Common mental disorders during pregnancy: prevalence and associated factors among low-income women in São Paulo, Brazil

Depression and Anxiety during Pregnancy
  • Alexandre Faisal-CuryEmail author
  • Paulo Menezes
  • Ricardo Araya
  • Marcelo Zugaib
Original Contribution


To estimate the prevalence of common mental disorders (CMD) and factors associated with these disorders among pregnant women of low socio-economic status (SES) in São Paulo. We performed a cross-sectional study with 831 women in their 20th to 30th weeks of pregnancy, who were attending antenatal clinics in primary care in São Paulo, Brazil. CMD were assessed with the Clinical Interview Schedule-Revised. Crude and adjusted prevalence ratios and 95%CI were calculated to examine the association between CMD and exposure variables. The prevalence of CMD was 20.2% (95%CI 17.5 to 23.0). Age at current pregnancy and at first delivery, current obstetric complications, not having friends in the community, living in a crowded household, lower occupational status and history of previous psychiatric treatment were all independently associated with increased prevalence of CMD. CMD is highly prevalent among pregnant women of low SES seen in primary care settings in São Paulo. A combination of distal and proximal psychosocial factors increase the risk for CMD. Primary health care professionals need to be aware of how common CMD in such settings and properly trained to deal with CMD during pregnancy.


Common mental disorders Pregnancy Risk factors Prevalence 



The study was funded by FAPESP (proc. no. 05/05333-9). PRM was partly funded by the CNPq-Brazil (proc. no. 300747/2005-5). AFC received post-doctoral fellowships from the CNPq-Brazil (proc. no. 509141/2003-0) and FAPESP (proc. no.07/50273-2).


