Abstract
BackgroundThe aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy.MethodsThis is a secondary analysis of a randomised controlled trial among 384 women living in Khayelitsha, a low income setting in South Africa, recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale, were at least 18 years of age, less than 29 weeks pregnant and spoke isiXhosa. Participants were followed up at 8 months gestation, 3 and 12 months postpartum. Latent trajectories of depressive symptoms were identified using growth mixture modelling, based on the Hamilton Depression Rating Scale (HDRS). There were no differences in HDRS scores between the control and intervention arms, so all participants were assessed together. Health, social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms, using univariate logistic regression.ResultsTwo trajectories were identified: antenatal only (91.4%), with moderate to severe symptoms at baseline which later subside; and antenatal and postnatal (8.6%), with severe depressive symptoms during pregnancy and later in the postpartum period, which subside temporarily to moderate levels at 3 months postpartum. Predictors for the antenatal and postnatal trajectory include severe food insecurity, intimate partner violence, lower social support, greater functional impairment, problematic drinking and suicide risk.ConclusionsA small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period, and can be differentiated from those who show a natural remission. Identification and referral strategies should be developed with these findings in mind, especially given the limited mental health resources in low-income settings.
Highlights
The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy
Several factors have systematically been reported in low- and middle-income countries (LMICs) and high-income countries (HICs), such as a history of depression, social conflict, and lack of social support from family or partner [10,11,12,13]
Food insecurity, defined as the inability to access a sufficient quantity of healthy food on a daily basis and reported by 38% of households in South Africa [15], has consistently been identified as a risk factor for antenatal and postnatal depression in the Western Cape [5, 14, 16, 17]
Summary
The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy. Lower education status and being single are among the few demographic risk factors which have received some, Garman et al BMC Pregnancy and Childbirth (2019) 19:202 but mixed evidence, for both antenatal and postnatal depression [9, 11,12,13]. Food insecurity, defined as the inability to access a sufficient quantity of healthy food on a daily basis and reported by 38% of households in South Africa [15], has consistently been identified as a risk factor for antenatal and postnatal depression in the Western Cape [5, 14, 16, 17]. Intimate partner violence (IPV) has been reported as a risk factor for perinatal depression in South Africa [3, 18,19,20], where IPV is common and is reported by more than 40% of pregnant women [21]
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