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Birth. 2021;48:149–163. wileyonlinelibrary.com/journal/birt
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149
© 2021 Wiley Periodicals LLC
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INTRODUCTION
For most people, pregnancy and birth are a joyous period,
but for some it may be the most distressing experience of
their lives. Perinatal depression refers to the occurrence of
depression that arises during pregnancy (antenatal depres-
sion) or up to 1 year postpartum (postnatal depression).1
The medical definition of perinatal depression does not dif-
ferentiate between sexes, and researchers are recognizing
it as an emerging public health problem in fathers as well.
The World Health Organization has identified depression
as the single largest contributor to global disability, and a
major contributor to suicide deaths (approximately 800000
per year globally).2
Received: 6 December 2019
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Revised: 11 January 2021
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Accepted: 16 January 2021
DOI: 10.1111/birt.12535
SYSTEMATIC REVIEW
Perinatal depression in Pakistan: A systematic review and meta-
analysis
MariaAtif MPH1
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MarkHalaki PhD2
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CamilleRaynes- Greenow PhD3
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Chin- MoiChow PhD4
1Faculty of Health Sciences, The University
of Sydney, Sydney, New South Wales,
Australia
2Discipline of Exercise and Sport Science,
Faculty of Health Sciences, The University
of Sydney, Sydney, New South Wales,
Australia
3School of Public Health, Faculty of
Medicine and Health, The University
of Sydney, Sydney, New South Wales,
Australia
4Discipline of Exercise and Sport Science,
Faculty of Health Sciences, The University
of Sydney, Sydney, New South Wales,
Australia
Correspondence
Maria Atif, MPH, Faculty of Health
Sciences, University of Sydney, Sydney,
NSW, Australia.
Email: mati2476@uni.sydney.edu.au
Abstract
Objective: To estimate the prevalence and associated risk factors of perinatal de-
pression in Pakistan.
Methods: We conducted a systematic search of Medline, PsycINFO, CINAHL,
EMBASE, and Global health, up through May 31, 2019. Studies reporting on the
prevalence of perinatal depression in Pakistan with or without associated risks fac-
tors were included.
Results: Forty- three studies reporting data from 17544 women met the eligibility
criteria and were included. Overall, the pooled prevalence of antenatal depression
was 37% (95% CI: 30- 44), while that of postnatal depression was 30% (95% CI:
25- 36). The prevalence of perinatal depression in women residing in urban areas
and those living in rural settings was not significantly different. The most frequently
reported risk factors for antenatal depression were intimate partner violence and poor
relationship with spouse, and that reported for postnatal depression was low- income
level. An unintended pregnancy was significantly associated with perinatal depres-
sion in Pakistan.
Conclusions: We identified variability in prevalence rate of perinatal depression in
Pakistan. It is difficult to gauge the true magnitude of this problem potentially due
to differing risk factors between the antenatal and postnatal periods and the lack of
uniformity of data collection protocols and procedures. The high prevalence rates of
30%- 37% compared to global estimates suggest policy makers and stakeholders should
direct additional resources toward improving perinatal mental health in Pakistan.
KEYWORDS
depression, mental health, Pakistan, perinatal