Abstract
BackgroundLack of social support is an important risk factor for antenatal depression and anxiety in low- and middle-income countries. We translated, adapted and validated the Multi-dimensional Scale of Perceived Social Support (MSPSS) in order to study the relationship between perceived social support, intimate partner violence and antenatal depression in Malawi.MethodsThe MSPSS was translated and adapted into Chichewa and Chiyao. Five hundred and eighty-three women attending an antenatal clinic were administered the MSPSS, depression screening measures, and a risk factor questionnaire including questions about intimate partner violence. A sub-sample of participants (n = 196) were interviewed using the Structured Clinical Interview for DSM-IV to diagnose major depressive episode. Validity of the MSPSS was evaluated by assessment of internal consistency, factor structure, and correlation with Self Reporting Questionnaire (SRQ) score and major depressive episode. We investigated associations between perception of support from different sources (significant other, family, and friends) and major depressive episode, and whether intimate partner violence was a moderator of these associations.ResultsIn both Chichewa and Chiyao, the MSPSS had high internal consistency for the full scale and significant other, family, and friends subscales. MSPSS full scale and subscale scores were inversely associated with SRQ score and major depression diagnosis. Using principal components analysis, the MSPSS had the expected 3-factor structure in analysis of the whole sample. On confirmatory factor analysis, goodness–of-fit indices were better for a 3-factor model than for a 2-factor model, and met standard criteria when correlation between items was allowed. Lack of support from a significant other was the only MSPSS subscale that showed a significant association with depression on multivariate analysis, and this association was moderated by experience of intimate partner violence.ConclusionsThe MSPSS is a valid measure of perceived social support in Malawi. Lack of support by a significant other is associated with depression in pregnant women who have experienced intimate partner violence in this setting.
Highlights
Lack of social support is an important risk factor for antenatal depression and anxiety in low- and middle-income countries
We previously reported the validation of depression screening questionnaires [37] using the Structured Clinical Interview for DSM-IV (SCID) [38] interview as gold standard
On days when SCID interviews were done, 503 women were recruited. 196 were interviewed using SCID and this group was included in analyses concerning major depressive episode
Summary
Lack of social support is an important risk factor for antenatal depression and anxiety in low- and middle-income countries. We translated, adapted and validated the Multi-dimensional Scale of Perceived Social Support (MSPSS) in order to study the relationship between perceived social support, intimate partner violence and antenatal depression in Malawi. Depression occurring in the antenatal period is an important health problem globally including in low- and middle-income countries (LMIC) [1]. Lack of social support is an important risk factor for antenatal depression and anxiety in LMIC alongside obstetric, health and other psychosocial factors including intimate partner violence (IPV) [1,6,7,8,9,10]. It is perceived social support that has been most closely associated with mental wellbeing [11]
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