Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-16T05:21:04.043Z Has data issue: false hasContentIssue false
  • English
  • Français

First trimester antenatal depression and anxiety: prevalence and associated factors in an urban population in Soweto, South Africa

Part of: Advancing the DOHaD Agenda in Africa DOHaD on International Women's Day 2020

Published online by Cambridge University Press:  07 September 2017

S. Redinger ,
S. A. Norris ,
R. M. Pearson ,
L. Richter  and
T. Rochat
S. Redinger
Affiliation:
MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa Human and Social Development Research Programme, Human Sciences Research Council, Durban, South Africa
S. A. Norris
Affiliation:
MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Stellenbosch Institute of Advanced Study, University of Stellenbosch, Stellenbosch, South Africa
R. M. Pearson
Affiliation:
School of Social and Community Medicine, Centre for Academic Mental Health, Bristol University, Bristol, UK
L. Richter
Affiliation:
DST-NRF Centre of Excellence in Human Development, University of Witwatersrand, Johannesburg, South Africa
T. Rochat*
Affiliation:
MRC/Developmental Pathways to Health Research Unit, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa Human and Social Development Research Programme, Human Sciences Research Council, Durban, South Africa Department of Psychiatry, University of Oxford, Oxford, UK
*
*Address for correspondence: Dr T. Rochat, Human Science Research Council, 5th Floor, The Atrium, 430 Peter Mokaba Ridge Road, Durban 4001, South Africa. (Email trochat@hsrc.ac.za)
Get access Rights & Permissions [Opens in a new window]

Abstract

Depression and anxiety in the antenatal period are of public health concern given potential adverse effects for both mother and infant. Both are under-researched in the first trimester of pregnancy, especially in Africa. We examine the prevalence of first trimester antenatal depression and anxiety in a cohort of South African women and investigate associated risk factors. Data were collected from 946 women (2014–2016) in the Soweto First 1000 Days Cohort, a prospective pregnancy cohort in Soweto, South Africa. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale with a score of ⩾13 indicating probable depression. Anxiety was assessed using the short form of the State-Trait Anxiety Index with a score ⩾12 indicating probable anxiety. Prevalence of antenatal depression was 27% [95% confidence interval (CI) 24.2–29.8] and anxiety 15.2% (95% CI 12.9–17.5). Factors associated with antenatal depression and anxiety were predominantly relationship- and family-centred. Women who perceived that their partner made life harder for them had three-fold increased odds for depression [(odds ratio (OR) 3.33 [2.28–4.85] P<0.001], whereas those with family stressors had almost double the odds for depression (OR 1.78 [1.22–2.59] P=0.003) and anxiety (OR 1.75 [1.44–2.69] P=0.0011). Antenatal depression and anxiety are common in the first trimester of pregnancy, and partner and family relationship stressors are central. Longitudinal analysis is needed to determine if this is a phase of adjustment to pregnancy or onset of persistent symptomology. Early intervention may have secondary preventative effects and should involve the partner and family.

