Antenatal depression and its risk factors: An urban prevalence study in KwaZulu-Natal

Department of Psychiatry, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa. .
South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde (Impact Factor: 1.63). 12/2012; 102(12):940-4. DOI: 10.7196/samj.6009
Source: PubMed


There has been a recent increase in interest in antenatal depression, which is associated with adverse obstetric, neonatal and maternal outcomes and has been overlooked and underdiagnosed. Local data on prevalence and risk factors are lacking.

To determine the prevalence and risk factors associated with antenatal depressive symptoms in a KwaZulu-Natal population.

The Edinburgh Postnatal Depression Scale and a socio-demographic questionnaire in English and isiZulu were administered to 387 antenatal outpatients at King Edward VIII Hospital in Durban.

Of the participants, 149 (38.5%) suffered from depression and 38.3% had thought of harming themselves in the preceding 7 days. Risk factors for depression included HIV seropositivity (p=0.02), a prior history of depression (p=0.02), recent thoughts of self-harm (p<0.000), single marital status (p=0.04) and unplanned pregnancy (p=0.01). CONCLUSION; The high prevalence of antenatal depressive symptoms and thoughts of deliberate self-harm supports a policy of routine screening for antenatal depression in South Africa, especially in HIV-seropositive women.

Download full-text


Available from: Jonathan Kenneth Burns,
  • Source
    • "An additional concern pertains to the psychometric characteristics of these scales with regard to cultural population characteristics and their use in populations in which illiteracy remains a problem. Although scholars have debated the extent to which the psychometric properties of those scales are adequate for use in AD, the EPDS and BDI have been utilized extensively in the antenatal period (Areias et al., 1996; Buist et al., 2006; Chung et al., 2001; Da-Silva et al., 1998; Evans et al., 2001; Josefsson et al., 2001; Gotlib et al. 1989; Manikkam and Burns, 2012; Matthey and Ross-Hamid, 2012; Milgrom et al., 2008; Rochat et al., 2011; Seguin et al., 1995). However, questions remain regarding whether there are major differences between the self-fulfillment scales (EPDS and BDI) and those applied by professionals, such as the Hamilton Depression Rating Scale (HAM-D) (Hamilton, 1960). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Antenatal depression (AD) can have devastating consequences. No existing scales are specifically designed to measure it. Common practice is to adapt scales originally developed for other circumstances. We designed this study to validate and determine the psychometric values for AD screening in Brazil. We collected clinical and socio-demographic data in the second gestational trimester. The following instruments were also administered during that period: MINI-PLUS, EPDS, BDI and HAM-D. At the time of assessment, 17.34% of the patients were depressed, and 31.98% met the diagnostic criteria for lifetime major depression. All instruments showed an area under the curve in a receiver operating characteristic analysis greater than 0.85, with the BDI achieving a 0.90 and being the best-performing screening instrument. A score ≥11 on the EPDS (81.58% sensitivity, 73.33% specificity), ≥15 on the BDI (82.00% sensitivity, 84.26% specificity) and ≥9 on the HAM-D (87.76% sensitivity, 74.60% specificity) revealed great dichotomy between depressed and non-depressed patients. Spearman׳s rank correlation coefficients (ρ) among the scales had good values (EPDS vs. BDI 0.79; BDI vs. HAM-D 0.70, and EPDS vs. HAM-D 0.67). This study was transversal, assessing only women in the second gestational trimester. Results may be applicable only to the Brazilian population since psychometric properties may vary with the population under study. Major depression can amplify somatic symptomatology, affecting depressive rating scale data. AD is highly prevalent in Brazil. To address the problem of under-recognition, physicians can use the EPDS, BDI and HAM-D to identify AD. Copyright © 2015 Elsevier B.V. All rights reserved.
    Journal of Affective Disorders 02/2015; 178:12-17. DOI:10.1016/j.jad.2015.02.003 · 3.38 Impact Factor
  • Source
