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Archives of Women's Mental Health

, Volume 17, Issue 2, pp 145–154 | Cite as

A cross-sectional study of antenatal depression and associated factors in Malawi

  • Robert C. StewartEmail author
  • Eric Umar
  • Barbara Tomenson
  • Francis Creed
Original Article

Abstract

Depression, and disabling levels of mixed depressive, anxious and somatic symptoms, termed common mental disorder, occurring in the perinatal period are an important health problem in low- and middle-income countries. In this cross-sectional study, pregnant women were recruited from a district hospital antenatal clinic in Malawi. Symptoms of depression and anxiety, and non-specific somatic symptoms commonly associated with distress, were measured using validated local versions of the Self Reporting Questionnaire (SRQ). In a sub-sample, Diagnostic Statistical Manual (DSM)-IV diagnoses of major and minor depressive disorders were made using the Structured Clinical Interview for DSM-IV. Maternal socio-demographic and health variables were measured, and associations with SRQ score and depression diagnosis were determined. Of 599 eligible women, 583 were included in the analysis. The adjusted weighted prevalence of current major depressive episode and current major or minor depressive episode were 10.7 % (95 % CI 6.9–14.5 %) and 21.1 % (95 % CI 15.5–26.6 %), respectively. On multivariate analysis, SRQ score was significantly associated with lower perceived social support, experience of intimate partner violence, having had a complication in a previous delivery, higher maternal mid-upper arm circumference and more years of schooling. Major depressive episode was associated with lower perceived social support and experience of intimate partner violence. This study demonstrates that antenatal depression/CMD is common in Malawi and is associated with factors that may be amenable to psychosocial interventions.

Keywords

Depression Common mental disorder Antenatal Low-income countries Risk factors Prevalence 

Notes

Acknowledgments

The authors would like to thank Ms. Patuma Chitimbe, the fieldworkers, the staff at Mangochi District Hospital, and the participants in the study. Funding for this study was provided from Professor Francis Creed's Journal of Psychosomatic Research Editorship fund (BA00457) administered through University of Manchester.

