Antenatal depressive symptoms among pregnant women: Evidence from a Southern Brazilian population-based cohort study

Carolina De Vargas Nunes Coll,Mariângela Freitas Da Silveira,Diego Garcia Bassani,Elena Netsi,Fernando César Wehrmeister,Fernando César Barros,Alan Stein

doi:10.1016/j.jad.2016.11.031

Abstract

BackgroundAntenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited. The aim of the study was to estimate the prevalence and identify risk factors for AD among Brazilian pregnant women. MethodsAll women living in the urban area of the city of Pelotas, Southern Brazil, with confirmed pregnancy and estimated delivery date in the year 2015, were invited to take part. Eligible pregnant women were recruited from health services. Symptoms of antenatal depression were assessed using the Edinburgh Postnatal Depression Scale (EPDS) by face-to-face interviews. A cutoff-point of 13 or more was used to define probable AD. ResultsEPDS scores were available for 4130 women. The prevalence of AD was 16% (95%CI 14·9–17·1). After adjustment for potential confounders, the factors most strongly associated with higher EPDS scores were a previous history of depression (PR 2·81; 95%CI 2·44-3·25), high parity (PR 1·72; 95%CI 1·38-2·15 - ≥2 children vs. 1 child) and maternal education (PR 5·47; 95%CI 4·22-7·09 - 0–4 vs. ≥12 years of formal education). LimitationsEPDS was administered through face-to-face interviews rather than questionnaires and some women may have felt uncomfortable reporting their symptoms leading to underreporting and consequently underestimation of the prevalence found. ConclusionAD prevalence is substantially higher in Brazil than in high-income countries (HICs) but similar to other LMICs. Our study identified relevant risk factors that may be potential targets to plan interventions, particularly a history of depression.

Highlights

Antenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited
Considering that Brazil is a large country with high rates of socioeconomic inequalities it is likely that the prevalence of depression among pregnant women living in the poorest areas of the country may be even higher
The data indicated that pregnant women living in this setting are exposed to multiple risk factors to antenatal depression

Summary

Introduction

Antenatal depression (AD) is a major public health issue but evidence regarding its prevalence and associated factors in low and middle-income countries (LMICs) is limited. Conclusion: AD prevalence is substantially higher in Brazil than in high-income countries (HICs) but similar to other LMICs. Our study identified relevant risk factors that may be potential targets to plan interventions, a history of depression. Antenatal depression research has been received as of lower priority, especially in low and middle-income countries (LMICs), there is evidence from high-income countries (HICs) studies that the prevalence of depressive symptoms during pregnancy is similar to or even higher than during the postpartum period. A recent systematic review on common antenatal mental disorders among women living in LMICs, reported a mean point prevalence of 15·6% (Fisher et al, 2012). Only 8% of all LMICs had available data, and samples included in the studies were disproportionately composed of women from higher socioeconomic status and better health, limiting the generalizability of the findings

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