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Perinatal depression in Pakistan: A systematic review and meta‐analysis

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Objective To estimate the prevalence and associated risk factors of perinatal depression 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 factors were included. Results Forty‐three studies reporting data from 17 544 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 depression 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.
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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 800000
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
MariaAtif MPH1
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MarkHalaki PhD2
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CamilleRaynes- Greenow PhD3
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Chin- MoiChow 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 17544 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
... Many quantitative studies have been performed to highlight different AD symptoms and their causes. Previous quantitative studies have demonstrated various predictors of depression in pregnant women, including poverty, poor intimate relationships, intimate partner violence, inadequate emotional support from family, lack of assistance in adverse situations, social distress, financial problems, lack of autonomy in making household decisions due to husbands' and mothers-in-laws' authoritative behaviour, family history of psychiatric illness, previous history of miscarriage or stillbirth and unplanned pregnancy [6][7][8][9]. In addition, preferences for male children and lack of freedom for women to use family planning techniques for reproductive health are additional factors in AD among pregnant women in the patriarchal system of Pakistani society [10]. ...
... It employs the core principles and techniques of cognitive behaviour therapy (CBT), such as building an empathetic relationship, focusing on the here and now, behaviour activation and problem-solving. The programme is fully manualised and has culturally appropriate pictorial illustrations aimed at helping mothers reflect on their thinking process and encouraging family support [6]. ...
... During the third phase of the present study, the THP intervention was applied. THP is a CBT-based intervention that the WHO mainly designed to reduce perinatal depression in low socioeconomic settings [6]. The THP intervention comprises sixteen sessions based on five modules. ...
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Background The present study is an intervention-based qualitative study that explores the factors causing depression among antenatal women and analyses coping strategies based on the modified version of the Thinking Healthy Programme (THP) intervention in the urban setting of Lahore, Pakistan. Methods An exploratory qualitative evaluation approach was used in the present study. The study comprises four phases, i.e., the screening phase, exploratory phase, intervention phase, and evaluation phase. During the first phase, pregnant women aged 18–45 years were screened for anxiety and depression by using the Urdu-translated Patient Health Care Questionnaire-9. In the second phase, identified women were interviewed to explore the factors responsible for depression. In the third phase, the intervention was administered via the THP intervention. In the last phase, the same women were reinterviewed to analyse the outcomes of the intervention. Thematic analysis was performed for the analysis of the interviews. Results Data was analyzed using thematic analysis following an deductive and indictive approach in both pre- and post-intervention phase. Three main themes emerged in the pre-intervention phase: (1) the impact of adverse life events on the mental health of pregnant women, (2) the adverse effects of marital relationship issues on pregnant women, and (3) depression-causing factors due to the joint family system. Furthermore, four themes emerged in the post-intervention stage: (1) development of positivity in thinking and attitude, (2) learning about stress management through the provision of compassion and sharing avenues, (3) gaining self-esteem to address matters positively, and (4) improving relationships with the unborn child and family. Numerous pregnant women praised the THP project and recommended that hospitals adopt it to assist pregnant patients in the Pakistani health system. Conclusion The study concludes that THP can be a valuable tool for helping many pregnant women who are experiencing prenatal depression recover, however, there is a further need for exploring its benefits in varying social and cultural contexts. Trial registration The study has been registered at https://clinicaltrials.gov/ (NCT04663243).
... [6][7][8] Studies conducted in Pakistan's urban tertiary care settings found percentages ranging from 24% to 42%. [9][10][11] As opposed to community-based research from rural Pakistan, which indicated a prevalence between 28% and 36%. 12 A Cross Sectional research conducted in Pakistan indicated that 67.96% of participants had persistent PPD which means depression was present at all three time periods in the first postnatal year. ...
... Whereas a meta-analysis carried out by Atif M et al. found prevalence of PPD between 30-37% in Pakistan. 10 Another study conducted by Yadav T et al. ...
