMCID: PMC7188237 DOI: 10.1371/journal.pone.0231940] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 04/05/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Postnatal depression (PND) is a major cause of negative health-related behaviors and outcomes during infancy, childhood and adolescent period. In Africa, the burden of postnatal depression is high. However, it is under-investigated hence under-treated. To fill this information gap and to advise further interventions, we aimed at analyzing its epidemiology in Africa. Methods We searched observational studies conducted in Africa and published in between 01/01/2007 and 30/06/2018 in CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases. We assessed the quality of the studies using the Newcastle Ottawa Scale (NOS) and included studies with good quality. We evaluated the heterogeneity using the Higgins I2 statistics. We used a random-effects model to pool estimates. We assessed publication bias using the funnel plot and Egger's test statistics and adjusted using Tweedie’s and Duval Trim and Fill analysis. The protocol has been registered in the PROSPERO (Protocol No. CRD42018100461). Results Nineteen studies involving 40,953 postnatal mothers were part of this systematic review and meta-analysis. The overall pooled prevalence of PND was 16.84% (95% CI: 14.49% –19.19%). The odds of having PND was higher among women with a poor obstetric condition (POR = 2.11; 95% CI: 1.11–4.01) and history of adverse birth and infant health outcomes (POR = 2.85; 95% CI: 1.29–6.25). Having a history of common mental health disorders (POR = 2.47; 95% CI: 1.51–4.04), poor social support (POR = 2.06; 95% CI: 1.05–4.05), lower economic status (POR = 2.38; 95% CI: 1.75–3.23), and those who had exposure to a different form of intimate partner violence (POR = 2.87; 95% CI: 1.60–5.16) had higher odds of PND. Conclusion While robust prevalence studies are scarce, our review indicated a high prevalence rate of postnatal depression. The analysis also identified postpartum women at increased risk of PND. Therefore, there is a need to design and escalate comprehensive strategies to decrease its burden, focusing on those women at risk of PND.
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Affiliation(s)
- Abel Fekadu Dadi
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
- College of Medicine and Public Health, Discipline of Public Health, Flinders University, Adelaide, Australia
| | - Temesgen Yihunie Akalu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Adhanom Gebreegziabher Baraki
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haileab Fekadu Wolde
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
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Govender D, Naidoo S, Taylor M. Antenatal and Postpartum Depression: Prevalence and Associated Risk Factors among Adolescents' in KwaZulu-Natal, South Africa. DEPRESSION RESEARCH AND TREATMENT 2020; 2020:5364521. [PMID: 32411457 PMCID: PMC7204344 DOI: 10.1155/2020/5364521] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/21/2019] [Accepted: 12/13/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Maternal depression is a major public health concern as it affects both mothers and their children. Antenatal depression, which is often underdiagnosed, has been associated with preterm labour, low birth weight, and intrauterine growth restriction. Research has demonstrated that postpartum depression is associated with mother-infant bonding impairment, child abuse, child neglect, maternal substance abuse, and self-harm. Globally, the prevalence of depression in pregnant and postpartum adolescents varies. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant and postpartum adolescents in KwaZulu-Natal, South Africa. METHODS Data were generated by means of a descriptive cross-sectional study that was conducted between June and November 2017 utilizing a sample of 326 adolescent females accessing maternal health services in a medium-sized rural peripheral district hospital in Ugu, Southern KwaZulu-Natal. The Edinburgh Postnatal Depression Scale questionnaire was used to screen participating pregnant and postnatal adolescents for depression. A cut-off score of ≥13 was used to identify pregnant and postnatal adolescents with symptoms of depression. The data were analysed using R software. RESULTS The prevalence of depression among the pregnant participants was 15.9% (21/132), whereas it was 8.8% (17/194) among the postpartum participants. Antenatal depression was associated with physical violence (adjusted odds ratio (aOR) 6.47, 95% CI 1.36-30.53, p = 0.01) and verbal abuse (adjusted odds ratio (aOR) 4.8, 95% CI 1.5-15.16, p = 0.006). The pregnant participants who indicated they received a lot of support from their partners were 0.93% less likely to have depression. Postnatal depression was associated with physical violence (adjusted odds ratio (aOR) 7.32, 95% CI 1.66-29.44, p = 0.005), verbal abuse (adjusted odds ratio (aOR) 4.3, 95% CI 1.03-15.79, p = 0.03), and intimate partner violence (adjusted odds ratio (aOR) 9.58, 95% CI 1.58-48.82, p = 0.008). CONCLUSION The prevalence of antenatal depression was higher than postpartum depression in the study sample. In light of the findings, maternal healthcare professionals are cautioned to consider the mental health of pregnant and postpartum adolescents who seek their services at health facilities.
