Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study

  • Kaniz GausiaEmail author
  • Colleen Fisher
  • Mohammed Ali
  • Jacques Oosthuizen
Original Contribution


Depression during pregnancy is a significant public health problem because of its negative effects on the health of both mother and infant. Data on its prevalence and determinants are lacking in Bangladesh. To estimate the prevalence of depression during pregnancy and to identify potential contributory factors among rural Bangladeshi women, a community-based study was conducted during 2005 in Matlab sub-district, a rural area of eastern Bangladesh. Three hundred and sixty-one pregnant women were identified through an existing health and demographic surveillance system covering a population of 110,000 people. The women were interviewed at home at 34–35 weeks of pregnancy. Information on risk factors was collected through structured questionnaires, with the Bangla version of the Edinburgh Postnatal Depression Scale (EPDS-B) used to measure their psychological status. Both univariate analysis and multivariate logistic regression were applied using the SPSS 15.0 statistical software. The prevalence of depression at 34–35 weeks pregnancy was 33% (95% CI, 27.6–37.5). After adjustment in a multivariate logistic regression model, a history of being beaten by her husband either during or before the current pregnancy had the highest association with depression followed by having an unhelpful or unsupportive mother-in-law or husband, and family preference for a male child. Of the antenatally depressed women, 17 (14%) admitted to thoughts of self-harm during the pregnancy. This paper further explores the reasons why women have considered some form of self-harm during pregnancy. Depression during pregnancy is common among Bangladeshi women, with about a third being affected. The study highlights the need to allocate resources and develop strategies to address depression in pregnancy.


Antenatal depression Self-harming thoughts Suicide Rural women Bangladesh 



This research study was funded by ICDDR,B and the Department for International Development, UK (DFID). ICDDR,B acknowledges with gratitude the commitment of DFID to the Centre's research efforts. ICDDR,B also gratefully acknowledges the following donors which provide unrestricted support to the Centre's research efforts: Australian Agency for International Development (AusAID), Government of the People’s Republic of Bangladesh, Canadian International Development Agency (CIDA), Embassy of the Kingdom of the Netherlands (EKN), Swedish International Development Cooperation Agency (Sida), Swiss Agency for Development and Cooperation (SDC), and Department for International Development, UK (DFID). We gratefully acknowledge these donors for their support and commitment to the Centre's research efforts.