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. Abiodun OA, Adetoro OO, Ogunbode OO (1993) Psychiatric morbidity in a pregnant population in Nigeria. Gen Hosp Psychiatry 15(2):125–128PubMedCrossRefGoogle Scholar
  2. Adewuya AO, Ola BA, Aloba OO, Dada AO, Fasoto OO (2006a) Prevalence and correlates of depression in late pregnancy among Nigerian women. Depress Anxiety 24(1):15–21CrossRefGoogle Scholar
  3. Adewuya AO, Ola BA, Aloba OO, Mapayi BM (2006b) Anxiety disorders among Nigerian women in late pregnancy: a controlled study. Arch Women's Ment Health 9(6):325–328CrossRefGoogle Scholar
  4. Akhtar A, Rahman A, Husain M, Chaudhry IB, Duddu V, Husain N (2010) Multidimensional scale of perceived social support: psychometric properties in a South Asian population. J Obstet Gynaecol Res 36(4):845–851PubMedCrossRefGoogle Scholar
  5. Allison PD (2001) Missing data, SAGE University Papers Series on Quantitative Applications in the Social Sciences. Sage, Thousand Oaks, pp 7–136Google Scholar
  6. Bernatsky S, Souza R, de Jong K (2007) Mental health in HIV-positive pregnant women: results from Angola. AIDS Care 19(5):674–676PubMedCrossRefGoogle Scholar
  7. Beydoun HA, Beydoun MA, Kaufman JS, Lo B, Zonderman AB (2012) Intimate partner violence against adult women and its association with major depressive disorder, depressive symptoms and postpartum depression: a systematic review and meta-analysis. Soc Sci Med 75(6):959–975PubMedCentralPubMedCrossRefGoogle Scholar
  8. Bindt C, Appiah-Poku J, Te Bonle M, Schoppen S, Feldt T, Barkmann C, Koffi M, Baum J, Nguah SB, Tagbor H, Guo N, N'goran E, Ehrhardt S, for the International CDS Study Group (2012) Antepartum depression and anxiety associated with disability in African women: cross-sectional results from the CDS Study in Ghana and Côte d'Ivoire. PloS one 7(10):e48396PubMedCentralPubMedCrossRefGoogle Scholar
  9. Bolton P, Tang AM (2002) An alternative approach to cross-cultural function assessment. Soc Psychiatry Psychiatr Epidemiol 37(11):537–543PubMedCrossRefGoogle Scholar
  10. Coleman R, Morison L, Paine K, Powell RA, Walraven G (2006) Women's reproductive health and depression. Soc Psychiatry Psychiatr Epidemiol 41(9):720–727PubMedCrossRefGoogle Scholar
  11. Collin SM, Chisenga MM, Kasonka L, Haworth A, Young C, Filteau S, Murray SF (2006) Factors associated with postpartum physical and mental morbidity among women with known HIV status in Lusaka, Zambia. AIDS Care 18(7):812–820PubMedCrossRefGoogle Scholar
  12. Cooper PJ, Tomlinson M, Swartz L, Woolgar M, Murray L, Molteno C (1999) Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. Br J Psychiatry 175:554–558PubMedCrossRefGoogle Scholar
  13. Cox JL (1979) Psychiatric morbidity and pregnancy: a controlled study of 263 semi-rural Ugandan women. Br J Psychiatry 134:401–405PubMedCrossRefGoogle Scholar
  14. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry 150(6):782–786PubMedCrossRefGoogle Scholar
  15. Esimai OA, Fatoye FO, Quiah AG, Vidal OE, Momoh RM (2008) Antepartum anxiety and depressive symptoms: A study of Nigerian women during the three trimesters of pregnancy. J Obst Gynaecol 28(2):202–203CrossRefGoogle Scholar
  16. Field T (2011) Prenatal depression effects on early development: a review. Infant Behav Dev 34(1):1–14PubMedCrossRefGoogle Scholar
  17. First M, Spitzer R, Williams J (2002) Structured Clinical Interview for DSM-IV-TR Axis I Disorders, Research Version, Non-patient Edition. (SCID-I/NP).Google Scholar
  18. Fisher J, Tran T, La BT, Kriitmaa K, Rosenthal D, Tran T (2010) Common perinatal mental disorders in northern Vietnam: community prevalence and health care use. Bull World Health Organ 88(10):737–745PubMedCentralPubMedCrossRefGoogle Scholar
  19. Fisher J, Cabral de Mello M, Patel V, Rahman A, Tran T, Holton S, Holmes W (2012) Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ 90(2):139G–149GPubMedCrossRefGoogle Scholar
  20. Goldberg D, Goodyer I (2005) The origins and course of common mental disorders. Routledge, LondonGoogle Scholar
  21. Gorman LL, O'Hara MW, Figueiredo B, Hayes S, Jacquemain F, Kammerer MH, Klier CM, Rosi S, Seneviratne G, Sutter-Dallay A-L, TCS-PND Group (2004) Adaptation of the structured clinical interview for DSM-IV disorders for assessing depression in women during pregnancy and post-partum across countries and cultures. Br J Psychiatry Suppl 46:s17–s23PubMedCrossRefGoogle Scholar
  22. Government of Malawi, Ministry of Health. (2011) Quarterly HIV Programme Report. Quarter 4 2011. Lilongwe (Malawi): Government of Malawi.Google Scholar
  23. Hanlon CA, Medhin G, Alem A, Araya M, Abdulahi A, Tesfaye M, Wondimagegn D, Taha H, Anbesse B, Baheretibeb Y, Dewey M, Prince M (2008) Measuring common mental disorders in women in Ethiopia: reliability and construct validity of the comprehensive psychopathological rating scale. Soc Psychiatry Psychiatr Epidemiol 43(8):653–659PubMedCentralPubMedCrossRefGoogle Scholar
  24. Hanlon CA, Medhin G, Alem A, Tesfaye F, Lakew Z, Worku B, Dewey M, Araya M, Abdulahi A, Hughes M, Tomlinson M, Patel V, Prince M (2009) Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: The P-MaMiE population-based cohort study. Tropical Med Int Health 14(2):156–166CrossRefGoogle Scholar
  25. Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, le Roux I, Mbewu N, Rotheram-Borus MJ (2011) Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health 8:9PubMedCentralPubMedCrossRefGoogle Scholar
  26. Husain N, Bevc I, Husain M, Chaudhry IB, Atif N, Rahman A (2006) Prevalence and social correlates of postnatal depression in a low income country. Arch Women's Mental Health 9(4):197–202CrossRefGoogle Scholar
