Background: A major barrier to improving perinatal mental health in Africa is the lack of locally validated tools for identifying probable cases of perinatal depression or for measuring changes in depression symptom severity. We systematically reviewed the evidence on the reliability and validity of instruments to assess perinatal depression in African settings. Methods and Findings:Of 1,027 records identified through searching 7 electronic databases, we reviewed 126 fulltext reports. We included 25 unique studies, which were disseminated in 26 journal articles and 1 doctoral dissertation. These enrolled 12,544 women living in nine different North and sub-Saharan African countries. Only three studies (12%) used instruments developed specifically for use in a given cultural setting. Most studies provided evidence of criterion-related validity (20 [80%]) or reliability (15 [60%]), while fewer studies provided evidence of construct validity, content validity, or internal structure. The Edinburgh postnatal depression scale (EPDS), assessed in 16 studies (64%), was the most frequently used instrument in our sample. Ten studies estimated the internal consistency of the EPDS (median estimated coefficient alpha, 0.84; interquartile range, 0.71-0.87). For the 14 studies that estimated sensitivity and specificity for the EPDS, we constructed 2 x 2 tables for each cut-off score. Using a bivariate random-effects model, we estimated a pooled sensitivity of 0.94 (95% confidence interval [CI], 0.68-0.99) and a pooled specificity of 0.77 (95% CI, 0.59-0.88) at a cut-off score of ≥9, with higher cut-off scores yielding greater specificity at the cost of lower sensitivity. Conclusions:The EPDS can reliably and validly measure perinatal depression symptom severity or screen for probable postnatal depression in African countries, but more validation studies on other instruments are needed. In addition, more qualitative research is needed to adequately characterize local understandings of perinatal depression-like syndromes in different African contexts. Funding:The authors received no specific funding to conduct this study but acknowledge the following sources of salary support: U.S. National Institutes of Health (NIH) K23 MH-096620 (ACT), NIH K23 MH-095655 (LTM), NIH K23 MH-096651 (CP), and the National Research Foundation (South Africa) and the Department for International Development (MT). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.Competing interests: ACT is a member of the PLoS ONE Editorial Board. MT is a member of the PLoS Medicine Editorial Board. This does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials. * E-mail: actsai@partners.org IntroductionMajor depressive disorder is a major public health issue and accounts for a large proportion of the global burden of disease impacts provide added impetus for alleviating the burden of perinatal depression in low-and middle-income countries [6,7]. H...

Alexander Tsai and colleagues show that in sexually active women in Brazil severe food insecurity with hunger was positively associated with symptoms potentially indicative of sexually transmitted infection and with reduced odds of condom use.

Objective To estimate the association between urinary incontinence and probable depression, work disability, and workforce exit. Methods The analytic sample consisted of 4,511 women enrolled in the population-based Health and Retirement Study cohort. The analysis baseline was 1996, the year that questions about urinary incontinence were added to the survey instrument, and at which time study participants were 54–65 years of age. Women were followed with biennial interviews until 2010–2011. Outcomes of interest were onset of probable depression, work disability, and workforce exit. Urinary incontinence was specified in different ways based on questions about experience and frequency of urine loss. We fit Cox proportional hazards regression models to the data, adjusting the estimates for baseline socio-demographic and health status variables previously found to confound the association between urinary incontinence and the outcomes of interest. Results At baseline, 727 participants (survey-weighted prevalence, 16.6 percent; 95% confidence interval [CI], 15.4–18.0) reported any urinary incontinence, of which 212 (survey-weighted prevalence, 29.2 percent; 95% CI, 25.4–33.3) reported urine loss on more than 15 days in the past month; and 1,052 participants were categorized as having probable depression (survey-weighted prevalence, 21.6 percent; 95% CI, 19.8–23.6). Urinary incontinence was associated with increased risks for probable depression (adjusted hazard ratio [AHR], 1.43; 95% CI, 1.27–1.62) and work disability (AHR, 1.21; 95% CI, 1.01–1.45) but not workforce exit (AHR, 1.06; 95% CI, 0.93–1.21). Conclusions In a population-based cohort of women between the ages of 54 and 65, urinary incontinence was associated with increased risks for probable depression and work disability. Improved diagnosis and management of urinary incontinence may yield significant economic and psychosocial benefits.