Depressive Symptoms and Posttraumatic Stress Disorder as Determinants of Preference Weights for Attributes of Obstetric Care among Ethiopian Women

Abstract

BackgroundMental health, specifically mood/anxiety disorders, may be associated with value for health care attributes, but the association remains unclear. Examining the relation between mental health and attributes in a context where quality of care is low and exposure to suboptimal health conditions is increased, such as in Sub Saharan Africa (SSA), may elucidate the association.Methodology/Principal FindingsWe assessed whether preference weights for obstetric care attributes varied by mental health among 1006 women from Jimma Zone, Ethiopia, using estimates obtained through a discrete choice experiment (DCE), a method used to elicit preferences. Facilities were described by several attributes including provider attitude and performance and drug/equipment availability. Mental health measures included depressive symptoms and posttraumatic stress disorder (PTSD). We used Bayesian models to estimate preference weights for attributes and linear models to investigate whether these weights were associated with mental health. We found that women with high depressive symptoms valued a positive provider attitude [β = −0.43 (95% CI: −0.66, −0.21)] and drug/equipment availability [β = −0.43 (95% CI: −0.78, −0.07)] less compared to women without high depressive symptoms. Similar results were obtained for PTSD. Upon adjusting for both conditions, value for drug/equipment availability was lower only among women with both conditions [β = −0.89 (95% CI −1.4, −0.42)].Conclusions/SignificanceWe found that women with psychopathology had lower preference weights for positive provider attitude and drug/equipment availability. Further work investigating why value for obstetric care attributes might vary by psychopathology in SSA is needed.

Women’s Preferences for Treatment of Perinatal Depression and Anxiety: A Discrete Choice Experiment

“…Applications in mental health include treatment types [ 43 ], tests for depression [ 44 ] and treatment modalities [ 45 , 46 ]. One examined public willingness-to-pay for counselling regarding antidepressant use in pregnancy [ 47 ], another explored effects of mental health problems on obstetric care preferences [ 48 ]. However, to our knowledge this is the first DCE examining women’s preferences for PNDA treatment.…”

Stated Preference Research in Reproductive and Maternal Healthcare Services in Sub-Saharan Africa: A Systematic Review

“…All except one of the included studies were DCEs (17,(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38) and the remaining one was a…”

“…Best-Worst-Scaling study (39). The studies were conducted between 2009 and 2020 and were from Ethiopia (28,31,37), South Africa (29,34,39), Kenya (35,36), Tanzania (17,30), Nigeria (38) or conducted in more than one SSA country (32,33). Participants in eight studies were pregnant women or women aged 18-49 years who had recently delivered a child (17,28,30,31,(35)(36)(37)(38), and three studies focused only on women living with HIV (29,32,39).…”

“…The studies were conducted between 2009 and 2020 and were from Ethiopia (28,31,37), South Africa (29,34,39), Kenya (35,36), Tanzania (17,30), Nigeria (38) or conducted in more than one SSA country (32,33). Participants in eight studies were pregnant women or women aged 18-49 years who had recently delivered a child (17,28,30,31,(35)(36)(37)(38), and three studies focused only on women living with HIV (29,32,39). In majority of studies, the experimental design for the DCE choice questions was created in either Sawtooth (17, 30-32, 34, 37) or Ngene (28,33,35,36) software using a D-efficient algorithm to construct a fractional factorial experimental design.…”

“…Conditional logit, mixed logit regression and latent class analysis were often used by studies to analyse the data. The included studies assessed perceived preferences in limited ranges of maternal healthcare service domains (obstetric care (17,28,30,31,(35)(36)(37)(38) followed by HIV care and services (29,32,33,39)). The respondents were presented with a maximum of three different choice sets in most studies.…”