Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model

Abstract

Background: Various forms of life stressors have been implicated as causes of antenatal depression. However, there is a lack of understanding of which forms of stress lead to antenatal depression and through what mechanisms. Modeling stress processes within a theoretical model framework can enhance an understanding of the mechanisms underlying relationships between stressors and stress outcomes. This study used the stress process model framework to explore the causal mechanisms underlying antenatal depression in Gondar, Ethiopia. Methods: Questionnaires, using an Online Data collection Kit (ODK) tool were administered face-to-face in 916 pregnant women in their second and third trimesters. Pregnant women were included from six randomly selected urban districts in Gondar, Ethiopia during June and August 2018. The Edinburgh Postnatal Depression Scale (EPDS) was used to screen for antenatal depression. A Structural Equation Model (SEM) was employed to explore the direct, indirect, and total effect of stressors and mediators of antenatal depression. Result: Sixty-three participants (6.9%) reported symptoms of depression. Of these, 16 (4.7%) and 47 (8.1%) were in their second and third trimesters, respectively. The SEM demonstrated several direct effects on antenatal depression scores including unplanned pregnancy (standardized β = 0.15), having a history of common mental health disorder (standardized β = 0.18) and fear of giving birth to the current pregnancy (standardized β = 0.29), all of which were associated with a higher depression score. Adequate food access for the last 3 months (standardized β = − 0.11) was associated with decreased depression score. Social support (β = − 0.21), marital agreement (β = − 0.28), and partner support (β = −.18) appeared to partially mediate the link between the identified stressors and the risk of antenatal depression.

Depression remains a neglected public health problem among pregnant women in Northwest Ethiopia

“…The result of the present study was higher than the prevalence reported in several other countries such as USA 9% [ 69 ], South India 16% [ 70 ], Australia 16.9% [ 26 ], Brazil 14.2% [ 15 ], Bangladesh 18% [ 24 ], Portugal 18.5% [ 71 ], and at different parts of Ethiopia such as: Gondar town 6.9% [ 72 ] and Anended woreda15.20% [ 28 ].…”

“…In the current study, the prevalence of antenatal depression was in line with studies done in the United States of America 25% [66], Canada 27% [67], China 28.5% [68], Brazil 21.2% [25], Nigeria 24.5% [29] and other studies done in Ethiopia such as Addis Ababa 24.94% [19], Hawasa 21.5% [20], Gondar 23% [21], Shashemane 25.6% [22], and Dupti Hospital 17.9% [30]. The result of the present study was higher than the prevalence reported in several other countries such as USA 9% [69], South India 16% [70], Australia 16.9% [26], Brazil 14.2% [15], Bangladesh 18% [24], Portugal 18.5% [71], and at different parts of Ethiopia such as: Gondar town 6.9% [72] and Anended woreda15.20% [28].…”

Antenatal Depressive Symptoms in Rwanda: Rates, Predictors, and Social Support

“…Lack of support from the husband/partner was found to be important in the development of antenatal depressive symptoms, a nding consistent with previous research in Rwanda [15] and in a study by Faleschini and colleagues [29]. This nding may be related to the impact of having an unwanted or unplanned pregnancy, which has been veri ed as a risk factor for antenatal depression in Rwanda [15] and in other African countries such as Ethiopia [30]. Unplanned pregnancy affects partner support [30], and thus could have contributed to poor husband/partner support in this study which was found to predict depressive symptoms among pregnant women.…”

“…This nding may be related to the impact of having an unwanted or unplanned pregnancy, which has been veri ed as a risk factor for antenatal depression in Rwanda [15] and in other African countries such as Ethiopia [30]. Unplanned pregnancy affects partner support [30], and thus could have contributed to poor husband/partner support in this study which was found to predict depressive symptoms among pregnant women. However, even if unwanted pregnancy increases women's risk of depression, increased social support plays a protecting role from depression [11].…”

Depression and Antidepressants During Pregnancy: Craniofacial Defects Due to Stem/Progenitor Cell Deregulation Mediated by Serotonin

“…The depressive symptomatology during pregnancy has been identified as a predictor for postnatal depression ( Field, 2011 ; Koutra et al, 2014 ; Raskin et al, 2016 ). On the other hand, the development of the fetus is affected by maternal depression, being correlated with fetus low heart rate baseline, premature births, protracted descent ( Emory and Dieter, 2006 ), and low size and weight of the newborns ( Field, 2011 ; Dadi et al, 2020 ; Hompoth et al, 2020 ). Also, the offspring of depressed mothers has a high risk of depression ( Pawlby et al, 2009 ) and negative consequences in affective, cognitive, and behavioral development ( Grace et al, 2003 ; Milgrom et al, 2008 ; Pearson et al, 2012 ).…”