  1. Abiodun OA, Adetoro OO, Ogunbode OO (1993) Psychiatric morbidity in a pregnant population in Nigeria. Gen Hosp Psychiatry 15:125–128PubMedCrossRefGoogle Scholar
  2. Adewuya AO, Ola BA, Aloba OO, Dada AO, Fasoto OO (2007) Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety 24:15–21PubMedCrossRefGoogle Scholar
  3. American Academy of Pediatrics (2000) Committee on Substance Abuse and Committee on children with disability. Fetal Alcohol syndrome and alcohol-related neurodevelopmental disorders. Pediatrics 106:358–361CrossRefGoogle Scholar
  4. Andersson L, Sundström-Poromaa I, Bixo M, Wulff M, Bondestam K, Aström M (2003) Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population–based study. Am J Obstet Gynecol 189:148–154PubMedCrossRefGoogle Scholar
  5. Araya R, Rojas G, Fritsch R, Acuña J, Lewis G (2001) Common mental disorders in Santiago, Chile: Prevalence and socio- demographic correlates. Br J Psychiatry 178:228–233PubMedCrossRefGoogle Scholar
  6. Araya R, Gaete J, Rojas G, Fritsch R, Lewis G (2007) Smoking and common mental disorders: a population-based survey in Santiago, Chile. Soc Psychiatry Psychiatr Epidemiol 42:874–80PubMedCrossRefGoogle Scholar
  7. Austin MP, Leader L (2000) Maternal stress and obstetric and infant outcomes: epidemiological findings and neuroendocrine mechanisms. Aust NZ J Obstet Gynaecol 40:331–337CrossRefGoogle Scholar
  8. Barros AJ, Hirakata VN (2003) Alternatives for logistic regression in cross-sectional studies: an empirical comparison of models that directly estimate the prevalence ratio. BMC Med Res Methodol 20;3:21CrossRefGoogle Scholar
  9. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103:698–709PubMedGoogle Scholar
  10. Birndorf CA, Madden A, Portera L, Leon AC (2001) Psychiatric symptoms, functional impairment, and receptivity toward mental health treatment among obstetrical patients. Int J Psychiat Med 31:355–65CrossRefGoogle Scholar
  11. Botega NJ, Pereira WA, Bio MR, Garcia Junior C, Zomignani MA (1995) Psychiatric morbidity among medical in-patient: a standardized assessment (GHQ-12 and CIS-R) made by “lay” interviewers in a Brazilian hospital. Soc Psychiatry Psychiatr Epidemiol 30:127–131PubMedCrossRefGoogle Scholar
  12. Chang G, McNamara TK, Orav EJ, Koby D, Lavigne A, Ludman B, Vincitorio NA, Wilkins-Haug L (2005) Brief intervention for prenatal alcohol use: a randomized trial. Obstet Gynecol 105:991–998PubMedGoogle Scholar
  13. Chen H, Chan YH, Tan KH, Lee T (2004) Depressive symptomatology in pregnancy. Soc Psychiatry Psychiatr Epidemiol 39:975–979PubMedCrossRefGoogle Scholar
  14. Chung TKH, Lau TK, Yip ASK, Chiu HFK, Lee DTS (2001) Antepartum depressive symptomatology is associated with adverse obstetric and neonatal outcomes. Psychosom Med 63:830–834PubMedGoogle Scholar
  15. Dayan J, Creveuil C, Herlicoviez M, Herbel C, Baranger E, Savoye C, Thouin A (2002) Role of anxiety and depression in the onset of spontaneous preterm labor. Am J Epidemiol 155:293–301PubMedCrossRefGoogle Scholar
  16. Dole N, Savitz A, Hertz-Picciotto I, Siega-Riz AM, McMahon MJ, Buekens P (2003) Maternal stress and preterm birth. Am J Epidemiol 157:14–24PubMedCrossRefGoogle Scholar
  17. England LJ, Kendrick JS, Wilson HG, Merritt RK, Gargiullo PM, Zahniser SC (2001) Effects of smoking reduction during pregnancy on the birth weight of term infants. Am L Epidemiol 154:694–701CrossRefGoogle Scholar
  18. Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323:257–260PubMedCrossRefGoogle Scholar
  19. Evans J, Heron J, Patel RR, Wiles N (2007) Depressive symptoms during pregnancy and low birth weight at term: longitudinal study. Br J Psychiatry 191:84–85PubMedCrossRefGoogle Scholar
  20. Faisal-Cury A, Menezes PR (2007) Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Women Mental Health 10:25–32CrossRefGoogle Scholar
  21. Ferri CP, Mitsuhiro SS, Barros MC, Chalem E, Guinsburg R, Patel V, Prince M, Laranjeira R (2007) The impact of maternal experience of violence and common mental disorders on neonatal outcomes: a survey of adolescent mothers in São Paulo, Brazil. BMC Public Health 7:209–218PubMedCrossRefGoogle Scholar
  22. Goldberg D, Huxley P (1992) Common Mental Disorders: A Biopsychosocial Approach. Routledge, LondonGoogle Scholar
  23. Gureje O, Lasebikan VO (2006) Use of mental health services in a developing country. Results from the Nigerian survey of mental health and well-being. Soc Psychiatry Psychiatr Epidemiol 41:44–49PubMedCrossRefGoogle Scholar
  24. Halbreich U (2005) The association between pregnancy processes, preterm delivery, low birth weight, and postpartum depressions. The need for interdisciplinary integration. Am J Obstet Gynecol 193:1312–22PubMedCrossRefGoogle Scholar
  25. Heron J, O’Connor TH, 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 80:65–73PubMedCrossRefGoogle Scholar
  26. Instituto Brasileiro de Geografia e Estatistica (2001) Sinopse preliminar do censo demografico 2000. (accessed 22/10/2007)
  27. Instituto Brasileiro de Geografia e Estatística (2000). (accessed 23/06/2008)
  28. Jacob KS, Bhugra D, Mann AH (1997) The validation of the 12-item General Health Questionnaire among ethnic Indian women living in the United Kingdom. Psychol Med 27:1215–1217PubMedCrossRefGoogle Scholar
  29. Johnson RC, Slade P (2003) Obstetric complications and anxiety during pregnancy: is there a relationship? J Psychosom Obstet Gynecol 24:1–14CrossRefGoogle Scholar
