Elsevier

Midwifery

Volume 96, May 2021, 102937
Midwifery

Direct and indirect determinants of prenatal depression among Arab-Bedouin women in Israel: The role of stressful life events and social support

https://doi.org/10.1016/j.midw.2021.102937Get rights and content

Highlights

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    We identified direct and indirect predictors of PNDS in Bedouin women in israel.

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    Stressful life events and education emerged as direct and indirect predictors of PNDS.

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    History of depression found to be the single strongest direct predictor of PNDS.

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    Yet the combined direct and indirect effects of stressful life events greatest.

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    Social support is a significant buffer to PNDS, predicted only by education.

Abstract

Objective: Prenatal depression (PND) negatively affects the health and well-being of both mother and child. The aim of this study was to identify the direct and indirect determinants of prenatal depression symptoms (PNDS) among Arab-Bedouin women in southern Israel. Design: Data collection was conducted in two women's health centers from October 2017 to February 2018. Setting: Participants were recruited during visits to women's health centers in southern Israel. Participants: We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. We recruited 376 Arab-Bedouin women as part of a larger study of perinatal health and well-being. All women were 18+ years of age and 26–38 weeks of gestational age. Measurements: PNDS were measured by an Arabic version of the Edinburgh Postnatal Depression Scale. We computed path analyses to identify direct and indirect determinants of PND and estimated the contribution of stressful life events and social support. Results: Positive direct associations emerged between stressful life events, history of depression and gestational age, and PNDS; direct inverse associations were found between social support, PND awareness, and education, and PNDS. History of depression was the single strongest direct predictor of PNDS yet when considering combined direct and indirect effects, the contribution of stressful life events is greater. Stressful life events (via history of depression and PND awareness) and education (via PND awareness) had both direct and indirect effects on PNDS. Age of the mother indirectly affects PNDS via education and PND awareness. Polygamy emerged as neither a direct nor indirect predictor of PNDS. Conclusions: PNDS in the underserved and understudied Bedouin women has serval direct and indirect predictors. Interventions aiming at reducing stress and increasing social support, via PND awareness might be successful in reducing PND and possibly future postpartum depression.

Section snippets

Background

Prenatal depression (PND) is one of the most common medical complications during pregnancy (Gavin et al., 2005), presenting most often in the second and third trimesters (Bisetegn and Mihretie, 2016; Bennett et al., 2004). PND prevalence ranges from 10% to 50% across countries and cultures (Stuart-Parrigon and Stuart, 2014; Woody et al., 2017; Mukherjee et al., 2016). Despite this prevalence, PND remains a neglected aspect of prenatal care (World Health Organization, 2017). In 2018, the

Study design, ethics, and sampling

Study design: This cross-sectional study set out to identify the direct and indirect predictors of PNDS among Arab-Bedouin women in southern Israel. This study received ethical approval from Clalit Health Services (COM-004–16).

Study sample: Data collection was conducted in two women's health centers from October 2017 to February 2018. All participants were Arab‐Bedouin women who were 26 to 38 weeks pregnant. This sample included only single birth pregnancies.

Sample size: We set the threshold

Results

Table 1 presents descriptive statistics for study participants (N = 376). Participants were 28 years of age on average (SD = 6; range 18–48), 32% had 1–2 children and 40% had three and more children (range 0–12). About one-third indicted they had post-secondary education, close to half (45%) were married to a first cousin and 13% reported polygamous marriages (husbands had 2+ wives). Most (63%) planned their current pregnancy and 28% reported that this was their first time pregnant. Table 2.

Discussion

We set out to identify both direct and indirect predictors of PNDS among Bedouin women. More than one-third (34%) reported elevated symptom levels suggesting that PND is high among Bedouin women in southern Israel. Similarly, study conducted with Aboriginal women in Canada reported that one-third (32.2%) had PND, higher than non-Aboriginal women at risk (26.7%) (Bowen et al., 2009). In Brazil, PND prevalence is estimated at 14.2% (Pereira et al., 2009). Yet a rate of 40.1% has been reported in

Conclusion

Our findings indicate that PNDS appear to have both direct and indirect predictors in our sample. Stressful life events and lack of social support during pregnancy directly and indirectly predict PNDS in Bedouin women in southern Israel. These findings should inform psychosocial interventions and health promotion initiatives intended to reduce PND prevalence in this vulnerable population.

Declaration of Competing Interest

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Acknowledgments

We are grateful to the research participants for their willing cooperation and patience. In addition, we thank Clalit Healthcare Services for their assistance in facilitating this study.

Ethical Approval

Ethics approval for this study was obtained from Helsinki Committee of Clalit Health Care Services (COM-004–16)

Funding Sources

The study was funded by the Ministry of Science and Technology, Grant Number: 8762591, Israel.

Clinical Trial Registry and Registration number: ClinicalTrials.gov NCT02862444

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