Progression of antepartum depression differs by level of perceived social support and food insecurity

Abstract

BackgroundAntepartum depression (AD) is a risk factor for adverse pregnancy outcomes and may be worsened by food insecurity (FI) and lack of social support (SS). We studied the progression of AD from mid gestation to term and examined whether such progression differed by measures of SS and longitudinal measures of FI.Methods403 women were recruited (mean (±SD) gestational age =19.4 (±−3.8) weeks) and followed to term or dropout. At baseline, SS was assessed using a modified Duke‐UNC functional scale. Women were binned into 2 SS groups, based on scoring < or ≥ than the median SS value. FI (IFIAS) and AD (CES‐D≥17) were assessed at each visit using validated scales. Other variables were assessed at baseline using structured tools. Separately by SS category, we used mixed effects logistic regression models to examine the progression of AD; and, assessed whether such AD progression differed by longitudinal measures of FI.ResultsAt baseline, 55.8% of the pregnant women belonged to the higher SS group. At this time point, the prevalence of AD among women in the low SS group (80.9%) was 2 times higher than similar levels in the higher SS group (40.4%). AD in the low SS group tended to decline with increasing gestational age but was always more prevalent than AD in the high SS group. In both SS groups, the progression of AD was positively associated with longitudinal measures of FI; and, the effect of FI on the progression of AD attained statistical significance among women in the low SS group. In the adjusted analyses, the probability of AD was three times higher among food insecure women in the low SS group than it was among food secure women in the high SS category.ConclusionsWe observed high levels of antepartum depression among women in northern Uganda that differed by social support and food insecurity suggesting the need for integrating mental health services that include food security and social support components into antenatal programs in this or similar contexts.Support or Funding InformationThis research was funded in part by Cornell University Weill Medical College Intercampus Seed Funds, K01 MH098902 from NIMH and USAID Cooperative Agreement AIDOAAL1000006