Antenatal depression and suicidal ideation among rural Bangladeshi women: a community-based study

Abstract

Depression during pregnancy is a significant public health problem because of its negative effects on the health of both mother and infant. Data on its prevalence and determinants are lacking in Bangladesh. To estimate the prevalence of depression during pregnancy and to identify potential contributory factors among rural Bangladeshi women, a community-based study was conducted during 2005 in Matlab sub-district, a rural area of eastern Bangladesh. Three hundred and sixty-one pregnant women were identified through an existing health and demographic surveillance system covering a population of 110,000 people. The women were interviewed at home at 34-35 weeks of pregnancy. Information on risk factors was collected through structured questionnaires, with the Bangla version of the Edinburgh Postnatal Depression Scale (EPDS-B) used to measure their psychological status. Both univariate analysis and multivariate logistic regression were applied using the SPSS 15.0 statistical software. The prevalence of depression at 34-35 weeks pregnancy was 33% (95% CI, 27.6-37.5). After adjustment in a multivariate logistic regression model, a history of being beaten by her husband either during or before the current pregnancy had the highest association with depression followed by having an unhelpful or unsupportive mother-in-law or husband, and family preference for a male child. Of the antenatally depressed women, 17 (14%) admitted to thoughts of self-harm during the pregnancy. This paper further explores the reasons why women have considered some form of self-harm during pregnancy. Depression during pregnancy is common among Bangladeshi women, with about a third being affected. The study highlights the need to allocate resources and develop strategies to address depression in pregnancy.

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review

“…Such difficulties included having a partner who rejected paternity, who was unsupportive and uninvolved, or critical and quarrelsome, and who used alcohol to excess. 8,27,28,31,38,39,45,48 Higher average symptom scores among women in polygamous rather than monogamous marriages were found in Nigeria 53 and Nepal, 31 but not in Ethiopia. 30 Only seven 24,25,28,[30][31][32]40 studies investigated an association with intimate partner violence.…”

“…In Pakistan, Rahman et al 45 recruited women via household visits by female community health workers and thereby included pregnant women unlikely to attend antenatal services. Gausia et al 27 in Bangladesh and Hanlon et al 30 in Ethiopia used sites covered by Demographic Surveillance Systems to identify eligible pregnant women who were then assessed during household visits by a health worker or surveillance site enumerator. Box 1.…”

“…The most representative ones, on the other hand, are those that recruited systematically in health services, including those located in rural areas, in low-and lower-middleincome countries where most women (> 90%) make at least one antenatal visit, 25,38 or those that recruited women who would not usually attend antenatal care, systematically 27,30,45 (Fig. 2 and Table 4).…”

“…Eleven studies 9,10,14,18,[25][26][27][28]38,45,48 investigated the risks associated with difficult interpersonal relationships other than with the spouse. They focused in particular on conflicts between a woman and her in-laws in settings where women move into the in-laws' household after marriage.…”

“…45 However, no significant relationship of this kind was found in other studies. 26,27 There was also mixed evidence regarding the relationship between CPMD and the number of living children in a woman's care. While three studies 22,38,45 found higher prevalence of CPMDs among women who had three or more children other studies found no association between family size and mental health.…”