    • "Although some early work suggested that depression risk was reduced during pregnancy (Paffenbarger, 1964), recent studies indicate that the risk of a major depressive episode (MDE) during pregnancy may be greater than previously recognized, particularly in women with a previous personal or family history of depression (Cohen et al., 2010). Antepartum MDE risk appears to increase in conjunction with comorbidities such as physical and emotional abuse, poverty, limited education, lack of social support, single marital status, and human immunodeficiency virus (HIV) seropositivity (Coelho et al., 2013; Makara-Studzinska et al., 2013; Manikkam & Burns, 2012). Some recent studies estimate depression prevalence during pregnancy in the range of 8–16% (Bowen et al., 2012; Colvin et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Current research suggests that mood varies from season to season in some individuals, in conjunction with light-modulated alterations in chronobiologic indices such as melatonin and cortisol. The primary aim of this study was to evaluate the effects of seasonal variations in darkness on mood in depressed antepartum women, and to determine the relationship of seasonal mood variations to contemporaneous blood melatonin and cortisol measures; a secondary aim was to evaluate the influence of seasonal factors on measures of melancholic versus atypical depressive symptoms. We obtained measures of mood and overnight concentrations of plasma melatonin and serum cortisol in 19 depressed patients (DP) and 12 healthy control (HC) antepartum women, during on-going seasonal variations in daylight/darkness, in a cross-sectional design. Analyses of variance showed that in DP, but not HC, Hamilton Depression Rating Scale (HRSD) scores were significantly higher in women tested during seasonally longer versus shorter nights. This exacerbation of depressive symptoms occurred when the dim light melatonin onset, the melatonin synthesis offset, and the time of maximum cortisol secretion (acrophase) were phase-advanced (temporally shifted earlier), and melatonin quantity was reduced, in DP but not HC. Serum cortisol increased across gestational weeks in both the HC and DP groups, which did not differ significantly in cortisol concentration. Nevertheless, serum cortisol concentration correlated positively with HRSD score in DP but not HC; notably, HC showed neither significant mood changes nor altered melatonin and cortisol timing or quantity in association with seasonal variations. These findings suggest that depression severity during pregnancy may become elevated in association with seasonally related phase advances in melatonin and cortisol timing and reduced melatonin quantity that occur in DP, but not HC. Thus, women who experience antepartum depression may be more susceptible than their nondepressed counterparts to phase alterations in melatonin and cortisol timing during seasonally longer nights. Interventions that phase delay melatonin and/or cortisol timing-for example, increased exposure to bright evening light-might serve as an effective intervention for antepartum depressions whose severity is increased during seasonally longer nights.
    Chronobiology International 09/2013; 30(9). DOI:10.3109/07420528.2013.808652 · 3.34 Impact Factor
  • Source
    • "In HIV-epidemic regions of Southern Africa, the burden of antenatal and postnatal depression has been shown to be as high as 30–50 % in multiple studies (Hartley et al. 2011; Manikkam and Burns 2012; Chibanda et al. 2010; Rochat et al. 2006; Rochat et al. 2011; Stewart et al. 2010). In these resource-scarce settings, women are known to be at high risk, but given low availability of resources, they are unlikely to be screened in primary care. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Risk of antenatal depression has been shown to be elevated in Southern Africa and can impact maternal and child outcomes, especially in the context of the Human Immunodeficiency Virus (HIV). Brief screening methods may optimize access to care during pregnancy, particularly where resources are scarce. This research evaluated shorter versions of the Edinburgh Postnatal Depression Scale (EPDS) to detect antenatal depression. This cross-sectional study at a large primary health care (PHC) facility recruited a consecutive series of 109 antenatal attendees in rural South Africa. Women were in the second half of pregnancy and completed the EPDS and Structured Clinical Interview for Depression (SCID). The recommended EPDS cutoff (≥13) was used to determine probable depression. Four versions, including the 10-item scale, seven-item depression, and novel three- and five-item versions developed through regression analysis, were evaluated using receiver operating characteristic (ROC) analysis. High numbers of women 51/109 (47 %) were depressed, most depression was chronic, and nearly half of the women were HIV positive 49/109 (45 %). The novel three-item version had improved positive predictive value (PPV) over the 10-item version and equivalent specificity to the seven-item depression subscale; the novel five-item provided the best overall performance in terms of ROC and Cronbach's reliability statistics and had improved specificity. The brevity, sensitivity, and reliability of the short and ultrashort versions could facilitate widespread community screening. The usefulness of the novel three- and five-item versions are underscored by the fact that sensitivity is important at first screening, while specificity becomes more important at higher levels of care. Replication in larger samples is required.
    Archives of Women s Mental Health 04/2013; 16(5). DOI:10.1007/s00737-013-0353-z · 2.16 Impact Factor
Show more