  30. Kelly RH, Zatzick DF, Anders TF (2001) The Detection and Treatment of Psychiatric Disorders and Substance Use Among Pregnant Women Cared for in Obstetrics. Am J Psych 158:213–219CrossRefGoogle Scholar
  31. Kroeff LC, Mengue SS, Schimdt MI, Duncan BB, Favaretto ALF, Nucci LB (2004) Fatores associados ao fumo em gestantes avaliadas em cidades brasileiras. Rev Saude Publica 38:261–267PubMedCrossRefGoogle Scholar
  32. Kurki T, Hiilesmaa V, Raitasalo R, Mattila H, Ylikorkala O (2000) Depression and anxiety in early pregnancy and risk for preeclampsia. Obstet Gynecol 95:487–490PubMedCrossRefGoogle Scholar
  33. Lee DT, Chan SS, Sahota DS, Yip AS, Tsui M, Chung TK (2004) A prevalence study of antenatal depression among Chinese women. J Affect Disord 82:93–99PubMedCrossRefGoogle Scholar
  34. Lewis G, Pelosi A, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardised assessment for use by lay interviewers. Psychol Med 22:465–486PubMedCrossRefGoogle Scholar
  35. Lima MS, Hotopf M, Mari JJ, Beria JU, De Bastos AB, Mann A (1999) Psychiatric disorder and the use of benzodiazepines: an example of the inverse care law from Brazil. Soc Psychiatry Psychiatr Epidemiol 34:316–322PubMedCrossRefGoogle Scholar
  36. 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 9:131–138PubMedCrossRefGoogle Scholar
  37. Lovisi GM, López JRA, Coutinho ESF, Patel V (2005) Poverty, violence and depression during pregnancy: a survey of mothers attending a public hospital in Brazil. Psychol Med 35:1485–1492PubMedCrossRefGoogle Scholar
  38. Matthews S, Meaney MJ (2005) Maternal adversity, vulnerability and disease. In: Riecher-Rössler A, Steiner M (eds) Perinatal Stress, Mood and Anxiety Disorders: from bench to bedside. Karger, BaselGoogle Scholar
  39. Ministerio da Saude (2007) Saude da Familia. (accessed in 22/10/2007).
  40. Ministerio da Saude (2008). (accessed 23/06/2008).
  41. O’Hara MW, Swain AM (1996) Rates and risks of postpartum depression: a meta analysis. Int Rev Psychiatry 8:37–45CrossRefGoogle Scholar
  42. Orr ST, James AS, Prince CB (2002) Maternal prenatal depressive symptoms and spontaneous preterm births among African-Americans women in Baltimore, Maryland. Am J Epidemiol 156:797–802PubMedCrossRefGoogle Scholar
  43. Patel V, Kleinman A (2003) Poverty and common mental disorders in developing countries. Bull WHO 81:609–615PubMedGoogle Scholar
  44. Patel V, Prince M (2006) Maternal psychological morbidity and low birth weight in India. Br J Psychiatry 168:284–285CrossRefGoogle Scholar
  45. Patel V, Araya R, Lima M, Ludemir A, Todd A (1999) Women, poverty and common mental disorders in four restructuring societies. Soc Sci Med 49:1461–1471PubMedCrossRefGoogle Scholar
  46. Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry 159:43–47PubMedCrossRefGoogle Scholar
  47. Patel V, Araya R, Chowdhary N, King M, Kirkwood B, Nayak S, Simon G, Weiis HA (2008) Detecting common mental disorders in primary care in India: a comparison of five screening questionnaires. Psychol Med 38:221–228PubMedCrossRefGoogle Scholar
  48. Pinheiro SN, Laprega MR, Furtado EF (2005) Psychiatric morbidity and alcohol use by pregnant women in a public obstetric service. Rev Saude Publica 39:593–598PubMedCrossRefGoogle Scholar
  49. 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 33:1161–1167PubMedCrossRefGoogle Scholar
  50. Rahman A, Bunn J, Lovel H, Creed F (2007) Association between antenatal depression and lowbirthweight in a developing country. Acta Psychiatr Scan 115:481–486CrossRefGoogle Scholar
  51. Riecher-Rössler A, Rohde A (2005) Diagnostic classification of perinatal mood disorders. In: Riecher-Rössler A, Steiner M (eds) Perinatal Stress, Mood and Anxiety Disorders: from bench to bedside. Karger, BaselGoogle Scholar
  52. Rigotti NA, Park ER, Regan S, Chang Y, Perry K, Loudin B, Quinn V (2006) Efficacy of telephone counselling for pregnant smokers: a randomized controlled trial. Obstet Gynecol 108:83–92PubMedGoogle Scholar
  53. Seade. Governo do Estado de São Paulo, 2003.
  54. Seguin L, Potvin L, STDenis M, Loiselle J (1995) Chronic stressors, social support, and depression during pregnancy. Obstet Gynecol 85:583–589PubMedCrossRefGoogle Scholar
  55. Shen YC, Zhang MY, Huang YQ, He YL, Liu ZR, Cheng H, Tsang A, Lee S, Kessler RC (2006) Twelve-month prevalence, severity, and unmet need for treatment of mental disorders in metropolitan China. Psychol Med 36:257–267PubMedCrossRefGoogle Scholar
  56. Smith MV, Rosenheck RA, Cavaleri MA, Howell HB, Poschman K, Yonkers KA (2004) Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv 55:407–414PubMedCrossRefGoogle Scholar
  57. StataCorp. Stata Statistical software. Stata Corporation, 2005Google Scholar
  58. Susan JA, Sterling KC, Ruth EL, Paul DS, Janet RD (1992) Analysis of facials shape in children gestationally exposed to marijuana, alcohol, and/or cocaine. Pediatrics 89:67–77Google Scholar
  59. WHO (2004) Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA 291:2581–2590CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Alexandre Faisal-Cury
    • 1
    Email author
  • Paulo Menezes
    • 1
  • Ricardo Araya
    • 2
  • Marcelo Zugaib
    • 1
  1. 1.University of São PauloSão PauloBrazil
  2. 2.University of BristolBristolUK

Personalised recommendations