Keywords

antenatalanxietydepressionSouth Africa
Type
Original Article
Information
Journal of Developmental Origins of Health and Disease , Volume 9 , Issue 1: Themed Issue: DOHaD AFRICA , February 2018 , pp. 30 - 40
Check for updates
Copyright
© Cambridge University Press and the International Society for Developmental Origins of Health and Disease 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Glover, V. Maternal depression, anxiety and stress during pregnancy and child outcome; what needs to be done. Best Prac Res Clin Obstet Gynaecol. 2014; 28, 25–35.CrossRefGoogle Scholar
2. Herba, CM, Glover, V, Ramchandani, PG, Rondon, MB. Maternal depression and mental health in early childhood: an examination of underlying mechanisms in low-income and middle-income countries. Lancet Psychiatry. 2016; 3, 983–992.CrossRefGoogle ScholarPubMed
3. Stein, A, Pearson, RM, Goodman, SH, et al. Effects of perinatal mental disorders on the fetus and child. Lancet. 2014; 384, 1800–1819.CrossRefGoogle ScholarPubMed
4. Bennett, HA, Einarson, A, Taddio, A, Koren, G, Einarson, TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004; 103, 698–709.CrossRefGoogle ScholarPubMed
5. Howard, LM, Molyneaux, E, Dennis, C-L, et al. Non-psychotic mental disorders in the perinatal period. Lancet. 2014; 384, 1775–1788.CrossRefGoogle ScholarPubMed
6. Biaggi, A, Conroy, S, Pawlby, S, Pariante, CM. Identifying the women at risk of antenatal anxiety and depression: a systematic review. J Affect Disord. 2016; 191, 62–77.CrossRefGoogle ScholarPubMed
7. Grigoriadis, S, VonderPorten, EH, Mamisashvili, L, et al. The impact of maternal depression during pregnancy on perinatal outcomes: a systematic review and meta-analysis. J Clin Psychiatry. 2013; 74, 321–341.CrossRefGoogle ScholarPubMed
8. Grote, NK, Bridge, JA, Gavin, AR, et al. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010; 67, 1012–1024.CrossRefGoogle ScholarPubMed
9. Ding, X-X, Wu, Y-L, Xu, S-J, et al. Maternal anxiety during pregnancy and adverse birth outcomes: a systematic review and meta-analysis of prospective cohort studies. J Affect Disord. 2014; 159, 103–110.CrossRefGoogle ScholarPubMed
10. Milgrom, J, Gemmill, AW, Bilszta, JL, et al. Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord. 2008; 108, 147–157.CrossRefGoogle ScholarPubMed
11. Black, MM, Walker, SP, Fernald, LC, et al. Early childhood development coming of age: science through the life course. Lancet. 2017; 389, 77–90.CrossRefGoogle ScholarPubMed
12. Gelaye, B, Rondon, MB, Araya, R, Williams, MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016; 3, 973–982.CrossRefGoogle ScholarPubMed
13. Hancock, KJ, Mitrou, F, Shipley, M, Lawrence, D, Zubrick, SR. A three generation study of the mental health relationships between grandparents, parents and children. BMC Psychiatry. 2013; 13, 299.CrossRefGoogle ScholarPubMed
14. Bauer, A, Parsonage, M, Knapp, M, Iemmi, V, Adelaja, B. Costs of perinatal mental health problems. London School of Economics and Political Science: London, UK. 2014.Google Scholar
15. Fisher, J, Cabral de Mello, M, Patel, V, et al. Prevalence and determinants of common perinatal mental disorders in women in low-and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012; 90, 139–149.CrossRefGoogle ScholarPubMed
16. Sawyer, A, Ayers, S, Smith, H. Pre- and postnatal psychological wellbeing in Africa: a systematic review. J Affect Disord. 2010; 123, 17–29.CrossRefGoogle ScholarPubMed
17. Brittain, K, Myer, L, Koen, N, et al. Risk factors for antenatal depression and associations with infant birth outcomes: results from a South African birth cohort study. Paediatr Perinat Epidemiol. 2015; 29, 505–514.CrossRefGoogle ScholarPubMed
18. Hartley, M, Tomlinson, M, Greco, E, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011; 8, 1.CrossRefGoogle ScholarPubMed
19. Rochat, TJ, Tomlinson, M, Bärnighausen, T, Newell, M-L, Stein, A. The prevalence and clinical presentation of antenatal depression in rural South Africa. J Affect Disord. 2011; 135, 362–373.CrossRefGoogle ScholarPubMed
20. Manikkam, L, Burns, JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012; 102, 940–944.CrossRefGoogle ScholarPubMed
21. van Heyningen, T, Myer, L, Onah, M, et al. Antenatal depression and adversity in urban South Africa. J Affect Disord. 2016; 203, 121–129.CrossRefGoogle Scholar
22. McManus, S, Bebbington, P, Jenkins, R, Brugha, T. Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014, NHS Digital, Leeds, 2016.Google Scholar