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Objective: A type of mental sickness known as postpartum depression (PPD), which affects some women after giving birth, is characterized by feelings of melancholy, anxiety, and weariness that can interfere with day-to-day activities and the ability to form attachments with the infant. The social and cognitive development of the infant is said to suffer from PPD. In multiethnic urban areas in Pakistan, this study sought to determine the prevalence and risk factors for postpartum depression. Methods: A cross-sectional study was carried out in various parts of Pakistan, and information from 126 women who lived in urban areas, was gathered. To gauge postpartum depression, the Edinburgh Postnatal Depression Scale was utilized, and a cut-off score of 13 was chosen to separate depressed from non-depressed women. Results: PPD was shown to be 41.27% prevalent among urban women. Lack of social support from the husband, lack of social support from in-laws, lack of knowledge, difficulty in handling the baby, social conflicts, and lack of postpartum support were some of the causes of PPD. Conclusion: In Pakistan, where postpartum depression is a severe public health concern and frequently goes unreported due to cultural stigmas, this study emphasizes the value of early detection and care for Pakistani urban women at risk of developing the condition. During postpartum visits, healthcare providers should frequently screen new mothers for depression and utilize instruments like the Edinburgh Postnatal Depression Scale to identify those experiencing symptoms. A complete approach to addressing this issue must include strengthening social support, expanding access to mental health services, and teaching medical staff how to identify and treat postpartum depression. Keywords: Postpartum Depression, Edinburgh Postnatal Depression Scale, Urban Population, Mental Health, Social Support, Public Health.
... This meta-analysis found that the pooled prevalence of "AND" and "PND" among Bangladeshi women were 19.5 % and 27.75 %, respectively. Similar studies on depression in Turkey and Pakistan found a close pooled prevalence of "PND" of 24 % and 30 %, respectively [50,51]. The "PND" prevalence similarity with Asian countries like Pakistan and Turkey might have been due to their homogeneous demographic and socioeconomic characteristics. ...
... A scoping review found that the prevalence of AND ranges from 4.9 % to 46.8 % among the mothers of Southeast Asian countries [11]. The study was conducted in Pakistan [51]. However, the current study found a relatively lower prevalence of "AND" compared to Pakistan, which might result from the low numbers of studies conducted in Bangladesh on "AND." ...
... Specifically, women with unplanned pregnancies were 2.29 times more likely to experience antenatal depression compared to their counterparts (POR = 2.29, 95% CI: 1.75-2.82). This finding was supported by studies done in South Asia [67], Spain [68], India [69], Pakistan [70], Worldwide [60]. The consistent finding across different studies suggests that unplanned pregnancy is a strong predictor of antenatal depression, likely due to the added stress, lack of preparation, and potential socioeconomic implications associated with unplanned pregnancies. ...
