Postpartum depressive symptoms in the context of high social adversity and reproductive health threats: a population-based study

Abstract

* Research * Open Access Postpartum depressive symptoms in the context of high social adversity and reproductive health threats: a population-based study * Telake Azale1, 5, * Abebaw Fekadu3, 4, 5 and * Charlotte Hanlon2, 5Email authorView ORCID ID profile International Journal of Mental Health Systems2018 12:42 https://doi.org/10.1186/s13033-018-0219-x © The Author(s) 2018 * Received: 19 February 2018 * Accepted: 14 July 2018 * Published: 28 July 2018 Abstract Background Postpartum depression is an important but neglected public health issue in low- and middle-income countries. Table 2 Socio-demographic, obstetric, and psychosocial characteristics of postpartum women in Sodo district, Ethiopia (n = 3147) Characteristics of participants Frequency Percent Age (years) Less than 20 107 3.4 20–29 1754 55.7 30–39 1217 38.7 40 or more 69 2.2 Marital status Not currently married 51 1.6 Married 3096 98.4 Residence Rural 2788 88.6 Urban 359 11.4 Education attended No formal education 2212 70.3 Primary education 802 25.5 Secondary and above 133 4.2 Occupational status Housewife 2722 86.5 Government or private employee 351 11.2 No job or daily laborer 74 2.4 Religion Orthodox Christian 2931 93.1 Protestant, Muslim, Catholic or other 216 6.9 Ethnicity Gurage 2856 90.8 Amhara, oromo or other 291 9.2 Baby gender Male 1607 51.1 Female 1540 48.9 Happy about baby gender Yes 2871 91.2 No 276 8.8 Husband happy about baby gender Yes 2781 88.4 No 366 11.6 Perinatal complicationa Yes 346 11.0 No 2801 89.0 History of stillbirth Yes 162 5.1 No 2985 94.9 History of abortion Yes 296 9.4 No 2851 90.6 Parity of women Primipara 504 16.0 Multipara 1393 44.3 Grand multipara 1250 39.7 Experienced hunger in the past 1 month Yes 434 13.8 No 2713 86.2 Relative wealth Less 800 25.4 Same 2083 66.2 Better 264 8.4 Level of social support Poor support 569 18.1 Intermediate support 1565 49.7 Strong support 1013 32.2 Stressful event in the past 6 months No 1621 51.5 1 stressful event 715 22.7 2 or more stressful events 811 25.8 Husband drinks too much alcohol No 2450 77.9 Yes 697 22.1 Marital relationship Poor 291 9.2 Good 2856 90.8 Problem drinking (≥ 3 on the FAST) No 3121 99.2 Yes 26 0.8 FAST Fast Alcohol Screening Test aBleeding in pregnancy or post-partum period, prolonged labour or high blood pressure The prevalence of high PPD symptoms (PHQ-9 score of 5 or more) was 12.2% (385/3147) with 95% confidence interval 11.1–13.4. Table 3 Crude and adjusted odds ratios for factors associated with postpartum depressive symptoms in women from Sodo district, Ethiopia Characteristic Postpartum depressive symptoms (Patient Health Questionnaire-9 ≥ 5) N = 3147 Crude odds ratio (95% confidence interval) Adjusted Odds ratio (95% confidence interval) (n = 3147) Yes 385 (12.2) No 2762 (88.8) Age (years) < 20 11 (10.3) 96 (89.7) Reference Reference 20–29 191 (10.9) 1563 (89.1) 1.06 (0.56, 2.02) 2.38 (0.76, 7.39) 30–39 175 (14.4) 1042 (85.6) 1.46 (0.77, 2.79) 1.90 (0.82, 4.38) 40 or more 8 (11.6) 61 (88.4) 1.14 (0.43, 3.00) 1.87 (0.83, 4.20) Not currently married 11 (21.6) 40 (78.4) 2.00 (1.01, 3.93) 1.05 (0.46, 2.40) Rural residence 363 (13.0) 2425 (87.0) 2.93 (1.46, 3.57) 2.60 (1.58, 4.27) No formal education 308 (13.9) 1904 (86.1) 1.80 (1.38, 2.34) 1.31 (0.96, 1.80) Husband unhappy about baby gender 58 (15.8) 308 (84.2) 1.43 (1.04, 1.91) 1.20 (0.77, 1.85) Perinatal complication 86 (24.9) 260 (75.1) 2.76 (2.10, 3.63) 2.43 (1.80, 3.29) History of stillbirth 37 (22.8) 125 (77.2) 2.24 (1.52, 3.29) 1.42 (0.92, 2.19) History of abortion 61 (20.6) 235 (79.4) 2.02 (1.49, 2.74) 1.45 (1.03, 2.04) Parity Primiparous 40 (7.9) 464 (92.1) Reference Reference 2–4 live births 149 (10.7) 1244 (89.3) 1.38 (0.96, 2.00) 1.43 (0.91, 2.23) Five or more 196 (15.7) 1054 (84.3) 2.15 (1.50, 3.08) 1.94 (1.18, 3.20) Hunger in the previous month 126 (29.0) 308 (71.0) 3.87 (3.03, 4.94) 1.95 (1.43, 2.67) Relative wealth Less 171 (21.4) 629 (78.6) 4.21 (2.47, 7.18) 1.84 (1.03, 3.29) Same 198 (9.5) 1885 (90.5) 1.62 (0.96, 2.75) 1.34 (0.77, 2.31) Better 16 (6.1) 248 (93.9) Reference Reference Social support Poor 104 (18.3) 465 (81.7) 2.18 (1.61, 2.95) 0.89 (0.66, 1.19) Intermediate 187 (11.9) 1378 (88.1) 1.32 (1.02, 1.72) 0.81 (0.58, 1.14) Strong 94 (9.3) 919 (90.7) Reference Reference Husband does not live in the same house 70 (18.0) 319 (82.0) 1.70 (1.28, 2.26) 1.31 (0.93, 1.83) Husband drinks too much alcohol 95 (13.6) 602 (86.4) 1.17 (0.91, 1.50) 0.79 (0.60, 1.04) Poor marital relationship 80 (27.5) 211 (72.5) 3.17 (2.38, 4.21) 2.13 (1.53, 2.97) Reference category The variables with statistically significant association (p < 0.05) are written in italics Discussion In this paper we report findings from a large population-based study of PPD symptoms in a rural Ethiopian setting, using a culturally validated measure of depression and a wide range of potentially relevant associated factors measured using standardized instruments. Authors’ Affiliations (1) Department of Health Education and Behavioral Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia (2) Centre for Global Mental Health, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK (3) Center for Innovative Drug Development and Therapeutic Trials for Africa, Addis Ababa University, Addis Ababa, Ethiopia (4) Centre for Affective Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK (5) Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia Shidhaye P, Giri P. Maternal depression: a hidden burden in developing countries.