Depression among HIV positive pregnant women in Zimbabwe: a primary health care based cross-sectional study

Abstract

BackgroundDepression is a common psychiatric disorder that is highly prevalent among people living with HIV (PLWH). Depression is linked to poor adherence to anti-retroviral medication while in the peri-natal period may affect birth outcomes. Intimate partner violence (IPV) has been linked to depression. Little is known about the factors associated with depression in HIV positive pregnant women in Zimbabwe.MethodsWe carried out a cross-sectional study in 4 busy primary care clinics offering antenatal services during the months of June through to September in 2016. Simple random sampling was used to screen HIV positive pregnant women while they waited to be attended to at each clinic. Eligible women who gave written informed consent were screened using a locally validated screening tool-the Edinburgh Postnatal Depression Scale (EPDS).ResultsA total of 198(85%) participants were recruited out of 234 that were approached. The mean age of participants was 26.6(SD 4.5), of these, 176 (88.9%) had secondary education or more. A total of 78 (39.4%) (95% CI 32.5–46.3) met criteria for antenatal depression according to the local version of the EPDS. Factors associated with antenatal depression after multivariate analysis were intimate partner violence (IPV) [OR 3.2 (95% CI 1.5–6.7)] and previous history of depression OR 4.1 (95% CI 2.0–8.0)].ConclusionThe prevalence of antenatal depression among HIV positive pregnant women in primary care clinics is high. Factors associated with antenatal depression in pregnant HIV positive women are IPV and previous history of depression. There is need for routine screening for depression during the antenatal period and interventions targeting depression in this population should include components to address IPV.

Antenatal depression: an examination of prevalence and its associated factors among pregnant women attending Harare polyclinics

“…Factors associated with antenatal depression, such as intimate partner violence (IPV), experiencing a negative life event, and marital status, are relational. This is consistent with other regional studies [12][13][14][15][16][17][18][19][20][21][22][23]. In Zimbabwe, recent studies have also shown that intimate partner violence is a risk factor for depression in the perinatal period [22,39].…”

“…This is unsurprising as given the high depression comorbidity in people living with HIV [24]. Nevertheless, in the aforementioned study, Nyamukoho et al [22], used a screening tool, the Edinburgh Postnatal Depression Scale (EPDS), to measure depression, instead of a diagnostic tool as used in our study which may explain discrepancies with the current study. Previous studies suggest that depression screening tools overtly yield higher prevalence rates than diagnostic tools [27].…”

“…In South Africa, for example, the prevalence of antenatal depression ranges from 20 to 49% [19,21,23,38]. A recent local/Zimbabwean study among HIV-positive pregnant women [22] also showed a higher prevalence of antenatal depression (39.4%). This is unsurprising as given the high depression comorbidity in people living with HIV [24].…”

“…depression in women from Sub-Saharan Africa ranges from 20 to 49% [5,[12][13][14][15][16][17][18][19][20][21][22][23]. These prevalence variations can be explained by several reasons.…”

“…Firstly, the population studied can explain these differences. Studies investigating HIVpositive, pregnant women reported higher prevalence of antenatal depression [20][21][22]; HIV infection typically increases the risk of depression up to four times [24,25]. Secondly, pregnancy stage influences prevalence estimates; depression occurrence is trimester-dependent with the burden being greater in the third trimester [13,26].…”