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Introduction Antenatal depression, ranging from mild to severe, is influenced by hormonal changes during pregnancy and childbearing years, making it a significant public health issue. Antenatal depression, with its far-reaching effects on mothers, infants, and children, continues to be a significant public health issue in developing countries such as Ethiopia. Research on antenatal depression in Ethiopia has produced varied results. Although previous systematic reviews and meta-analyses studies have addressed this topic, a comprehensive summary of existing reviews has not been available. Therefore, this umbrella review aims to consolidate the findings on antenatal depression and associated factors among pregnant women in Ethiopia. Methods This review included five systematic reviews and meta-analyses from various databases, including PubMed, PsycINFO, Research4life, CINHALE and Science Direct. Only reviews published between January 1, 2010, and July 30, 2024, were considered. The search, conducted from August 5 to 15, 2024, used CoCoPop questions and included only English-language reviews. Study quality was assessed with the AMSTAR tool, and data extraction and analysis were performed using Microsoft Excel 2016 and STATA 14.0. The I² and Cochran’s Q tests were used to assess heterogeneity. Pooled effect sizes were calculated based on the pooled prevalence of antenatal depression and odds ratios for associated factors, with a 95% confidence interval indicating statistical significance. Results This umbrella review encompassed 50 primary studies from five systematic reviews and meta-analyses, involving a total of 25,233 pregnant women. The pooled prevalence of antenatal depression in Ethiopia was found to be 24.60% (95% CI: 22.46–26.73). Significant associations were identified between antenatal depression and several factors: unplanned pregnancy (POR = 2.29; 95% CI: 1.75, 2.82), poor social support (POR = 2.10; 95% CI: 1.37, 2.84), history of abortion (POR = 2.49; 95% CI: 1.64, 3.34), history of depression (POR = 3.57; 95% CI: 2.43, 4.71), and history of obstetric complications (POR = 2.94; 95% CI: 1.61, 4.28). Conclusions The significant prevalence of antenatal depression (24.60%) among pregnant women in Ethiopia is closely linked to factors such as unplanned pregnancy, poor social support, history of abortion, previous depression, and obstetric complications. To tackle this issue, it is recommended to enhance social support networks, increase access to family planning services to minimize unplanned pregnancies, conduct regular mental health screenings, and incorporate mental health services into antenatal care.
... 13 A systemic review conducted in Pakistan revealed that the combined prevalence of antenatal depression stood at 37% whereas postnatal depression was found to be 30%. 14 In a research effort in Hyderabad, Sindh, depression frequency during pregnancy was observed at 18% using the Aga Khan University Anxiety Depression Scale (AKUADS) in the latter part of the 2 nd trimester. In a separate study in Punjab, the prevalence of antenatal depression was determined to be 25%. ...
Article
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Objective To determine the relationship between sleep pattern dysfunction with stress, anxiety and depression among pregnant women in a tertiary care hospital. Method An analytical cross-sectional study was conducted at Dr. Ruth K. M. Pfau at Civil Hospital, Karachi from December, 2021 till January, 2022 in which total three hundred pregnant women were included. The association between maternal psychiatric symptoms with the sleep pattern was explored using the Chi- square test. The multivariable logistic regression technique was used to estimate adjusted odds ratios (ORs) and to estimate the association of sleep pattern dysfunction with psychiatric illnesses. Results Sleep disorder was found in 49.3% of the pregnant women. Among these women, 54.0% had antepartum depression, 31.3% had stress and 44% reported anxiety. Women with sleep pattern dysfunction were nine times more likely to develop antepartum depression as compared to women without sleep pattern dysfunction (OR: 9.25, 95% CI: 5.45-15.70). Similarly, stress was five times more likely to develop in women with sleep pattern dysfunction (OR: 5.06, 95% CI: 2.92-8.76). Furthermore, Anxiety is also four times likely to develop in women with sleep pattern dysfunction (OR: 4.76, 95% CI: 2.91-7.80) compared to women without any sleep disturbances. Conclusions During pregnancy, sleep disturbances were related to the increased risk of developing psychiatric illnesses. It was found that women with disturbed sleep patterns had high rates of antepartum depression followed by stress and anxiety as compared to women without disturbed sleep patterns.
... The issues related to perinatal distress have been underrecognized in the area of research and intervention (Wilkinson, et al., 2022.). In Pakistan, a systematic review and meta-analysis revealed a prevalence of 37% antenatal depression and 30% postnatal depression in 17544 women (Atif, et al., 2021) whereas another study reported a prevalence of 29.2% antenatal anxiety and 24.4% postnatal anxiety in low-and middle-income countries, respectively, including Pakistan (Nielsen-Scott, et al., 2022). However, the overall incidence of perinatal mental disorders, as estimated by a systematic review and meta-analysis, has been reported to be 28% in Pakistan (Doraiswamy, et al., 2020). ...