23. Rochat, TJ, Tomlinson, M, Newell, M-L, Stein, A. Detection of antenatal depression in rural HIV-affected populations with short and ultrashort versions of the Edinburgh Postnatal Depression Scale (EPDS). Arch Womens Ment Health. 2013; 16, 401–410.CrossRefGoogle Scholar
24. Tsai, AC, Scott, JA, Hung, KJ, et al. Reliability and validity of instruments for assessing perinatal depression in African settings: systematic review and meta-analysis. PLoS One. 2013; 8, e82521.CrossRefGoogle ScholarPubMed
25. Shrestha, SD, Pradhan, R, Tran, TD, Gualano, RC, Fisher, JRW. Reliability and validity of the Edinburgh Postnatal Depression Scale (EPDS) for detecting perinatal common mental disorders (PCMDs) among women in low-and lower-middle-income countries: a systematic review. BMC Pregnancy Childbirth. 2016; 16, 1–19.CrossRefGoogle ScholarPubMed
26. Chibanda, D, Mangezi, W, Tshimanga, M, et al. Validation of the Edinburgh Postnatal Depression Scale among women in a high HIV prevalence area in urban Zimbabwe. Arch Womens Ment Health. 2010; 13, 201–206.CrossRefGoogle Scholar
27. Marteau, TM, Bekker, H. The development of a six‐item short‐form of the state scale of the Spielberger State—Trait Anxiety Inventory (STAI). Br J Clin Psychol. 1992; 31, 301–306.CrossRefGoogle ScholarPubMed
28. Ramchandani, PG, Richter, LM, Norris, SA, Stein, A. Maternal prenatal stress and later child behavioral problems in an urban South African setting. J Am Acad Child Adolesc Psychiatry. 2010; 49, 239–247.Google Scholar
29. Ramchandani, PG, Richter, LM, Stein, A, Norris, SA. Predictors of postnatal depression in an urban South African cohort. J Affect Disord. 2009; 113, 279–284.CrossRefGoogle Scholar
30. Booysen, F, Van Der Berg, S, Burger, R, Von Maltitz, M, Du Rand, G. Using an asset index to assess trends in poverty in seven Sub-Saharan African countries. World Dev. 2008; 36, 1113–1130.CrossRefGoogle Scholar
31. StataCorp. Stata Statistical Software: Release 13. 2013. StataCorp LP: College Station, TX.Google Scholar
32. Meades, R, Ayers, S. Anxiety measures validated in perinatal populations: a systematic review. J Affect Disord. 2011; 133, 1–15.CrossRefGoogle ScholarPubMed
33. Sowa, NA, Cholera, R, Pence, BW, Gaynes, BN. Perinatal depression in HIV-infected African women: a systematic review. J Clin Psychiatry. 2015; 76, 1385–1396.CrossRefGoogle ScholarPubMed
34. Mitchell, J, Wight, M, Van Heerden, A, Rochat, TJ. Intimate partner violence, HIV, and mental health: a triple epidemic of global proportions. Int Rev Psychiatry. 2016; 28, 452–463.CrossRefGoogle ScholarPubMed
35. Rochat, TJ, Richter, LM, Doll, HA, et al. Depression among pregnant rural South African women undergoing HIV testing. JAMA. 2006; 295, 1373–1378.CrossRefGoogle ScholarPubMed
36. Howard, LM, Oram, S, Galley, H, Trevillion, K, Feder, G. Domestic violence and perinatal mental disorders: a systematic review and meta-analysis. PLoS Med. 2013; 10, e1001452.CrossRefGoogle ScholarPubMed
37. Bilszta, JL, Tang, M, Meyer, D, et al. Single motherhood versus poor partner relationship: outcomes for antenatal mental health. Aust N Z J Psychiatry. 2008; 42, 56–65.CrossRefGoogle ScholarPubMed
38. Rahman, A, Iqbal, Z, Harrington, R. Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychol Med. 2003; 33, 1161–1167.CrossRefGoogle ScholarPubMed
39. Coll, CdVN, da Silveira, MF, Bassani, DG, et al. Antenatal depressive symptoms among pregnant women: evidence from a Southern Brazilian population-based cohort study. J Affect Disord. 2017; 209, 140–146.CrossRefGoogle ScholarPubMed
40. Breedlove, G, Fryzelka, D. Depression screening during pregnancy. J Midwifery Womens Health. 2011; 56, 18–25.CrossRefGoogle ScholarPubMed
41. Kagee, A, Tsai, AC, Lund, C, Tomlinson, M. Screening for common mental disorders in low resource settings: reasons for caution and a way forward. Int Health. 2013; 5, 11–14.CrossRefGoogle Scholar
42. Chowdhary, N, Sikander, S, Atif, N, et al. The content and delivery of psychological interventions for perinatal depression by non-specialist health workers in low and middle income countries: a systematic review. Best Pract Res Clin Obstet Gynaecol. 2014; 28, 113–133.CrossRefGoogle ScholarPubMed
43. Chibanda, D, Weiss, HA, Verhey, R, et al. Effect of a primary care–based psychological intervention on symptoms of common mental disorders in Zimbabwe: a randomized clinical trial. JAMA. 2016; 316, 2618–2626.CrossRefGoogle ScholarPubMed