Abstract
Quantitative studies have demonstrated that depression and anxiety in the perinatal period are common amongst women in low- and middle-income countries and are associated with a range of psychosocial and health-related stressors. In this exploratory qualitative study conducted in southern Malawi, we investigated the thoughts and emotions experienced by women in pregnancy and the postnatal period, their expectations of support from husband and others, problems and difficulties faced and the impact of these on psychological wellbeing. We conducted 11 focus group discussions with a total of 98 parous women. A thematic analysis approach was used. Three major themes were identified: pregnancy as a time of uncertainty, the husband (and others) as support and stressor, and the impact of stressors on mental health. Pregnancy was seen as bringing uncertainty about the survival and wellbeing of both mother and unborn child. Poverty, lack of support, HIV, witchcraft and child illness were identified as causes of worry in the perinatal period. Husbands were expected to provide emotional, financial and practical support, with wider family and friends having a lesser role. Infidelity, abuse and abandonment were seen as key stressors in the perinatal period. Exposure to stressors was understood to lead to altered mental states, the symptoms of which are consistent with the concept of common perinatal mental disorder. This study confirms and expands on evidence from quantitative studies and provides formative data for the development of a psychosocial intervention for common perinatal mental disorder in Malawi.
Similar content being viewed by others
References
Adewuya AO, Ola BO, Aloba OO et al (2008) Impact of postnatal depression on infants’ growth in Nigeria. J Affect Disord 108:191–193. doi:10.1016/j.jad.2007.09.013
Bass JK, Ryder RW, Lammers M-C et al (2008) Post-partum depression in Kinshasa, Democratic Republic of Congo: validation of a concept using a mixed-methods cross-cultural approach. Trop Med Int Health 13:1534–1542. doi:10.1111/j.1365-3156.2008.02160.x
Bindt C, Guo N, Bonle MT et al (2013) No association between antenatal common mental disorders in low-obstetric risk women and adverse birth outcomes in their offspring: results from the CDS study in Ghana and Côte D’Ivoire. PLoS ONE 8:e80711. doi:10.1371/journal.pone.0080711
Bowie C, Geubbels E (2013) Epidemiology of maternal mortality in Malawi – 2nd edition In: http://www.medcol.mw/commhealth/publications/epi%20book/Maternal%20health%20v2%202.pdf. Accessed 18 Dec 2013
Chapman RR (2004) A nova vida: the commoditization of reproduction in Central Mozambique. Med Anthropol 23:229–261. doi:10.1080/01459740490487107
Chilimampunga C, Thindwa G (2011) The extent and nature of witchcraft-based violence against children, women and the elderly in Malawi. In: http://www.norway.mw/Global/SiteFolders/weblil/Final%20Witchcraft%20Report.pdf. Accessed 14 Dec 2013
Clarke K, King M, Prost A (2013) Psychosocial interventions for perinatal common mental disorders delivered by providers who are not mental health specialists in low- and middle-income countries: a systematic review and meta-analysis. PLoS Med 10(10):e1001541. doi:10.1371/journal.pmed.1001541
Fisher J, Cabral de Mello M, Patel V et al (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 90:139G–149G
Government of Malawi (2012) Gender and development index 2011. In: http://www.nsomalawi.mw/images/stories/data_on_line/economics/Gender/MALAWI_GENDER_AND_DEVELOPMENT_INDEX%20-June%202012.pdf. Accessed 16 Dec 2013
Guo N, Bindt C, Te Bonle M et al (2013) Association of antepartum and postpartum depression in Ghanaian and Ivorian women with febrile illness in their offspring: a prospective birth cohort study. Am J Epidemiol 178:1394–1402. doi:10.1093/aje/kwt142
Hanlon CA, Medhin G, Alem A et al (2009a) Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: the P-MaMiE population-based cohort study. Tropical Med Int Health 14:156–166. doi:10.1111/j.1365-3156.2008.02198.x
Hanlon CA, Whitley R, Wondimagegn D et al (2009b) Postnatal mental distress in relation to the sociocultural practices of childbirth: an exploratory qualitative study from Ethiopia. Soc Sci Med 69:1211–1219. doi:10.1016/j.socscimed.2009.07.043
Hanlon CA, Whitley R, Wondimagegn D et al (2010) Between life and death: exploring the sociocultural context of antenatal mental distress in rural Ethiopia. Arch Womens Ment Health 13:385–393. doi:10.1007/s00737-010-0149-3