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Objectives: To develop an indigenous perinatal distress model (PDM) for couples, measured with the indigenously developed Perinatal Distress Inventory (PDI), and verified via statistical regression analysis. Methodology: An exploratory sequential mixed method research design was used. In Phase-I, an item pool of 209 items was generated by reviewing the literature and conducting semi-structured interviews with experts and perinatal couples at high risk of distress. Reflexive thematic analysis and interpretative phenomenological analysis were used to construct the PDM. In Phase II, the face and content validation of 209 items in the PDI was carried out and 200 items were finalized. The try-out (50 couples) and pilot study (2080 participants) was carried out via purposive sampling technique, from hospitals. Exploratory factor analysis yielded 194 items in PDI with Parental Perinatal Distress Scale (PPDS), Parental Perinatal Distress Expression Scale (PPDES), and Parental Perinatal Distress Aetiology Scale (PPDAS), with acceptable Cronbach’s alpha reliability coefficients 0.90, 0.97, and 0.91 respectively. Results: PDM showed reciprocal interactions between assessments of distress in terms of depression, anxiety, mania, and psychosis and cultural expressions of emotions, somatization, maladaptive coping, and beliefs in religious and supernatural cognitions, and between the cultural aetiology of stressful and traumatic events; gender roles, mental health stigma, mental health illiteracy, family support, perinatal cognitions, emotional attachment, and bonding, all of which contributed to perinatal distress in couples. The regression analysis revealed that cultural expression and cultural aetiology significantly predicted perinatal distress in couples. Conclusion: Indigenous PDM was developed, measured with PDI, and verified via regression analysis in couples.
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We synthesise perinatal mental health (PMH) evidence and provide recommendations for future research and practices in Pakistan. The burden is significantly higher relative to many other countries, with adverse effects on women and children. Few locally developed interventions involving non-specialists have shown promise, but integrating these into maternal and child health services (MCH) at scale remains a challenge. We recommend broadening the scope of PMH research in accordance with the World Health Organization's stepped care model, and advancing the use of implementation science, digital technology and exploring low-cost models. Programmes and policies should prioritise incorporating PMH into MCH services in health planning and budgeting.
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Antenatal depression was common in pregnant women and can cause adverse maternal and neonatal outcomes. Objective: This study was conducted to evaluate the incidence of antenatal depression in hospitalized pregnant women and its association with maternal and neonatal outcomes. Methods: A prospective observational study was conducted in the Gynecology and Obstetrics and Psychiatry Department of the Hospital from July 2023 to July 2024. A total of 300 pregnant women with gestation age 240/7 weeks or less, admitted to the OBGYN department as high-risk pregnancy patients were selected by consecutive sampling. Women were presented with the Edinburgh Post Natal Depression Scale questionnaire 2-4 times every week for the entire study period along with questionnaires to personal collect data. EPDS was generally used to assess post-partum depression but we used it to evaluate perinatal depression as it is also validated for antenatal depression measurement. Patients were divided into two groups based on EDPS score, the study group contained patients at high risk of antenatal depression with a score of 10 ≤, and the comparison group contained women at low risk of depression with a score <10. Data analysis was done by SPSS version 24.0. Results: The frequency of preterm delivery was significantly higher in the study group with 40% preterm births and 23.4% early preterm births as compared to 19.1% and 12.4% in the comparison group, respectively. Similarly, birthweight was lower in the study group (40%) and low 1-minute (20%) and 5-minute Apgar scores. Multivariate regression analysis revealed an independent and significant relationship between maternal depression and preterm delivery (aOR: 3.27, 95% CI: 1.23-9.47) (p=0.030). However, no independent association was found between NICU admission and antenatal depression (aOR: 3.1, 95% CI: 1.0-5.2) (p=0.087) and risk of C-section (aOR: 0.9, 95% CI: 0.9-1.9) (p=0.731). Conclusions: Antepartum depression was a frequent condition among hospitalized pregnant women independently correlated to preterm births. Depression screening of pregnant women was recommended to prevent adverse maternal and neonatal outcomes.
