Measures that produce valid and reliable antenatal depressive symptom scores in low resource country contexts are important for research efforts to better understand risk factors, outcomes, and effective interventions in these contexts. Establishing the psychometric comparability of scores across countries also facilitates cross-country analysis of similarities and differences across contexts. To date, however, very few studies have evaluated the psychometric properties and comparability of widely used antenatal depressive symptom measures across diverse cultural, political and social contexts. To address this gap, we used data from the Evidence for Better Lives Study – Foundational Research (EBLS-FR) to examine the reliability, validity, and cross-country invariance of the 9-item version of the Patient Health Questionnaire (PHQ-9) in antenatal samples across eight low- and middle-income countries (LMICs). We found that the PHQ-9 scores had good internal consistency and construct validity across all eight countries. However, in measurement invariance analyses, only partial metric invariance held and only across four of the countries. Further, there were some notable between-site contrasts in the nomological networks of PHQ-9 scores. Our results suggest that the PHQ-9 yields reliable scores when administered in antenatal populations; however, the meaning of the scores varies by country. Thus, interpretation of PHQ scores should consider local meanings of depression to ensure that local conceptualisations and manifestations of antenatal depressive symptoms are adequately reflected.
Perinatal domestic violence (P-DV) is a common form of violence experienced by women and is associated with adverse impacts on their own physical and mental health and that of their offspring. Illuminating the risk factors for and potential effects of P-DV, and promising interventions is essential for informing policies to reduce P-DV and mitigate its negative impacts. This umbrella review of recent high-quality systematic reviews and meta-analyses of research on P-DV provides a systematic synthesis of current knowledge relating to the prevalence, risk factors for, possible outcomes of, and interventions to reduce and prevent P-DV. Thirteen reviews identified through systematic searches of computerised databases, manual search and expert consultation met our inclusion criteria (i.e., English systematic reviews and/ or meta-analyses that were from recent ten years, focused on women exposed to P-DV, assessed risk factors, possible outcomes, and/ or interventions, and were of fair to high methodological quality). Our results suggest that while there is a growing understanding of risk factors and possible outcomes of P-DV, this knowledge has far been translated into effective interventions for P-DV. P-DV intervention programmes that have been subject to rigorous evaluation are mostly relatively narrow in scope and could benefit from targeting a wider range of maternal and child wellbeing outcomes, and perpetrator, relationship, and community risk factors. The overall quality of the evidence syntheses in this field is reasonable; however, future studies should involve multiple reviewers at all key stages of systematic reviews and meta-analyses to help enhance the reliability of review conclusions.
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