Harkness S (1987) The cultural mediation of postpartum depression. Med Anthropol Q 1:194–209
Harpham T (2005) Maternal mental health and child nutritional status in four developing countries. J Epidemiol Community Health 59:1060–1064. doi:10.1136/jech.2005.039180
Kaaya SF, Mbwambo JK, Fawzi MCS et al (2010) Understanding women’s experiences of distress during pregnancy in Dar es Salaam, Tanzania. Tanzan J Health Res 12:36–46
Malawi Human Rights Commission (2005) Cultural practices and their impact on the enjoyment of human rights, particularly the rights of women and children in Malawi, http://www.medcol.mw/commhealth/publications/cultural_practices_report.pdf. Accessed 18 Dec 2013
Medhin G, Hanlon CA, Dewey M et al (2010) The effect of maternal common mental disorders on infant undernutrition in Butajira, Ethiopia: the P-MaMiE study. BMC Psychiatry 10:32. doi:10.1186/1471-244X-10-32
Mwape L, McGuinness TM, Dixey R, Johnson SE (2012) Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation. Int J Ment Health Syst 6:12. doi:10.1186/1752-4458-6-12
National Statistical Office, ICF Macro (2011) Malawi demographic and health survey 2010. National Statistical Office, Zomba, Malawi and ICF Macro, Calverton
Ndokera R, MacArthur C (2011) The relationship between maternal depression and adverse infant health outcomes in Zambia: a cross-sectional feasibility study. Child Care Health Dev 37:74–81. doi:10.1111/j.1365-2214.2010.01129.x
Patel V, Simunyu E, Gwanzura F (1995) Kufungisisa (thinking too much): a Shona idiom for non-psychotic mental illness. Cent Afr J Med 41:209–215
Peltzer K (1989) Nosology and etiology of a spirit disorder (vimbuza) in Malawi. Psychopathology 22:145–151
QSR International Pty Ltd (2012) NVivo qualitative data analysis software, Version 10; QSR International Pty Ltd.
Rahman A, Malik A, Sikander S et al (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 372:902–909. doi:10.1016/S0140-6736(08)61400-2
Rochat TJ, Tomlinson M, Bärnighausen T et al (2011) The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord 135:362–373. doi:10.1016/j.jad.2011.08.011
Ross J, Hanlon CA, Medhin G et al (2011) Perinatal mental distress and infant morbidity in Ethiopia: a cohort study. Arch Dis Child Fetal Neonatal Ed 96:F59–F64. doi:10.1136/adc.2010.183327
Sawyer A, Ayers S, Smith H (2010) Pre- and postnatal psychological wellbeing in Africa: a systematic review. J Affect Disord 123:17–29. doi:10.1016/j.jad.2009.06.027
Sawyer A, Ayers S, Smith H et al (2011) Women’s experiences of pregnancy, childbirth, and the postnatal period in The Gambia: a qualitative study. Br J Health Psychol 16:528–541. doi:10.1348/135910710X528710
Stewart RC, Bunn J, Vokhiwa M et al (2010) Common mental disorder and associated factors amongst women with young infants in rural Malawi. Soc Psychiatry Psychiatr Epidemiol 45:551–559. doi:10.1007/s00127-009-0094-5
Stewart RC, Umar E, Tomenson B, Creed F (2013) A cross-sectional study of antenatal depression and associated factors in Malawi. Arch Womens Ment Health. doi:10.1007/s00737-013-0387-2
Surkan PJ, Kennedy CE, Hurley KM, Black MM (2011) Maternal depression and early childhood growth in developing countries: systematic review and meta-analysis. Bull World Health Organ 89:608–615. doi:10.2471/BLT.11.088187
Tomlinson M, Cooper PJ, Stein A et al (2006) Post-partum depression and infant growth in a South African peri-urban settlement. Child Care Health Dev 32:81–86. doi:10.1111/j.1365-2214.2006.00598.x
UNICEF (2013) http://www.unicef.org/infobycountry/malawi_statistics.html, Accessed 20 Dec 2013
Acknowledgements
The authors would like to thank Ms Patuma Chitimbe, Ms Aaishah Milanzi, the staff at Mangochi District Hospital, the staff of ILINS-DYAD (Malawi) 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 statement
On behalf of all authors, the corresponding author states that there is no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic supplementary material.
ESM 1
(DOCX 93 kb)
Rights and permissions
About this article
Cite this article
Stewart, R.C., Umar, E., Gleadow-Ware, S. et al. Perinatal distress and depression in Malawi: an exploratory qualitative study of stressors, supports and symptoms. Arch Womens Ment Health 18, 177–185 (2015). https://doi.org/10.1007/s00737-014-0431-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-014-0431-x