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Affiliation(s)
- Desiree Govender
- KwaZulu-Natal Department of Health, South Africa
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, South Africa
- Developing Research Innovation Localisation and Leadership (DRILL) Fellow, South Africa
| | - Saloshni Naidoo
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, South Africa
| | - Myra Taylor
- School of Nursing and Public Health, Discipline of Public Health Medicine, University of KwaZulu-Natal, South Africa
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Pellowski JA, Bengtson AM, Barnett W, DiClemente K, Koen N, Zar HJ, Stein DJ. Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum. J Affect Disord 2019; 259:279-287. [PMID: 31454590 PMCID: PMC6851529 DOI: 10.1016/j.jad.2019.08.052] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 06/24/2019] [Accepted: 08/17/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. METHODS Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. RESULTS Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. LIMITATIONS Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. CONCLUSIONS Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.
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Affiliation(s)
- Jennifer A. Pellowski
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA,Corresponding author.
| | - Angela M. Bengtson
- Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA
| | - Whitney Barnett
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Kira DiClemente
- Department of Behavioral and Social Sciences, International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Nastassja Koen
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
| | - Heather J. Zar
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital and South African Medical Research Council (SAMRC) Unit on Child & Adolescent Health, University of Cape Town, South Africa
| | - Dan J. Stein
- Department of Psychiatry and Mental Health and South African Medical Research Council (SAMRC) Unit on Risk & Resilience in Mental Disorders, Neuroscience Institute, University of Cape Town, South Africa
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Dlamini LP, Mahanya S, Dlamini SD, Shongwe MC. Prevalence and factors associated with postpartum depression at a primary healthcare facility in Eswatini. S Afr J Psychiatr 2019; 25:1404. [PMID: 31745444 PMCID: PMC6851868 DOI: 10.4102/sajpsychiatry.v25i0.1404] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 08/21/2019] [Indexed: 11/14/2022] Open
Abstract
Background Routine mental health screening has not been integrated into maternal and child health (MCH) services in many developing countries, including in Eswatini (formerly Swaziland). As a result, the burden of postpartum depression (PPD) is not well understood and thus PPD remains untreated in such settings. Aim To describe the prevalence and factors associated with PPD among women seeking postnatal and child welfare services at a primary healthcare facility in Eswatini. Setting The study was conducted at the King Sobhuza II Public Health Unit in Manzini, Eswatini. Methods This was a cross-sectional study that used convenience sampling and the Edinburgh Postnatal Depression Scale (EPDS) to screen for depression among 114 mothers during the first 6 weeks of postpartum at the King Sobhuza II Public Health Unit, Manzini, Eswatini. Multiple logistic regression analysis was conducted to determine sociodemographic and clinical factors associated with PPD. Results A majority of the participants were older than 24 years (52.6%) and unemployed (64.9%), whereas 47.4% screened positive for PPD (≥ 13 score). Adjusting for other covariates, those who were unemployed (odds ratio [OR] = 3.20, 95% confidence interval [CI] 1.17–8.79) and with poor social support from their partners (OR = 9.41, 95% CI: 3.52–25.14) were more likely to be depressed, while those who attended antenatal classes fewer than four times were less likely to be depressed (OR = 0.32, 95% CI 0.11–0.92). Conclusion We found a high prevalence of PPD. There is a need to introduce routine maternal mental health screening during the postpartum period to ensure early detection and treatment of PPD.