  1. Appleby L (1991) Suicide during pregnancy and in the first postnatal year. Bmj 302(6769):137–140PubMedCrossRefGoogle Scholar
  2. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103(4):698–709PubMedGoogle Scholar
  3. Bolton HL, Hughes PM, Turton P, Sedgwick P (1998) Incidence and demographic correlates of depressive symptoms during pregnancy in an inner London population. J Psychosom Obstet Gynaecol 19(4):202–209PubMedCrossRefGoogle Scholar
  4. Bowen A, Muhajarine N (2006) Prevalence of antenatal depression in women enrolled in an outreach program in Canada. J Obstet Gynecol Neonatal Nurs 35(4):491–498PubMedCrossRefGoogle Scholar
  5. Chan SW, Levy V, Chung TK, Lee D (2002) A qualitative study of the experiences of a group of Hong Kong Chinese women diagnosed with postnatal depression. J Adv Nurs 39(6):571–579PubMedCrossRefGoogle Scholar
  6. Chandran M, Tharyan P, Muliyil J, Abraham S (2002) Post-partum depression in a cohort of women from a rural area of Tamil Nadu India. Incidence and risk factors. Br J Psychiatry 181:499–504PubMedCrossRefGoogle Scholar
  7. Chew-Graham C, Bashir C, Chantler K, Burman E, Batsleer J (2002) South Asian women, psychological distress and self-harm: lessons for primary care trust. Health and social care in the community 10(5):339–347PubMedCrossRefGoogle Scholar
  8. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150:782–786PubMedCrossRefGoogle Scholar
  9. Da-Silva VA, Moraes-Santos AR, Carvalho MS, Martins ML, Teixeira NA (1998) Prenatal and postnatal depression among low income Brazilian women. Braz J Med Biol Res 31(6):799–804PubMedCrossRefGoogle Scholar
  10. El-Gilany AH, Shady E (2007) Determinants and causes of son preference among women delivering in Mansoura, Egypt. East Mediterr Health J 13(1):119–128PubMedGoogle Scholar
  11. Faisal-Cury A, Rossi Menezes P (2007) Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Womens Ment Health 10(1):25–32PubMedCrossRefGoogle Scholar
  12. Fauveau V, Blanchet T (1989) Deaths from injuries and induced abortion among rural Bangladeshi women. Soc Sci Med 29(9):1121–1127PubMedCrossRefGoogle Scholar
  13. Ferri CP, Mitsuhiro SS, Barros MC, Chalem E, Guinsburg R, Patel V et al (2007) The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in Sao Paulo, Brazil. BMC Public Health 7:209PubMedCrossRefGoogle Scholar
  14. Freitas GV, Cais CF, Stefanello S, Botega NJ (2008) Psychosocial conditions and suicidal behavior in pregnant teenagers : A case-control study in Brazil. Eur Child Adolesc Psychiatry 17(6):336–342PubMedCrossRefGoogle Scholar
  15. Gausia K, Hamadani JD, Islam MM, Ali M, Algin S, Yunus M et al (2007a) Bangla translation, adaptation and piloting of Edinburgh Postnatal Depression Scale. Bangladesh Med Res Counc Bull 33(3):81–87PubMedGoogle Scholar
  16. Gausia K, Fisher C, Algin S, Oosthuizen J (2007b) Validation of the Bangla version of the Edinburgh Postnatal Depression Scale for a Bangladeshi sample. Journal of Reproductive and Infant Psychology 25(4):308CrossRefGoogle Scholar
  17. Gausia K, Fisher C, Ali M, Oosthuizen J (2009). Magnitude and contributory factors of postnatal depression: a community-based cohort study from a rural subdistrict of Bangladesh. Psychol Med 39(6):999–1007PubMedCrossRefGoogle Scholar
  18. Green JM, Snowdon C, Statham H (1999) EPDS by post. Br J Psychiatry 158:865CrossRefGoogle Scholar
  19. Harrison PA, Sidebottom AC (2009) Alcohol and drug use before and during pregnancy: an examination of use patterns and predictors of cessation. Matern Child Health J 13(3):386–394PubMedCrossRefGoogle Scholar
  20. Heron J, O'Connor TG, Evans J, Golding J, Glover V (2004) The course of anxiety and depression through pregnancy and the postpartum in a community sample. J Affect Disord 80(1):65–73PubMedCrossRefGoogle Scholar
  21. Imam MJ (2003) Women's right in Bangladesh: the need for a paradigm shift. The Daily Star. Dhaka: The Daily Star Internet edition, retrieved on 18.3.2009.
  22. Kammerer M, Taylor A, Glover V (2006) The HPA axis and perinatal depression: a hypothesis. Arch Womens Ment Health 9(4):187–196PubMedCrossRefGoogle Scholar
  23. Kelly RH, Danielsen BH, Golding JM, Anders TF, Gilbert WM, Zatzick DF (1999) Adequacy of prenatal care among women with psychiatric diagnoses giving birth in California in 1994 and 1995. Psychiatr Serv 50(12):1584–1590PubMedGoogle Scholar
  24. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O (2000) Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 95(4):487–490PubMedCrossRefGoogle Scholar
  25. Limlomwongse N, Liabsuetrakul T (2006) Cohort study of depressive moods in Thai women during late pregnancy and 6–8 weeks of postpartum using the Edinburgh Postnatal Depression Scale (EPDS). Arch Womens Ment Health 9(3):131–138PubMedCrossRefGoogle Scholar
  26. Lindahl V, Pearson JL, Colpe L (2005) Prevalence of suicidality during pregnancy and the postpartum. Arch Womens Ment Health 8(2):77–87PubMedCrossRefGoogle Scholar
  27. Lovisi GM, Lopez JR, Coutinho ES, Patel V (2005) Poverty, violence and depression during pregnancy: a survey of mothers attending a public hospital in Brazil. Psychol Med 35(10):1485–1492PubMedCrossRefGoogle Scholar
  28. Martin SL, Li Y, Casanueva C, Harris-Britt A, Kupper LL, Cloutier S (2006) Intimate partner violence and women's depression before and during pregnancy. Violence Against Women 12(3):221–239PubMedCrossRefGoogle Scholar
  29. Naved RT, Akhtar N (2008) Spousal violence against women and suicidal ideation in bangladesh. Womens Health Issues 18(6):442–452PubMedCrossRefGoogle Scholar
  30. Naved RT, Persson LA (2005) Factors associated with spousal physical violence against women in Bangladesh. Stud Fam Plann 36(4):289–300PubMedCrossRefGoogle Scholar
  31. Patel V, Prince M (2006) Maternal psychological morbidity and low birth weight in India. Br J Psychiatry 188:284–285PubMedCrossRefGoogle Scholar
  32. Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry 159(1):43–47PubMedCrossRefGoogle Scholar
  33. Rahman A, Iqbal Z, Harrington R (2003) Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychol Med 33(7):1161–1167PubMedCrossRefGoogle Scholar
  34. Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R (2004) Impact of maternal depression on infant nutritional status and illness: a cohort study. Arch Gen Psychiatry 61(9):946–952PubMedCrossRefGoogle Scholar
  35. Rahman A, Bunn J, Lovel H, Creed F (2007) Association between antenatal depression and low birthweight in a developing country. Acta Psychiatr Scand 115(6):481–486PubMedCrossRefGoogle Scholar
  36. Rodriguez MA, Heilemann MV, Fielder E, Ang A, Nevarez F, Mangione CM (2008) Intimate partner violence, depression, and PTSD among pregnant Latina women. Ann Fam Med 6(1):44–52PubMedCrossRefGoogle Scholar
  37. UNFPA (2003) Male attitudes towards violence against women in Bangladesh. UNFPA, DhakaGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Kaniz Gausia
    • 1
    • 2
    • 4
    Email author
  • Colleen Fisher
    • 2
  • Mohammed Ali
    • 3
  • Jacques Oosthuizen
    • 2
  1. 1.International Centre for Diarrhoeal Diseases Research (ICDDR,B)DhakaBangladesh
  2. 2.Edith Cowan UniversityPerthAustralia
  3. 3.Centre for International HealthCurtin University of TechnologyPerthAustralia
  4. 4.Public Health, School of Exercise, Biomedical & Health SciencesEdith Cowan UniversityJoondalupAustralia

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