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Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh

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Abstract

Objectives Depression following pregnancy is common, but its extent and association with maternal morbidity in the first 6 months postpartum have not been well described in low resource settings such as rural Bangladesh. Methods We used data from a population-based, community trial of approximately 39,000 married rural Bangladeshi women aged 13–44 between 2001 and 2007 to examine the relation between women’s reported morbidity symptoms from childbirth to 3 months postpartum, and subsequent depressive symptoms assessed at 6 months postpartum. We calculated crude and adjusted risk ratios for depressive symptoms following women’s reports of reproductive, urinary, neurologic, nutrition and other illness measures constructed based on symptomatic reporting. Results In models adjusted for sociodemographic factors and co-morbidities, all postpartum illnesses were associated with an increased relative risk [RR, with 95% confidence intervals (CI) excluding 1] of depressive symptoms by 6 months postpartum. These morbidities included uterine prolapse (RR 1.20, 95% CI 1.04–1.39), urinary tract infection (RR 1.24, 95% CI 1.11–1.38), stress related incontinence (SRI) (RR 1.49, 95% 1.33–1.67), simultaneous SRI and continuously dripping urine (RR 1.60–2.96), headache [RR 1.20 (95% CI 1.12–1.28)], convulsions (RR 1.67, 95%CI 1.36–2.06), night blindness (RR 1.33, 95% CI 1.19–1.49), anemia (RR 1.38, 95% CI 1.31–1.46), pneumonia (RR 1.24, 95% CI 1.12–1.37), gastroenteritis (RR 1.24, 95% CI 1.17–1.31) and hepatobiliary disease (RR 2.10, 96% CI 1.69–2.60). Conclusions for Practice Illnesses during the first three postpartum months were risk factors for depressive symptoms, with the strongest associations noted for convulsions and hepatobiliary disease. Symptoms of depression may be of particular concern among women suffering from physical illnesses.

Clinical trial registration: ClinicalTrials.gov NCT0019882.

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Acknowledgements

The trial was supported by the Bill and Melinda Gates Foundation (GH614, Global Control of Micronutrient Deficiency, Project Officer: Ellen Piwoz), Seattle, WA; The analyses for this paper was supported by the National Institute of Child Health and Development, NIH [1 RO3 HD069731-01A1], Bethesda, MD; Other funding for data collection included the Office of Health, Infectious Diseases and Nutrition, USAID (Micronutrients for Health Cooperative Agreement HRN-A-00-97-00015-00 and Global Research Activity GHS-A-00-03-00019-00), Washington DC; USAID Mission Bangladesh, Dhaka; Ministry of Health and Family Welfare, Government of the Peoples’ Republic of Bangladesh, Dhaka; The Sight and Life Global Nutrition Research Institute, Baltimore, MD.

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Authors and Affiliations

  1. Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205-2179, USA

    Pamela J. Surkan, Parul Christian, Sucheta Mehra, Alain Labrique, Hasmot Ali, Barkat Ullah, Lee Wu, Rolf Klemm, Mahbubur Rashid & Keith P. West Jr

  2. Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA

    Pamela J. Surkan & Kwame S. Sakyi

  3. Nutrition|Global Development, Bill and Melinda Gates Foundation, Seattle, WA, USA

    Parul Christian

  4. The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh

    Parul Christian, Sucheta Mehra, Alain Labrique, Hasmot Ali, Lee Wu, Rolf Klemm, Mahbubur Rashid & Keith P. West Jr

  5. Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205-2179, USA

    Pamela J. Surkan & Donna M. Strobino

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  1. Pamela J. Surkan
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Correspondence to Pamela J. Surkan.

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Surkan, P.J., Sakyi, K.S., Christian, P. et al. Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh. Matern Child Health J 21, 1890–1900 (2017). https://doi.org/10.1007/s10995-017-2299-7

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