Abstract

BackgroundPerinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth. In India, increased priority accorded to mental health programs mean it is now possible to reduce the population-level burden of perinatal depression. In this secondary analysis of two studies, we aimed to describe the epidemiological features of depression among community- and facility-based samples of perinatal women from rural central India, and to describe the help-seeking behaviours from those women who screened positive for depression.MethodsThe Community Study was a multi-round population-based cross-sectional survey (n = 6087). The Facility Study was a multi-round facility-based cross-sectional survey (n = 1577). Both studies were conducted in Sehore District, Madhya Pradesh between 2013 and 2017. Field workers conducted structured interviews with perinatal women. The questionnaire had sections relating to sociodemographic characteristics, depression screening using the Patient’s Health Questionnaire (PHQ9), treatment seeking for depression-related symptoms, and disability. Using data pooled from both studies, we tested each characteristic for association with the total screening score and with screening positive for depression.ResultsWe identified 224 perinatal women from the Community Study and 130 perinatal women from the Facility Study, of whom 8.8% and 18.5% screened positive for depression, respectively. For the continuous PHQ9 score, there was evidence of a “U” shaped association with age, and positive associations with pregnancy, disability score, suicidality and being a health facility attendee. For the binary PHQ9 score, there was evidence of positive associations with pregnancy, disability score, suicidality and being a health facility attendee.ConclusionsThis study highlights where the largest population-level variations in perinatal depression symptoms are present in this Indian sample, for which mental health service provision should be made a priority. Epidemiological evidence generated by this study, as well as new evidence on peer-delivered interventions for perinatal depression, must be utilized by policy-makers to prioritize mental health services for mothers along with maternal and child health services.

Highlights

  • Perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth

  • A global systematic review by Stein et al, found evidence that perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, and mixed evidence for negative effects on birth outcomes and physical growth [2]

  • In a subsequent systematic review by Gelaye et al of perinatal depression among low- and middle-income country (LMIC) populations there was largely consistent evidence of negative impacts for birth outcomes and physical growth [3], though insufficient evidence is available for the other impacts which were identified in the global review

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Summary

Introduction

Perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, birth outcomes, and physical growth. In India, increased priority accorded to mental health programs mean it is possible to reduce the population-level burden of perinatal depression. In this secondary analysis of two studies, we aimed to describe the epidemiological features of depression among community- and facility-based samples of perinatal women from rural central India, and to describe the help-seeking behaviours from those women who screened positive for depression. A global systematic review by Stein et al, found evidence that perinatal depression is associated with negative effects on child behavioural, cognitive and emotional development, and mixed evidence for negative effects on birth outcomes (i.e. pre-term and birth weight) and physical growth [2]. The high variation in estimates could be due the use of screening tools; two studies from South India which used diagnostic interviews had prevalence estimates of 11% and 16% [8, 14]

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