Prevalence and Correlates of Depression Among Pregnant Women Enrolled in a Maternal and Newborn Health Program in Rural Northern Ghana: a Cross-sectional Survey

Margaret Lillie,Mohammed Ali,Safiyatu Abubakr-Bibilazu,Raymond Aborigo,Joy Noel Baumgartner,Elena Mcewan,John A Gallis,Raymond Kofi Owusu,John Hembling,John Koku Awoonor-Williams,Haliq Adam

doi:10.1007/s40609-020-00170-8

Abstract

Women in many sub-Saharan African countries are at elevated risk of depression during pregnancy. However, there are still gaps in the estimates of antenatal depression and associated risk factors in very low-resource settings such as Northern Ghana. This study describes the prevalence of depression among rural pregnant women, participating in a maternal and child health program, in Ghana, and examines associated risk factors for depression. Pregnant women who were registered for group-based maternal and child health community programs were recruited for study participation from 32 communities in two rural districts in Northern Ghana (n = 374). Baseline surveys were conducted and depression was assessed using the Patient Health Questionnaire (PHQ-9). Bivariate and multivariable analyses used a modified Poisson and generalized estimating equations (GEE) model. Of the women in our study population, 19.7% reported symptoms indicative of moderate to severe depression (PHQ-9 score ≥ 10), with 14.1% endorsing suicidal ideation in the last 2 weeks. Bivariate analyses revealed that lower hopefulness, moderate and severe hunger, experiences of emotional, physical, and/or sexual intimate partner violence (IPV), and insufficient social support from female relatives were associated with symptoms indicating moderate to severe depression. In the multivariable analyses, low hopefulness, household hunger, emotional IPV, physical and/or sexual IPV, and insufficient female relative support remained significantly associated with depression. Antenatal depression is associated with unmet basic needs and safety. Perinatal mental health programming must take an ecological perspective and address personal, familial, and community-level factors.

Highlights

The current study describes the prevalence of depression among rural pregnant women in northern Ghana who are participating in a community-based, maternal and child health promotion interventions and examines associated risk factors for depression in women who are pregnant
We examined pre-intervention baseline data obtained from a longitudinal, cluster randomized control trial (NCT03665246) that is evaluating the impact of the Integrated Mothers and Babies Course (Le et al 2015; Le et al 2010) being administered by Catholic Relief Services (CRS), an international, non-governmental organization (NGO) working in Northern Ghana in collaboration with the Ghana Health Service
We found that household hunger is strongly associated with antenatal depression

Summary

Introduction

Women experience elevated rates of depression during the antenatal period in both high- and low-resource settings (Ayano et al 2019; Fisher et al 2012; Mahendran et al 2019; Rahman et al 2013; Sawyer et al 2010; Weobong et al 2014). Global mental health researchers and policymakers are calling for a better understanding of social predictors of depression, such as access to resources and education, domestic violence, and social support, which may affect child outcomes (Bennett et al 2016; Collins et al 2011; Rahman et al 2013; Stein et al 2014; Waters et al 2014). While we know that mental distress exists among antenatal women in low- and middle-income settings, those in the most socially and economically disadvantaged households, there is a lack of widespread local evidence to make informed programming decisions in specific contexts (Fisher et al 2012)

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