Abstract
BackgroundThe public health significance of maternal mental health is well established. Armed conflicts expose populations to events that could have long-term negative consequences for mental health of pregnant women and their children. This study explores the prevalence and associated risk factors for psychological distress of women during pregnancy, including exposure to past conflict-related potentially traumatic events, in a population exposed to armed conflict in the Swat region of Pakistan.MethodsA community-based cross-sectional survey of 349 pregnant women in two union councils in Swat was conducted. Psychological distress was measured using the Self-Reporting Questionnaire (SRQ). Conflict-related potentially traumatic events (PTEs) were measured through an adapted version of the Harvard Trauma Questionnaire. Information was also collected on major life events (Life Events Checklist), social support (Multidimensional Scale of Perceived Social Support), and demographic and socio-economic variables.ResultsPrevalence of current psychological distress was 38.1 % (95 % CI: 33.1, 43.3). Psychological distress was significantly associated with three or more potentially traumatic events (PTEs) experienced during the conflict (OR = 2.62, 95 % CI: 1.22, 5.61); three or more major life events in the year following the conflict (OR = 3.25, 95 % CI: 1.82, 5.82) and inversely associated with family support (OR = 0.91, 95 % CI: 0.88, 0.95).ConclusionThis is one of the first community based cross sectional surveys in Swat valley, Pakistan to assess the prevalence of psychological distress during pregnancy in an area affected by conflict. Over a third of women show evidence of significant psychological distress. Exposure to potentially traumatic events remained independently associated with psychological distress 1 year after conflict ended, suggesting that conflict exposure may have long-term impacts upon maternal mental health. Combining this with findings relating to the cumulative impact of major life-events, and the protective factor of family support highlights the importance of developing culturally appropriate psychological interventions accessible to pregnant women rebuilding their lives following conflict.Electronic supplementary materialThe online version of this article (doi:10.1186/s13031-015-0063-4) contains supplementary material, which is available to authorized users.
Highlights
The public health significance of maternal mental health is well established
The study was conducted in the catchment area of two basic health units (BHUs) – primary healthcare facilities staffed by a primary care physician, a Lady Health Visitor, a vaccinator, a midwife and 15–20 community-based Lady Health Workers (LHWs)
Current psychological distress was positively associated with exposure to three or more potentially traumatic events during the years of the conflict, spanning 2007 to 2011
Summary
Armed conflicts expose populations to events that could have long-term negative consequences for mental health of pregnant women and their children. The public health significance of poor maternal mental health is well established, recognised as the second leading cause of the burden of disease in women worldwide with potential long-term adverse impact on physical and cognitive development of infants [1]. High prevalence of perinatal mental health problems have been documented in Pakistan (ibid) [1], linked to poor physical development of the child [2]. This finding has been confirmed in other studies conducted in low and middle income countries (LMIC) [3]. In conflict settings additional factors such as proximity to traumatic events, forced displacement, and destruction of property [7] potentially increase the risk of psychological distress
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