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Introduction: Postpartum depression (PPD), according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), is a multifactorial disease, which occurs during pregnancy until the fourth week postpartum. Objective: To assess whether family support, depression and/or anxiety before or during pregnancy, alcohol consumption and/or smoking during pregnancy, and age (<20 or >35 years), together or separately, in puerperal women influence the occurrence of PPD. Methods: A longitudinal and multicenter study, called “Projeto Viver”, with 3435 women who gave birth in three maternity hospitals in Espírito Santo. At the last follow-up, at the end of the neonatal period, 1818 puerperae were interviewed by telephone (52.9%). Poisson analysis with robust variance adjustment was performed for one, two, three and even four grouped factors, and adjusted for covariates. Results: The prevalence of PPD was 7.3% (95% CI 6.1% - 8.5%) in the first month after delivery. Most puerperae with PPD were between 20 and 34 years old (71.2%; 95%CI 62.8% - 78.3%), more than 12 years of education (60.7%; 95%CI 51.5% - 69.2%), non-white skin color (77.3%; 95%CI 69.2% - 83.8%) and social class C (51.5%; 95%CI 42.9% - 60.0%). The most prevalent risk factor in puerperae with PPD was the lack of family support (34.1%; 95%CI 26.4% - 42.6%) and the least was depression and/or anxiety before or during pregnancy (3.8%; 95%CI 1.6% - 8.8%). Women without family support, who smoked and/or drank during pregnancy had 98% and 60% risk for PPD, respectively. The presence of two and three risk factors doubled and tripled the risk for PPD among puerperae, respectively. In puerperae with two concurrent factors, such as lack of family support and smoking/ethylism, as well as those with depression and/or anxiety before or during pregnancy and age extremes, the risk for PPD was 2.1 (95% CI 1.2 - 3.9) and 3.7 (95% CI 1.2 - 11.7), respectively. Conclusion: The result of this study allowed the knowledge of the risk of aggregate factors, and can contribute to public health actions that minimize them in pregnant women, in order to reduce the occurrence of depression after childbirth.
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The Thinking Healthy Program (THP) is a multicomponent low-intensity cognitive behavioral therapy-based psychosocial intervention. This intervention has been shown to be clinically effective in perinatal depression (PND) and feasible for implementation in low-resourced settings. It has also been shown to work universally for different phenotypes of PND. However, the mechanism through which THP resolves different phenotypes of PND are unclear. The present investigation presents secondary mediation analyses of a dataset curated from a cluster randomized controlled trial conducted in Pakistan assessing the effectiveness of the THP. Women aged 16–45 years in their third pregnancy trimester, with a diagnosis of PND, underwent 16 sessions of the intervention. The severity of depression was assessed using the Hamilton Depression Rating Scale (HDRS). 2-1-1 mediation models revealed that social support exerted significant mediation in driving the intervention effects for improving the severity of depressive symptoms on the HDRS [B (SE) = 0.45 (0.09), 95% CI: 0.30–0.60] and its symptom dimensions of core emotional symptoms [B (SE) = 0.27 (0.06), 95% CI: 0.18–0.37], somatic symptoms [B (SE) = 0.24 (0.04), 95% CI: 0.16–0.31] and insomnia symptoms [B (SE) = 0.04 (0.02), 95% CI: 0.02–0.07].
