Wasserman GA: social environment and depression among pregnant women in urban areas of Pakistan: importance of social relations

Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Social Science & Medicine (Impact Factor: 2.89). 10/2006; 63(6):1466-76. DOI: 10.1016/j.socscimed.2006.05.019
Source: PubMed


Aspects of the social environment, including social conditions (socio-economic status, household situations, chronic illnesses) and social relations (attitude and behaviors of relations) are major determinants of depression among women. This study evaluates the relative power of social relations and social conditions in predicting depression among pregnant women in Pakistan. In the qualitative phase of the study, social environmental determinants were identified through literature search, and experts' opinions from psychologists, psychiatrists, gynecologists, sociologists and researchers. Along with this, 79 in-depth interviews were conducted with pregnant women drawn from six hospitals (public and private) and two communities in Karachi, Pakistan. Identified determinants of depression were grouped into themes of social conditions and social relations and pregnancy-related concerns. In the study's quantitative phase, the relative power of the identified themes and categories, based on their scores for predicting depression (determined by the Center for Epidemiological Studies-Depression Scale (CES-D scale)), was determined through multivariate linear regression. Social environmental determinants of pregnant women were described under the themes and categories of (1) social relations: involving husband, in-laws and children; (2) social conditions: involving the economy, illness, life events, household work, environmental circumstances and social problems; and (3) pregnancy-related concerns i.e. symptoms of pregnancy, changes during pregnancy, dependency and concern for unborn baby. Multivariate analysis found that among these themes, social relations and pregnancy-related concerns were significantly associated with total CES-D scores. Among the categories besides increasing age and less education, husband, in-laws, household work and pregnancy symptoms were significantly associated with total CES-D scores. The study highlights the importance of social relations compared to social conditions for determining depression in pregnant women.

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Available from: Unaiza Niaz, Dec 20, 2013
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    • "A cut-off value of 16 and above is used to report depressive symptoms [23]. CES-D has also been used in the Pakistani population [33]. "
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    ABSTRACT: Depression is common among elderly in developed countries and it is more pronounced in institutional settings. In Pakistan there is a lack of empirical data on depression among this segment of the population particularly with reference to their living arrangements. The objectives of the present study are to report the magnitude of depression among elderly having two different residential arrangements and to examine the association of depression and its established demographic factors. Data were collected from 141 respondents. 108 were community residents (m = 57 and f = 51) and 33 were living in the care homes (m = 29 and f = 4). Prevalence of depression as assessed by Geriatric Depression Scale (GDS) among community and Care Homes (CHs) participants was 31.5 percent and 60.6 percent, respectively. On Centre of Epidemiological Studies Depression Scale (CES-D), 42.6 percent of the community and 69.7 percent of the CH respondents were deemed depressed. Before adjusting for any other potential risk factors the odds of being depressed was significantly increased if the study participants were living in CH, relatively older, female, not currently married, had low educational level, had lower Mini Mental State Examination (MMSE) scores, and reported lower perceived emotional and practical support. In a partially adjusted logistic regression model an increased risk of depression was not confounded by any of the above mentioned risk factors. However, the risk associated was not significant when it was adjusted for social support. The findings of the current study are consistent with previous research and throws light on the dire need for interventions to address mental health needs of Pakistani elderly. Implications for improving the mental health status of elderly are also presented.
    BMC Research Notes 06/2014; 7(1):409. DOI:10.1186/1756-0500-7-409
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    • "Vários estudos demonstraram uma correlação significativa entre a percepção de apoio social e depressão durante a gravidez, revelando que mulheres grávidas que têm menos apoio social apresentam mais sintomas de depressão (Golbasi, Kelleci, Kisacik & Cetin, 2010; Kazi et al., 2006; Marcus, Flynn, Blow, & Barry, 2003; Records & Rice, 2007; Rubertsson & Waldenstrom, 2003). No estudo de Golbasi et al. (2010), a qualidade dos relacionamentos sociais esteve significativamente relacionada aos sintomas de depressão em mulheres. "
    11/2013; 17(1). DOI:10.5380/psi.v17i1.20159
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    • "Our findings are consistent with a rate of 39·4% among Pakistani women residing in Karachi [31] but lower than the rate of 18% reported by others [32]. Of note, this study and the study by Kazi et al., [31] used the CESD to measure symptoms of depression, which has items related to somatic symptoms of pregnancy, whereas the other Pakistani study [31] used the short form of the Aga Khan University Anxiety Depression Scale, which omits items on the somatic symptoms, which may have accounted for different findings. "
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    ABSTRACT: High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth; however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth. In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression respectively, and had a blood cortisol level drawn. Women were followed up after delivery to determine birth outcomes. Correlation coefficients and Wilcoxon rank sum test was used to assess relationship between preterm birth, stress, depression and cortisol. Logistic regression analysis was used to determine the key factors predictive of preterm birth. 132 pregnant women participated of whom 125 pregnant women had both questionnaire and cortisol level data and an additional seven had questionnaire data only. Almost 20% of pregnant women (19·7%, 95% CI 13·3-27·5) experienced a high level of stress and nearly twice as many (40·9%, 95% CI 32·4-49·8%) experienced depressive symptoms. The median of cortisol level was 27·40 ug/dl (IQR 22·5-34·2). The preterm birth rate was 11·4% (95% CI 6·5-18). There was no relationship between cortisol values and stress scale or depression. There was a significant positive relationship between maternal depression and stress. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. Insufficient numbers of preterm births were available to warrant the development of a multivariable logistic regression model. Preterm birth was associated with higher parity, past delivery of a male infant, and higher levels of paternal education. There was no relationship between stress, and depression, cortisol and preterm birth. There were high rates of stress and depression among this sample suggesting that there are missed opportunities to address mental health needs in the prenatal period. Improved methods of measurement are required to better understand the psychobiological basis of preterm birth.
    BMC Pregnancy and Childbirth 11/2011; 11(1):88. DOI:10.1186/1471-2393-11-88 · 2.19 Impact Factor
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