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Affiliation(s)
- Lindelwa P Dlamini
- Department of Nursing Science, Faculty of Health Sciences, Eswatini Medical Christian University, Mbabane, Eswatini.,International Advanced Program in Nursing, Department of Nursing, National Cheng Kung University, Tainan, Taiwan
| | | | - Sizakele D Dlamini
- Department of Psychology, Faculty of Applied Social Sciences, Eswatini Medical Christian University, Mbabane, Eswatini
| | - Mduduzi C Shongwe
- Department of Midwifery Science, Faculty of Health Sciences, University of Eswatini, Mbabane, Eswatini
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Abebe A, Tesfaw G, Mulat H, Hibdye G, Yohannes K. Postpartum depression and associated factors among mothers in Bahir Dar Town, Northwest Ethiopia. Ann Gen Psychiatry 2019; 18:19. [PMID: 31523264 PMCID: PMC6734592 DOI: 10.1186/s12991-019-0244-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 08/29/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Postpartum depressive symptoms are the occurrence of major depressive episode within 4 weeks following delivery. Globally, 10%-20% of mothers suffer from depressive symptoms during their postpartum course. Therefore, assessing postpartum depressive symptoms has a pivotal role in ensuring that their mental health needs are met. METHODS An institution-based cross-sectional study was conducted including 511 mothers coming for postnatal care service in public health centers in Bahir Dar Town. Data were collected using a pre-tested, structured, and interviewer-administered questionnaire, while the Edinburgh Postnatal Depression Scale (EPDS) was used to assess individuals' depressive symptoms. The systematic random sampling technique was employed to recruit the study participants. Adjusted odds ratio with a 95% confidence interval (CI) was used to declare the statistical significance of the factors. RESULTS Postpartum depressive symptoms among mothers were found to be 22.1 (95%, CI 18.6%, 25.8%). In multivariate logistic regression, stressful life events (AOR = 4.46, 95% CI 2.64, 7.54), domestic decision making (AOR = 4.26, 95% CI 2.54, 7.14), unplanned pregnancy (AOR = 1.86, 95% CI 1.02, 3.41), partner violence (AOR = 3.16, 95% CI 1.76, 5.67), and hospitalization of their babies (AOR = 2.24, 95% CI 1.17, 4.310) were factors significantly associated with postpartum depressive symptoms. CONCLUSIONS Postpartum depressive symptoms among mothers were common in the study area. Stressful life events, lack of empowerment in domestic decision making, intimate partner violence, unplanned pregnancy, and hospitalization of their baby were factors significantly associated with postpartum depression. The Ministry of Health needs to give training on how to screen postpartum depressive symptoms among mothers, and interventions that would address the above factors would benefit in tackling further complications.