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Background Antenatal depression carries significant adverse implications for the health and well-being of women, babies and their families. While prevalence of perinatal mental disorders in low-and lower-middle-income countries tends to be higher compared to high-income countries, rates tend to vary widely among countries in certain regions such as South Asia. This study estimated the pooled prevalence of antenatal depression in South Asia and examined variations in individual countries. Methods We conducted a systematic review and meta-analysis. A comprehensive search was conducted on thirteen electronic databases and grey sources for articles published between 1·1·2007 and 31·5·2018 from South Asian countries including Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka. Studies reporting quantitative prevalence estimates of antenatal depression using a validated diagnostic/ screening tool identified, screened and appraised using a two-stage process. A meta-analysis was conducted using the proportion (%) of pregnant women identified as having antenatal depression as the primary outcome. Results Thirty-three studies involving 13,087 pregnant women were included in the meta-analysis. Overall pooled prevalence was 24·57% (95% CI: 19·34, 30·69). Prevalence rates for India (17·74%, 95% CI: 11·19, 26·96) and Sri Lanka (15·87%, 95% CI: 14·04, 17·88) were lower compared to the overall prevalence whereas the rates for Pakistan (32·2%, 95% CI: 23·11, 42·87) and Nepal (50%, 95% CI: 35·64,64·36) were higher. Conclusions While robust prevalence studies are sparse in most South Asian countries, one in four pregnant women is likely to experience antenatal depression in the region. The issue needs to be recognised in health policy and practice for resource allocation and capacity building at regional and national levels for prevention, diagnosis and treatment. Key messages One in four pregnant women is likely to experience antenatal depression in South Asia region. Targeted efforts are needed at national and regional levels for prevention, diagnosis and treatment.
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Background: Pregnant women are more likely to develop antenatal depression due to multiple factors including sickness and death of close family member, unwanted pregnancy, unplanned pregnancy, economic and relationship difficulties. Food insecurity is a major issue in low resource settings, especially in developing countries. Malnourishment in pregnant women along with antenatal depression can lead to adverse effect on growth of foetus and can lead to adverse pregnancy outcomes. The aim of this study was to determine an association between food insecurity and antenatal depression among pregnant women living in slum settlements of Lahore. Methods: A community based, crosssectional study was conducted in slum settlements of district Lahore, with a sample of 367 pregnant women. Antenatal depression and household food insecurity was measured using Edinburgh Postnatal Depression Scale (EPDS) and Household food insecurity access scale (HFIAS). Data was entered and analysed in SPSS-20.0. Chi-square and multivariate logistic regression analysis was used to estimate effect of food insecurity on antenatal depression among pregnant women. Results: Prevalence ofantenatal depression was 39.5% among pregnant women. Majority of the sample, i.e., 46% were food insecure. In an adjusted model, multivariate logistic regression showed existence of strong association between food insecurity and antenatal depression (AOR=2.58, 95%, CI: 1.64-4.075) in women surveyed. Conclusions: Study results show strong association between food insecurity and antenatal depression. Findings also suggest the need of an effective intervention at community level to combat food insecurity and antenatal depression in marginalized populations.
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Background: Depression, a psychological disorder manifested as persistent sadness, sleep disturbance etc. is a threatening condition during pregnancy, as it has been shown to be associated with adverse maternal and fetal consequences. Aim: To evaluate the prevalence of antenatal depression in a hospital based sample in Lahore, Pakistan, ascertaining its significant predictors and frequently utilized coping techniques. Methods: A total of 197 antenatal attendees within the age limit of 20-40 years, visiting the out-patient department of the said tertiary-care hospital, were accepted as the study participants. Subjects receiving psychiatric treatment or anti depressant medication were excluded from the study. Beck's Depression Inventory, was utilized as the screening tool for depression. Results: Brief COPE was employed to assess the use of various coping strategies. Pearson Chi square and multiple linear regression analysis were used to evaluate significant risk factors and predictors respectively, for development of depression. As per investigation, 57.4% participants screened negative for depression, 23.4% showed mild mood disturbance, 4.6% screened positive for borderline clinical depression, 10.2% presented with moderate depression, 3.6% elicited severe depression and 1% reported with extreme depression. Conclusion: History of abortion/miscarriage, unplanned pregnancy, separation from husband and stressful life events, were identified as the predictors of antenatal depression. Great majority of the sample population used Problem Focused Coping techniques.
