Article

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: 1.71). 12/2012; 102(12):940-4. DOI: 10.7196/samj.6009
Source: PubMed

ABSTRACT Objective. 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. Aim. To determine the prevalence and risk factors associated with antenatal depressive symptoms in a KwaZulu-Natal population. Methods. 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. Results. 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.

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    • "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). "
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    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.
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    • "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). "
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    • "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. "
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