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Affiliation(s)
- Amsale Abebe
- Department of Psychiatry, Felege Hiwot Referral Hospital, Bahir Dar University, Bahar Dar, Ethiopia
| | - Getachew Tesfaw
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Haregewoine Mulat
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getahun Hibdye
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Sciences, Dilla University, 419, Dilla, Ethiopia
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Atukunda P, Muhoozi GKM, Westerberg AC, Iversen PO. Nutrition, Hygiene and Stimulation Education for Impoverished Mothers in Rural Uganda: Effect on Maternal Depression Symptoms and Their Associations to Child Development Outcomes. Nutrients 2019; 11:nu11071561. [PMID: 31373314 PMCID: PMC6683265 DOI: 10.3390/nu11071561] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/05/2019] [Accepted: 07/09/2019] [Indexed: 01/10/2023] Open
Abstract
Optimal nutrition improves child development, and impaired development is associated with maternal depression symptoms, in particular in low resource settings. In this follow-up of an open cluster-randomized education trial, we examined its effects among mothers in rural Uganda on their depression symptoms and the association of these symptoms to child development. The education comprised complementary feeding, stimulation, and hygiene. We assessed 77 intervention mothers and 78 controls using Beck Depression Inventory-II (BDI-II) and Center for Epidemiologic Studies Depression Scale (CES-D) scores. Child development was assessed with Bayley Scales of Infant and Toddler Development-III (BSID-III) composite scores for cognitive, language and motor development. Compared to controls, the intervention reduced depression symptoms’ scores with mean (95% CI) differences: −8.26 (−11.49 to −1.13, p = 0.0001) and −6.54; (−8.69 to −2.99, p = 0.004) for BDI II at 20–24 and 36 months, respectively. Similar results were obtained with CES-D. There was a negative association of BDI-II scores and BSID-III cognitive and language scores at 20–24 (p = 0.01 and 0.008, respectively) and 36 months (p = 0.017 and 0.001, respectively). CES-D associations with BSID-III cognitive and language scores showed similar trends. BSID-III motor scores were associated with depression scores at 36 months for both BDI-II and CES-D (p = 0.043 and 0.028, respectively). In conclusion, the group education was associated with reduced maternal depression scores. Moreover, the depression scores were inversely associated with child cognitive and language development outcomes.
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Affiliation(s)
- Prudence Atukunda
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway.
| | - Grace K M Muhoozi
- Department of Human Nutrition and Home Economics, Kyambogo University, P.O. Box 1, 256 Kyambogo, Uganda
| | - Ane C Westerberg
- Institute of Health Sciences, Kristiania University College, Kirkegata 24 Oslo, Norway
| | - Per O Iversen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, 0372 Oslo, Norway
- Department of Hematology, Oslo University Hospital, 0372 Oslo, Norway
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, 7505 Tygerberg, South Africa
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Ng’oma M, Meltzer-Brody S, Chirwa E, Stewart RC. "Passing through difficult times": Perceptions of perinatal depression and treatment needs in Malawi - A qualitative study to inform the development of a culturally sensitive intervention. PLoS One 2019; 14:e0217102. [PMID: 31211776 PMCID: PMC6581242 DOI: 10.1371/journal.pone.0217102] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 05/03/2019] [Indexed: 01/23/2023] Open
Abstract
PURPOSE This study was conducted to explore the perceptions of perinatal women and key maternal care health workers about perinatal depression and the health service needs required to inform development of a culturally sensitive and acceptable psychosocial intervention. METHODS This qualitative study used a descriptive exploratory design; it is the first phase of a larger mixed methods study aimed at adapting a psychosocial intervention for perinatal depression. We conducted in-depth interviews with 22 women who screened positive for depression using a locally validated Chichewa version of the Edinburgh Postnatal Depression Scale at antenatal and postnatal clinics in 1 rural and 1 urban health care setting in Lilongwe District, Malawi. We also conducted 10 key informant interviews with maternal care health workers. Informed consent was obtained from all participants. An interview guide was used to guide enquiry about perceptions of perinatal depression and health service needs. Interviews were transcribed, translated and analysed using content analysis approach. RESULTS Perinatal depression was recognized as a common mental health problem that affected self-care activities and functioning of women in the perinatal period. Financial difficulties, relationship problems (polygamy, lack of support, neglect, and infidelity), traumatic events (intimate partner violence and loss) and fear of birth outcomes were identified as causes of depression. All study participants acknowledged the need for support and an intervention that will address the identified challenges. Additionally, they viewed strengthening the health delivery system as crucial to effectively address their needs and gaps identified in the system. CONCLUSION The results of this study support plans to develop a family focused intervention for perinatal depression in Malawi addressing relationship, psychosocial and economic issues. It also highlights the importance of strengthening the health delivery system especially at primary care level where the majority of women access care in Malawi and across Sub-Saharan Africa.
