Abstract
BackgroundThe vast majority of research on mental health has been undertaken in high income countries. This study aimed at investigating the long-term course of maternal depressive symptoms and its association with various mother- and child-related characteristics in two West African lower middle income countries with focus on the relationship with long-term anxiety symptoms.MethodsIn the Child Development Study, a prospective birth cohort study in Côte d’Ivoire and Ghana, the 9-item Patient Health Questionnaire (PHQ-9) was answered by N = 776 women 3 months antepartum, and 3, 12, and 24 months postpartum between April 2010 and March 2014. Growth mixture modeling was used to identify distinct trajectories of depressive symptoms. Several psychosocial, obstetric, and sociodemographic characteristics were assessed and multinomial regression analysis was performed to investigate the influence of these variables on the different depression trajectories.ResultsWe found three distinct classes of depressive symptoms that were characterized by an asymptomatic trajectory (91.5%), by recurrent risk (4.3%) and by postnatal risk (4.3%). The longitudinal course of depressive symptoms was strongly associated with anxiety symptoms (χ2 = 258.54, df = 6, p < 0.001; φ = .577). Among other factors, higher levels of anxiety, new pregnancy 2 years after birth, economic stress, and family stress were associated with the risk classes.ConclusionsA substantial proportion of West African women in our sample developed unfavorable patterns of depressive symptoms during the vulnerable phase of pregnancy and early motherhood. Psychosocial factors, especially antepartum anxiety symptoms, played a decisive role in this process. Perceived economic hardship further exaggerated the mental health burden.
Highlights
Ante- and postpartum maternal depression is a global public health problem [1, 2]
We found three distinct classes of depressive symptoms that were characterized by an asymptomatic trajectory (91.5%), by recurrent risk (4.3%) and by postnatal risk (4.3%)
The longitudinal course of depressive symptoms was strongly associated with anxiety symptoms (χ2 = 258.54, df = 6, p < 0.001; φ = .577)
Summary
Ante- and postpartum maternal depression is a global public health problem [1, 2]. Besides the burden for the individual woman [3], perinatal depression may have adverse effects on the offspring’s health and development [4, 5], predicts their biological sensitivity to social stress well into adulthood [6], and may prevent them from achieving their developmental potential [7]. Women from low and middle income countries (LMIC) may be disadvantaged in terms of mental health due to numerous stressors [9, 10]. Africa is geographically divided into North Africa and sub-Saharan Africa To the latter belong 49 of the 54 African countries, including all West African countries. A handful of studies have investigated the long-term course of depressive symptoms during pregnancy and after childbirth, none of which were performed in West Africa, or subSahara or even in LMIC. This study aimed at investigating the long-term course of maternal depressive symptoms and its association with various mother- and child-related characteristics in two West African lower middle income countries with focus on the relationship with long-term anxiety symptoms
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