Predictors of maternal psychological distress in rural India: A cross-sectional community-based study

Audrey Prost,Aparna Bajpai,Raj Kumar Gope,Shibanand Rath,Anthony Costello,Rashmi Lakshminarayana,Rajendra Mahapatra,Nirmala Nair,Vikram Patel,Andrew Copas,Prasanta Tripathy,Suchitra Rath

doi:10.1016/j.jad.2012.01.029

Abstract

BackgroundMaternal common mental disorders are prevalent in low-resource settings and have far-reaching consequences for maternal and child health. We assessed the prevalence and predictors of psychological distress as a proxy for common mental disorders among mothers in rural Jharkhand and Orissa, eastern India, where over 40% of the population live below the poverty line and access to reproductive and mental health services is low.MethodWe screened 5801 mothers around 6 weeks after delivery using the Kessler-10 item scale, and identified predictors of distress using multiple hierarchical logistic regression.Results11.5% (95% CI: 10.7–12.3) of mothers had symptoms of distress (K10 score > 15). High maternal age, low asset ownership, health problems in the antepartum, delivery or postpartum periods, caesarean section, an unwanted pregnancy for the mother, small perceived infant size and a stillbirth or neonatal death were all independently associated with an increased risk of distress. The loss of an infant or an unwanted pregnancy increased the risk of distress considerably (AORs: 7.06 95% CI: 5.51–9.04 and 1.49, 95% CI: 1.12–1.97, respectively).LimitationsWe did not collect data on antepartum depression, domestic violence or a mother's past birth history, and were therefore unable to examine the importance of these factors as predictors of psychological distress.ConclusionsMothers living in underserved areas of India who experience infant loss, an unwanted pregnancy, health problems in the perinatal and postpartum periods and socio-economic disadvantage are at increased risk of distress and require access to reproductive healthcare with integrated mental health interventions.

Highlights

Maternal common mental disorders, characterised by significant levels of depressive, anxiety and somatic symptoms,⁎ Corresponding author at: Centre for International Health and Development, UCL Institute of Child Health, 30 Guilford Street, London WC1N 1EH, UK
In this study we aimed to identify socio-economic, gender and health-related predictors of maternal psychological distress, a proxy for maternal common mental disorders, among recently delivered mothers within a community-based sample in rural, tribal areas of eastern India
In an earlier study we reported data from a clusterrandomised controlled trial testing the impact of a participatory intervention with women's groups on neonatal mortality and maternal psychological distress in three districts of Jharkhand and Orissa, in eastern India (Tripathy et al, 2010)

Summary

Introduction

In this study we aimed to identify socio-economic, gender and health-related predictors of maternal psychological distress, a proxy for maternal common mental disorders, among recently delivered mothers within a community-based sample in rural, tribal areas of eastern India. We assessed the prevalence and predictors of psychological distress as a proxy for common mental disorders among mothers in rural Jharkhand and Orissa, eastern India, where over 40% of the population live below the poverty line and access to reproductive and mental health services is low. Conclusions: Mothers living in underserved areas of India who experience infant loss, an unwanted pregnancy, health problems in the perinatal and postpartum periods and socioeconomic disadvantage are at increased risk of distress and require access to reproductive healthcare with integrated mental health interventions

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