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Affiliation(s)
- Mwawi Ng’oma
- Department of Mental Health, University of Malawi College of Medicine, Blantyre, Malawi
- St John of God Hospitaller Services, Malawi, Lilongwe, Malawi
| | - Samantha Meltzer-Brody
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Ellen Chirwa
- Faculty of Midwifery, University of Malawi Kamuzu College of Nursing, Blantyre, Malawi
| | - Robert C. Stewart
- Department of Mental Health, University of Malawi College of Medicine, Blantyre, Malawi
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Mokhele I, Nattey C, Jinga N, Mongwenyana C, Fox MP, Onoya D. Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa. PLoS One 2019; 14:e0214849. [PMID: 30947293 PMCID: PMC6448929 DOI: 10.1371/journal.pone.0214849] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 03/17/2019] [Indexed: 12/03/2022] Open
Abstract
Background Postpartum depression (PPD) is a common mental health condition that can compromise the quality of life and functional capacity of mothers and cause health and developmental problems in children born to affected mothers. Objectives We set out to measure the prevalence of PPD comparing postpartum HIV-1 infected women with pre-pregnancy HIV care experience, newly diagnosed (in latest pregnancy) HIV-1 infected women and HIV negative women, and to identify predictors of major PPD among these women in a peri-urban clinic in South Africa. Methods We conducted a cross-sectional survey of 1151 adult (≥18 years) postpartum HIV-1 infected (690) and HIV negative (461) women who delivered up to 30 days before study enrolment, interviewed after their first post-natal visit (3–6 days post- delivery) at Midwife Obstetric Units in Gauteng, South Africa. PPD was categorised into no depression (CES-D 10 total score <5), low to medium depression (CES-D 10 total score ≥5 and <10) and major depressive symptoms (CES-D 10 total score≥10). We used ordered logistic regression to identify predictors of postpartum depression and report adjusted odds ratio (aOR) and 95% confidence intervals (CIs). Results Overall 288 (25.0%) women screened positive for postpartum depression, a total of 168 (14.6%) women had low to medium PPD and 120 (10.4%) had major PPD. A higher proportion of HIV negative women experienced PPD, 129/461 (28.0%) among HIV negative vs. 159/690 (23.0%) among HIV-1 infected. Among HIV positive women, there was no meaningful difference in PPD between newly HIV diagnosed and those diagnosed before the most recent pregnancy (aOR 1.3, 95% confidence interval (CI): 0.9–1.8). Predictors of PPD among HIV positive women were living with friends/in a house-share (aOR 0.5 for house-share vs. own home, 95% CI: 0.3–0.9), and attending antenatal care (ANC) for the most recent pregnancy (aOR 0.2 for ANC attendance vs. no ANC attendance, 95% CI: 0.0–0.5). Living with friends/in a house-share was also a predictor of PPD among HIV negative women (aOR 0.4 for house-share vs. own home, 95% CI: 0.2–0.8). Conclusions and recommendations Targeted symptom screening based on identified risk factors should be considered for postpartum women to increase PPD case-finding and referral to specialised social support services.