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Background Postpartum depression (PPD) poses a major global public health challenge. PPD is the most common complication associated with childbirth and exerts harmful effects on children. Although hundreds of PPD studies have been published, we lack accurate global or national PPD prevalence estimates and have no clear account of why PPD appears to vary so dramatically between nations. Accordingly, we conducted a meta-analysis to estimate the global and national prevalence of PPD and a meta-regression to identify economic, health, social, or policy factors associated with national PPD prevalence. Methods We conducted a systematic review of all papers reporting PPD prevalence using the Edinburgh Postnatal Depression Scale. PPD prevalence and methods were extracted from each study. Random effects meta-analysis was used to estimate global and national PPD prevalence. To test for country level predictors, we drew on data from UNICEF, WHO, and the World Bank. Random effects meta-regression was used to test national predictors of PPD prevalence. Findings 291 studies of 296284 women from 56 countries were identified. The global pooled prevalence of PPD was 17.7% (95% confidence interval: 16.6–18.8%), with significant heterogeneity across nations (Q = 16,823, p = 0.000, I² = 98%), ranging from 3% (2–5%) in Singapore to 38% (35–41%) in Chile. Nations with significantly higher rates of income inequality (R² = 41%), maternal mortality (R² = 19%), infant mortality (R² = 16%), or women of childbearing age working ≥40 h a week (R² = 31%) have higher rates of PPD. Together, these factors explain 73% of the national variation in PPD prevalence. Interpretation The global prevalence of PPD is greater than previously thought and varies dramatically by nation. Disparities in wealth inequality and maternal-child-health factors explain much of the national variation in PPD prevalence.
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Objective: To find out the association of stress with anxiety and depression during pregnancy and to identify common stressors in women. Methods: This cross-sectional study was conducted at Divisional Headquarters Teaching Hospital, Kohat, Pakistan, from February 2011 to October 2012, and comprised pregnant women. Convenient sampling technique was used. The participants were administered Urdu-translated version of A-Z perceived stress scale and Aga Khan University anxiety and depression scale. Women with a score of >19 on the Aga Khan University scale were labelled as anxious and depressed. Data was collected on a pre-designed proforma. SPSS 17 was used for data analysis. Results: There were 500 participants with an overall mean age of 28.3±6.3 years. The overall mean stress score on A-Z perceived stress scale was 12.93±5.19 and mean Aga Khan University anxiety and depression scale score was 28.58±13.82. Mean A-Z score was 14.18±4.881 in women with anxiety-depression and 9.75±4.58 in non-depressed women (p<0.001). Mean Aga Khan score in women with >10 stressors was significantly higher (32.18±13.79) compared to women with <10 stressors (19.87±9.30) (p<0.01). A-Z stressors score had significant positive correlation with the Aga Khan scale (p<0.001]. The most common stressors were concern about husband's worries and concern about feeling unwell during pregnancy, present in 433(86.6%) patients each, followed by concern about increase in the prices of everyday goods which was present in 364(72.8%) patients. Conclusions: The magnitude of stress was significantly associated with high anxiety and depression during pregnancy.
