Abstract
BackgroundPerinatal depression and anxiety are increasingly recognized as important public health issues in low and middle-income countries such as Rwanda and may have negative consequences for both mothers and their infants. Maternal mental health may be particularly challenged in Rwanda because of the prevalence of risk factors such as poverty, low education levels, negative life events and marital problems. However, there are limited data about perinatal depression and anxiety symptoms in Rwanda. This study thus aimed to explore the prevalence of symptoms of perinatal depression and anxiety in Rwanda, and factors associated with them.MethodsA sample of 165 women in the perinatal period (second and third trimester of pregnancy, up to 1 year postnatal) were interviewed individually over 1 month in October 2013. Women were interviewed at 5 of 14 health centres in the Eastern Province or the affiliated district hospital. Participants answered socio-demographic questions and scales measuring symptoms of perinatal depression (EPDS: Edinburgh Postnatal Depression Scale) and anxiety (SAS: Zung Self-rating Anxiety Scale).ResultsAmong women in the antenatal period (N = 85), 37.6% had symptoms indicating possible depression (EPDS ≥10) and 28.2% had symptoms associated with clinical levels of anxiety (SAS > 45). Among women within the postnatal period (N = 77), 63.6% had symptoms of possible depression, whereas 48,1% had symptoms of probable anxiety. Logistic regression showed that symptoms of postnatal depression were higher for respondents who had four or more living children relative to those having their first child (Odds Ratio: 0.07, C.I. = 0.01–0.42), and for those with a poor relationship with their partner (Odds Ratio: .09, C.I. =0.03–0.25). Any lifetime exposure to stressful events was the only predictor of symptoms of postnatal anxiety (Odds Ratio = 0.20, C.I. = 0.09–0.44).ConclusionsSymptoms of postnatal depression and anxiety were prevalent in this Rwandan sample and most strongly predicted by interpersonal and social factors, suggesting that social interventions may be a successful strategy to protect against maternal mental health problems in the Rwandan context.
Highlights
Perinatal depression and anxiety are increasingly recognized as important public health issues in low and middle-income countries such as Rwanda and may have negative consequences for both mothers and their infants
Perinatal depression and anxiety are referred to as Common Perinatal Mental Disorders (CPMDs) as they represent the most common mental health problems faced by women during the perinatal period [14, 15]
In a low-income setting in Cape Town, 39% of pregnant women screened positive on the Edinburgh Postnatal Depression Scale (EPDS: scores ≥14) for depressed mood and 34.7% of postnatal women were diagnosed with depression [23]
Summary
Perinatal depression and anxiety are increasingly recognized as important public health issues in low and middle-income countries such as Rwanda and may have negative consequences for both mothers and their infants. This study aimed to explore the prevalence of symptoms of perinatal depression and anxiety in Rwanda, and factors associated with them. Depression and anxiety occurring in the perinatal period, the time during pregnancy and up to 1 year following birth, can have serious consequences for women’s mental health and for that of their infants [1,2,3,4,5,6]. There is increasing evidence that CPMDs are two to three times more prevalent among pregnant women and mothers of infants in low-income countries (LMICs), including Rwanda, than in high-income countries [17,18,19]. A systematic review of studies conducted in LMICs reported that the prevalence of CPMDs was 15.6 and 19.8% antenatally and postnatally, respectively [20]. Rates may vary according to whether the tools in these cited studies were screening tools or diagnostic tools or interviews, as well as the use of different cut offs, with the EPDS
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