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Affiliation(s)
- Idah Mokhele
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Cornelius Nattey
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nelly Jinga
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Constance Mongwenyana
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Matthew P. Fox
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Global Health, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Dorina Onoya
- Health Economics and Epidemiology Research Office, Department of Internal Medicine, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Toru T, Chemir F, Anand S. Magnitude of postpartum depression and associated factors among women in Mizan Aman town, Bench Maji zone, Southwest Ethiopia. BMC Pregnancy Childbirth 2018; 18:442. [PMID: 30428843 PMCID: PMC6237000 DOI: 10.1186/s12884-018-2072-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 10/23/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The first 12 months after childbirth may represent a high-risk time for depression. In Ethiopia there is a paucity of evidence about its magnitude and associated factors during that period. So, the aim of this study was to assess the magnitude of depression and associated factors among postpartum women in Mizan Aman town, Bench Maji Zone, Southwest Ethiopia 2017. METHODS A community based cross- sectional study design was employed from March 15 to April 15, 2017. Four hundred sixty women were selected using multistage random sampling technique. Face to face interview were conducted using structured questionnaires and standardized scales. Bivariate logistic regression analysis was done to see crude association between each independent variable and outcome variable. Variables with p value < 0.25 in bivariate analysis were entered to multivariable logistic regression analysis to control for confounding. Adjusted odd ratios with 95%CI were calculated to identify independent predictors of postpartum depression. RESULT Four hundred fifty-six postpartum women participated in the study giving a response rate of 99%. The magnitude of postpartum depression among the study population was 102 (22.4%, 95% CI: 19.84-24.96). Postpartum depression is relatively higher in the first 6 weeks after birth. Postpartum depression is higher among mothers with age range between 18 and 23 years (aOR 3.89 95%CI: 1.53-9.90), unplanned pregnancy (aOR 3.35 95% CI: 1.701-6.58), child having sleeping problems (aOR 3.72 95%CI: 1.79-7.72), domestic violence (aOR 2.86 95%CI 1.72-8.79), unsatisfied marital relation (aOR 2.72 95% CI 1.32-5.62), poor social support (aOR 4.30 95% CI 1.79-10.30), history of previous depression (aOR 7.38 95% CI 3.12-17.35) and substance use (aOR 5.16 95% CI 2.52-10.60). CONCLUSION The magnitude of postpartum depression was high. This underlines health care planners' needs to incorporate screening strategies for depression following childbirth.
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Affiliation(s)
- Tigistu Toru
- Mizan Aman college of health science, Mizan Aman, Ethiopia.
| | - Fantaye Chemir
- School of nursing and midwifery, Jimma University, Jimma, Ethiopia
| | - Susan Anand
- School of nursing and midwifery, Jimma University, Jimma, Ethiopia
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January J, Chimbari MJ. Prevalence and factors associated with postnatal depression among women in two rural districts of Manicaland, Zimbabwe. S Afr J Psychiatr 2018; 24:1176. [PMID: 30473880 PMCID: PMC6244063 DOI: 10.4102/sajpsychiatry.v24i0.1176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 08/29/2018] [Indexed: 11/21/2022] Open
Abstract
Background Low- and middle-income countries are disproportionately affected by postnatal depression (PND). High prevalence of PND in urban Zimbabwe has been reported but the situation in rural settings is largely unknown and this is one of the first studies to report prevalence of PND in Chipinge and Mutasa districts. Objectives This study explored the prevalence and associated factors of PND among women attending postnatal care services in two rural districts of Chipinge and Mutasa, Manicaland, Zimbabwe between August and September 2017. Methods One hundred and ninety-two women were recruited consecutively as they attended postnatal services at 7 days and 42 days post-delivery. The Diagnostic and Statistical Manual for Mental Disorders, fifth edition criteria was used to classify depression among participants. Prevalence of PND and 95.0% confidence intervals (CIs) were estimated and associations with key socio-demographic and risk factors assessed. Results The mean age of participants was 23.7 years (standard deviation = 6.14). Pooled prevalence of PND across the two districts was 26.0% (95% CI: 19.04–31.74). There was a higher prevalence of PND in Mutasa (31.0%) as compared to Chipinge (21.48%) but this was not statistically significant (p = 0.142). Having insufficient food in the household, intimate partner violence and having a child with birthweight under 2500 g significantly increased the likelihood of PND twofold: adjusted odds ratio (aOR) = 2.8 (95% CI: 1.2–6.1), aOR = 2.5 (95% CI: 1.2–5.3) and aOR = 2.4 (95% CI: 1.1–5.6), respectively. Conclusion The high prevalence of PND and its associated risk factors indicates the need for routine screening and targeted interventions for PND in Zimbabwe, especially in rural areas.