  27. IBM Corp. Released (2011) IBM SPSS Statistics for Windows, Version 20.0. IBM Corp, ArmonkGoogle Scholar
  28. Kaaya SF, Mbwambo JK, Kilonzo GP, Van Den Borne H, Leshabari MT, Fawzi MCS, Schaalma H (2010) Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania. Tanzania J Health Res 12(1):23–35Google Scholar
  29. Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM (2010) Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol 202(1):5–14PubMedCentralPubMedCrossRefGoogle Scholar
  30. Melzer D, Tom BDM, Brugha TS, Fryers T, Meltzer H (2002) Common mental disorder symptom counts in populations: are there distinct case groups above epidemiological cut-offs? Psychol Med 32(7):1195–1201PubMedCrossRefGoogle Scholar
  31. Nakigudde J, Musisi S, Ehnvall A, Airaksinen E, Agren H (2009) Adaptation of the multidimensional scale of perceived social support in a Ugandan setting. Afr Health Sci 9(Suppl 1):S35–S41PubMedCentralPubMedGoogle Scholar
  32. National Statistics Office (2008) 2008 Population and housing census. Zomba, MalawiGoogle Scholar
  33. NSO (Malawi) & ORC Macro, (2005) Malawi demographic and health survey 2004. National Statistical Office and ORC Macro, CalvertonGoogle Scholar
  34. NSO (Malawi) & ORC Macro, (2011) Malawi demographic and health survey 2010. National Statistical Office and ORC Macro, CalvertonGoogle Scholar
  35. Ola BA, Crabb J, Tayo A, Gleadow Ware SH, Dhar A, Krishnadas R (2011) Factors associated with antenatal mental disorder in West Africa: a cross-sectional survey. BMC Pregnancy and Childbirth 11:90PubMedCentralPubMedCrossRefGoogle Scholar
  36. Patel V, Kleinman A (2003) Poverty and common mental disorders in developing countries. Bull World Health Organ 81(8):609–615PubMedCentralPubMedGoogle Scholar
  37. Patel V, Prince M (2006) Maternal psychological morbidity and low birth weight in India. Br J Psychiatry 188:284–285PubMedCrossRefGoogle Scholar
  38. 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
  39. Pickles A, Dunn G, Vazquez-Barquero JL (1995) Screening for stratification in two-phase (‘two- stage’) epidemiological surveys. Stat Methods Med Res 4(1):73–89PubMedCrossRefGoogle Scholar
  40. 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 61:946–952PubMedCrossRefGoogle Scholar
  41. Rahman A, Malik A, Sikander S, Roberts C, Creed F (2008) Cognitive behaviour therapy-based intervention by community health workers for mothers with depression and their infants in rural Pakistan: a cluster-randomised controlled trial. Lancet 372(9642):902–909PubMedCentralPubMedCrossRefGoogle Scholar
  42. Rahman A, Sikander S, Malik A, Ahmed I, Tomenson B, Creed F (2012) Effective treatment of perinatal depression for women in debt and lacking financial empowerment in a low-income country. Br J Psychiatry 201:451–457PubMedCrossRefGoogle Scholar
  43. Rochat TJ, Tomlinson M, Bärnighausen T, Newell M-L, Stein A (2011) The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord 135(1–3):362–373PubMedCentralPubMedCrossRefGoogle Scholar
  44. Ross J, Hanlon CA, Medhin G, Alem A, Tesfaye F, Worku B, Dewey M, Patel V, Prince M (2011) Perinatal mental distress and infant morbidity in Ethiopia: a cohort study. Archives of disease in childhood. Fetal Neonatal Ed 96(1):F59–F64CrossRefGoogle Scholar
  45. Sawyer A, Ayers S, Smith H (2010) Pre- and postnatal psychological wellbeing in Africa: a systematic review. J Affect Disord 123(1–3):17–29PubMedCrossRefGoogle Scholar
  46. StataCorp (2011) Stata Statistical Software: Release 12. StataCorp LP, College Station, TXGoogle Scholar
  47. Stewart RC, Kauye F, Umar E, Vokhiwa M, Bunn J, Fitzgerald M, Tomenson B, Rahman A, Creed F (2009) Validation of a Chichewa version of the Self-Reporting Questionnaire (SRQ) as a brief screening measure for maternal depressive disorder in Malawi, Africa. J Affect Disord 112(1–3):126–134PubMedCrossRefGoogle Scholar
  48. Stewart RC, Bunn J, Vokhiwa M, Umar E, Kauye F, Fitzgerald M, Tomenson B, Rahman A, Creed F (2010) Common mental disorder and associated factors amongst women with young infants in rural Malawi. Soc Psychiatry Psychiatr Epidemiol 45(5):551–559PubMedCrossRefGoogle Scholar
  49. Stewart RC, Umar E, Tomenson B, Creed F (2013) Validation of screening tools for antenatal depression in Malawi—a comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. J Affect Disord 150:1041–1047PubMedCrossRefGoogle Scholar
  50. WHO (1991) Maternal anthropometry for prediction of pregnancy outcomes: memorandum from a USAID/WHO/PAHO/MotherCare meeting. Bull World Health Organ 69(5):523–532Google Scholar
  51. WHO (1994) A user's guide to the self reporting questionnaire (SRQ).Google Scholar
  52. Wongpakaran T, Wongpakaran N, Ruktrakul R (2011) Reliability and validity of the Multidimensional Scale of Perceived Social Support (MSPSS): Thai version. Clin Pract Epidemiol Mental Health 7:161–166CrossRefGoogle Scholar
  53. World Bank (2013) http://data.worldbank.org/indicator/SH.MMR.RISK. Accessed 22 March 2013.
  54. Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988) The Multidimensional Scale of Perceived Social Support. J Pers Assess 52(1):30–41CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  • Robert C. Stewart
    • 1
    • 2
    Email author
  • Eric Umar
    • 3
  • Barbara Tomenson
    • 4
  • Francis Creed
    • 1
  1. 1.Institute of Brain, Behaviour and Mental HealthUniversity of ManchesterManchesterUK
  2. 2.Department of Mental Health, College of MedicineUniversity of MalawiBlantyreMalawi
  3. 3.Department of Community Health, College of MedicineUniversity of MalawiBlantyreMalawi
  4. 4.Biostatistics Unit, Institute of Public HealthUniversity of ManchesterManchesterUK

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