Abstract
PurposeLatent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed.MethodsThis is a secondary analysis of data collected among women living in Cape Town settlements (N = 446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socio-emotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes.ResultsFour trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-for-age z-scores at 18 months, and weight-for-age z-scores, length-for-age z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories.ConclusionsSevere depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential.
Highlights
Perinatal depression, broadly defined by the World Health Organization (WHO) as major depression occurring during pregnancy and the first postpartum year, is experienced by1 3 Vol.:(0123456789)Social Psychiatry and Psychiatric Epidemiology (2019) 54:1111–112313% of women living in low- and middle-income countries (LMICs) [1]
An association was found between postnatal depression at 2 months and insecure infant attachment at 18-month postpartum in a study conducted in a peri-urban settlement near Cape Town [21]
The chronic low trajectory identified was reported in a previous study conducted in Africa [32], suggesting that, despite the high number and ongoing stressors experienced in LMICs, the majority of women remain at low risk of developing depressive symptoms during the perinatal period
Summary
Broadly defined by the World Health Organization (WHO) as major depression occurring during pregnancy and the first postpartum year, is experienced by1 3 Vol.:(0123456789)Social Psychiatry and Psychiatric Epidemiology (2019) 54:1111–112313% of women living in low- and middle-income countries (LMICs) [1]. In LMICs, evidence has instead largely focused on physical outcomes, such as child physical growth, which is a key indicator of children’s health and nutritional status [15]. This is reasonable, given that, in LMICs, poor growth, malnutrition, and infections are the leading causes of under-five mortality [16, 17]. In a South African birth cohort study, there was an association between high maternal depressive symptoms at 6-month postpartum and greater externalising problems among 2-yearold children [20]. No associations were found between severe antenatal depressive symptoms and social withdrawal at 10–12-month postpartum among HIVinfected mothers and infants in Cape Town [5]. An association was found between postnatal depression at 2 months and insecure infant attachment at 18-month postpartum in a study conducted in a peri-urban settlement near Cape Town [21]
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