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Affiliation(s)
- James January
- Department of Psychiatry, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, South Africa
| | - Moses J Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, South Africa
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The association between social support and postpartum depression in women: A cross sectional study. Women Birth 2018; 32:e238-e242. [PMID: 30274879 DOI: 10.1016/j.wombi.2018.07.014] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 07/19/2018] [Accepted: 07/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Prevalence of postpartum depression is estimated to be about 10-15% worldwide. Many risk factors are supposed to play a role leading a new mother to maternal postpartum depression which can considerably affect the baby, mother, family and also the society. OBJECTIVE To investigate the prevalence of maternal postpartum depression and its association with social support. METHODS Using a cross-sectional study, 200 new mothers who attended three teaching hospitals in Tehran, Iran were selected with a convenience sampling. Postpartum depression was assessed using the Iranian version of Edinburgh Postpartum Depression Scale and women's levels of social support were measured using the Iranian version of Social Support Questionnaire. RESULTS Prevalence of postpartum depression was 43.5% in new mothers. The mean (±Standard Deviation) score of social support network was 2.09±0.99; which is lower in depressed mothers in comparison to non-depressed mothers (1.78±0.87 vs. 2.33±1.00 respectively, P<0.001). A reverse significant association was found between social support and postpartum depression after adjusting for confounding variables such as past history of depression, illness of baby and medication consumption during pregnancy (Odds Ratio=0.47, 95% Confidence Interval=0.33-0.67). CONCLUSION The bigger the social network of a mother, the less postpartum depression occurs. It is suggested to educate the family about the very important role of social support and improve it in every aspect of health care in order to prevent postpartum depression.
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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: 3.8] [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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Arifin SRM, Cheyne H, Maxwell M. Review of the prevalence of postnatal depression across cultures. AIMS Public Health 2018; 5:260-295. [PMID: 30280116 PMCID: PMC6141558 DOI: 10.3934/publichealth.2018.3.260] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 07/12/2018] [Indexed: 12/15/2022] Open
Abstract
The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.
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Affiliation(s)
- Siti Roshaidai Mohd Arifin
- Department of Special Care Nursing, International Islamic University Malaysia, Kuantan, Pahang, Malaysia
| | - Helen Cheyne
- Nursing, Midwifery and Allied Health Professional (NMAHP) Research Unit, University of Stirling Scotland, United Kingdom
| | - Margaret Maxwell
- Nursing, Midwifery and Allied Health Professional (NMAHP) Research Unit, University of Stirling Scotland, United Kingdom
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January J, Chimbari MJ. Study protocol on criterion validation of Edinburgh Postnatal Depression Scale (EPDS), Patient Health Questionnaire (PHQ-9) and Centre for Epidemiological Studies-Depression (CES-D) screening tools among rural postnatal women; a cross-sectional study. BMJ Open 2018; 8:e019085. [PMID: 29674363 PMCID: PMC5914896 DOI: 10.1136/bmjopen-2017-019085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Screening women for postnatal depression (PND) provides an opportunity to reach undetected cases and enhance pregnancy outcomes. In Zimbabwe, no validation of depression screening tools has been done on postnatal women in rural settings. OBJECTIVES This study aims to determine criterion validity of the Edinburgh Postnatal Depression Scale (EPDS), the Patient Health Questionnaire (PHQ-9) and the Center for Epidemiological Studies-Depression (CES-D) scale using the Diagnostic and Statistical Manual for Mental Disorders (DSM-5) criteria as the reference standard. METHODS Women (n=462) attending postnatal care at 7 or 42 days at two rural district hospitals in Zimbabwe will be assessed for depressive symptoms using the EPDS, PHQ-9 and CES-D. The women will be interviewed by a clinical psychologist using DSM-5 criteria. Sensitivities, specificities, positive predictive values, negative predictive values and test efficiencies will be calculated for each of the three tools. The area under the receiver operating curve will quantify the overall ability of the three tests to discriminate between those mothers with PND and those without. DISCUSSION Findings from this study will add to the body of knowledge on PND among women in resource-limited settings. Identifying women with PND will enable healthcare providers to link them with care, which will ultimately improve maternal and child health outcomes. Furthermore, this study will provide evidence on which screening tool would be best for screening PND in rural settings of Zimbabwe.