Article
Objective: To determine the frequency of antenatal anxiety and depression and its risk profile including demographic, psychosocial and obstetric risk factors, in middle socioeconomic women. Methods: A cross-sectional study was carried out at two private hospital centres of Karachi, over a pe- riod of five months from October 2016 to March 2017. A questionnaire (age, education, parity, socio- economic status, employment) and the Hospital Anxiety and Depression Scale (HADS) were the tools used to gather required information from pregnant women. Data collected was entered in SPSS 16 software. Descriptive statistics were used to calculate frequency and mean values. Logistic regres- sion both binary and multinomial was performed to identify significant predictors of anxiety and de- pression. Results: Our study showed that out of 520 pregnant women, 130 (25%) women had anxiety, whereas 220 (42.3%) had depression. The mean age of women was 26.9 ± 4.198 years. The range being from 18 years to 35 years. Significant risk factors among anxiety group were: working woman; 30.8% (p-value=0.000, OR=0.286), domestic violence; 84.6% (p-value=0.000, OR=2.8), difficult relationship with in-laws; 84.6% (p-value=0.000, OR=12.375), sleep disturbance; 76.9% (p-value=0.000, OR=9.667), primigravida; 23% (p-value=0.000, OR=2.576) and unplanned pregnancy; 23.1% (p- value=0.029, OR=0.511). Significant risk factors among women with depression were: working woman; 31.8% (p- value=0.000,OR=0.286), domestic violence; 68.2% (p-value=0.000, OR=3.571), difficult relationship with in-laws; 22.7% (p-value=0.000, OR=4.8), sleep disturbance; 54.5% (p-value=0.008, OR=2.0), primigravida; 45.5% (p-value=0.000, OR=17.246) and unplanned pregnancy; 18.2% (p-value=0.000, OR=3.0). Other factors that were found to be significant in the depression group only were: unsatis- factory relationship with husband; 22.7% (p-value=0.000, OR=4.118), stressful life event in previous year; 45.5% (p-value=0.000, OR=2.167), and tertiary education; 68.2% (p-value=0.002, OR=0.916). Conclusion: Psychosocial and demographic factors such as working woman, domestic violence, and difficult relationship with in-laws and sleep disturbance had a significant association with antenatal anxiety and depression. Obstetric risk factors were primigravida and unplanned pregnancy. Significant association with depression was unsatisfactory relationship with husband, stressful life event in a previous year and tertiary education.
Article
Objective To estimate the prevalence of antenatal depression in South Asia and to examine variations by country and study characteristics to inform policy, practice and future research. Methods We conducted a comprehensive search of 13 databases including international databases and databases covering scientific literature from South Asian countries in addition to Google Scholar and grey sources from 1 January 2007 to 31 May 2018. Studies reporting prevalence estimates of antenatal depression using a validated diagnostic/screening tool were identified, screened, selected and appraised. Primary outcome was proportion (%) of pregnant women identified as having antenatal depression. Results Thirty-three studies involving 13 087 pregnant women were included in the meta-analysis. Twelve studies were rated as high quality and 21 studies were of moderate quality. Overall pooled prevalence of antenatal depression was 24.3 % (95% Confidence Interval (CI) 19.03 to 30.47). Studies showed a high degree of heterogeneity (I ² =97.66%) and evidence of publication bias (p=0.668). Prevalence rates for India (17.74%, 95% CI 11.19 to 26.96) and Sri Lanka (12.95%, 95% CI 8.29 to 19.68) were lower compared with the overall prevalence, whereas prevalence rates for Pakistan (32.2%, 95% CI 23.11 to 42.87) and Nepal (50%, 95% CI 35.64 to 64.36) were higher. Conclusions While robust prevalence studies are sparse in most South Asian countries, available data suggest one in four pregnant women is likely to experience antenatal depression in the region. Findings highlight the need for recognition of the issue in health policy and practice and for resource allocation for capacity building at regional and national levels for prevention, diagnosis and treatment.
Article
Objective: To calculate the point frequency of post-partum depression among mothers. Methods: This cross-sectional, quantitative study was conducted at the immunisation clinics of General Hospital, Islamabad, and Tehsil Headquarters Hospital, Kahuta, Pakistan, in November 2015, and comprised women aged 18-44 years. Primary data collection was done through Edinburgh post-natal depression scale questionnaire. SPSS 20 was used for data analysis. Results: There were 434 participants in the study. Frequency of post-partum depression was 75(17.3%). The odds of post-partum depression was 2.3times more among non-exclusive breastfeeding mothers, 6.6 times more among women with no husband support, 6.1 times more among women with no family support, and 1.92 times more among women with youngest female child. Conclusions: Exclusive breastfeeding had a strong association with post-partum depression.