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Affiliation(s)
- James January
- Department of Psychiatry, School of Clinical Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Moses John Chimbari
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Lipinska G, Thomas KGF. Better Sleep in a Strange Bed? Sleep Quality in South African Women with Posttraumatic Stress Disorder. Front Psychol 2017; 8:1555. [PMID: 28955274 PMCID: PMC5601006 DOI: 10.3389/fpsyg.2017.01555] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 08/25/2017] [Indexed: 11/13/2022] Open
Abstract
Although individuals diagnosed with posttraumatic stress disorder (PTSD) regularly report subjective sleep disruption, many studies using objective measures (e.g., polysomnography) report no PTSD-related sleep disruption. To account for these inconsistencies, some authors hypothesize that PTSD-diagnosed individuals have sleep-state misperception; that is, they self-report experiencing poor sleep quality, but objectively sleep relatively normally. We tested this sleep-state misperception hypothesis, collecting data on subjectively-reported sleep quality (in the home, and in the laboratory) and on objectively-measured, laboratory-based, sleep quality in PTSD-diagnosed participants from low socioeconomic status South African communities. Women with PTSD (n = 21), with trauma exposure but no PTSD (TE; n = 19), and healthy controls (HC; n = 20) completed questionnaires on their average sleep quality in the past 30 days, and on their sleep quality after a night (8 h) of polysomnographic-monitored sleep in the laboratory. PTSD-diagnosed individuals reported poorer everyday subjective sleep quality than TE and HC individuals. In the laboratory, however, there were no between-group differences in subjective sleep quality, and few between-group differences in objective sleep quality (PTSD-diagnosed individuals only had decreased sleep depth). Furthermore, whereas measures of laboratory-based objective and subjective sleep quality correlated significantly, especially in PTSD-diagnosed individuals, there were few significant associations between objective sleep measures and everyday subjective sleep quality. Taken together, these findings suggest that PTSD-diagnosed individuals likely experienced better sleep quality in the laboratory than at home. Descriptive observations corroborated this interpretation, with almost half the sample rating their laboratory sleep (which they described as “safe” and “quiet”) as better than their home sleep (which was experienced in an atmosphere marked by high levels of violence and nighttime noise). These findings disconfirm the sleep-state misperception hypothesis as related to PTSD, and suggest that the laboratory environment may influence sleep quality positively in these individuals. Many investigations of sleep in PTSD do not consider the influence of the laboratory environment. Our findings suggest that future studies in this field should consider that sleep-state misperception may be an artifact of the laboratory setting, especially when samples are drawn from communities where violence and crime are an everyday reality.
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Affiliation(s)
- Gosia Lipinska
- UCT Sleep Sciences and Applied Cognitive Science and Experimental Neuroscience Team, Department of Psychology, University of Cape TownCape Town, South Africa
| | - Kevin G F Thomas
- UCT Sleep Sciences and Applied Cognitive Science and Experimental Neuroscience Team, Department of Psychology, University of Cape TownCape Town, South Africa
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Makhubela MS. Measurement invariance of the Beck Depression Inventory-Second Edition across race with South African university students. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2016. [DOI: 10.1177/0081246316645045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Measurement invariance of the Beck Depression Inventory-Second Edition across race (Blacks and Whites) was examined in a sample of university students, from two universities from diverse geographical areas of South Africa ( N = 870). Multigroup confirmatory factor analysis (i.e., means and covariance structures) was used to test the factorial invariance of the hierarchical four-factor structure, composed of three first-order factors (i.e., Negative Attitude, Performance Difficulty, and Somatic Complaints) and one second-order general factor (Depression) found with South African students. Evidence of measurement invariance was established at the level of configural, metric, and scalar invariance. However, there were some evidence of differential additive response style across race—with two non-invariant intercepts (Item 5 and 14) being identified. Results also revealed significant latent mean differences favoring Black students on the Performance Difficulty and Somatic Complaints factors but not on the Negative Attitude factor. Findings suggest that the Beck Depression Inventory-Second Edition provides an assessment of the severity of depressive symptoms that is equivalent across race in university students.
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