Factors associated with antenatal mental disorder in West Africa: A cross-sectional survey

Abstract

BackgroundMaternal mental illness is likely to have a profound impact in less developed parts of the world. A mother experiencing mental illness in a low income setting is at risk of providing sub-optimal care for her offspring which can have grave consequences in an environment where poverty, overcrowding, poor sanitation, malnutrition, tropical diseases and a lack of appropriate medical services may be pronounced. Given the profound consequences of antenatal and postnatal mental illness on maternal mental health, foetal wellbeing and childhood growth and development the factors associated with mental illness in a Sub-Saharan setting merit clarification and investigation.MethodsA prospective survey design was conducted in Lagos. Self reporting questionnaire 20 items - SRQ20 - assessed the presence of mental illness. The WHO Multi-country Study on Women's Health and Domestic Violence Questions assessed women's exposure to violence. Numerous variables potentially associated with mental illness including maternal socio-economic factors, maternal characteristics, obstetric variables and the characteristics of previous children were recorded. Direct logistic regression was performed to assess the impact of a number of variables on the likelihood of presence of mental disorder in the population.Results189 women were surveyed. 7% met the criteria for experiencing a common mental disorder according to their score on the SRQ-20. Of variables examined only the number of female children and the presence of inter personal violence predicted being a case of mental illness (OR = 3.400; 95%CI = 1.374 - 8.414 and OR = 5.676; 95%CI = 1.251 - 25.757 respectively).ConclusionsRates of mental disorder found in our study were lower than those previously observed internationally and in Africa, perhaps reflecting stigma about disclosing symptoms. The predictive nature of violence on mental disorder is in keeping with international evidence. Our study demonstrated that exposure to inter personal violence within the last 12 months and increasing numbers of female children predict the presence of mental illness in a sample of pregnant Nigerian women. Training and education for primary health care and obstetric health workers should highlight these areas.

Development of a brief screening tool for women's mental health assessment in refugee settings: A psychometric evaluation

“…Additionally, this tool was created with data from a sample of Congolese refugee women, and therefore it is not possible to determine the extent to which these results will generalize to other samples, for example samples that included men or populations exposed to different sorts of conflict. The stigma of mental health is well known in Africa (Bartels et al, 2012; Ola et al, 2011). It is possible that both responses about trauma and mental health symptomatology may have been underreported.…”

“…These items were added by the Centers for Disease Control in the Reproductive Health Assessment Toolkit for Conflict Affected Women (Division of Reproductive Health, 2007), to make it a 22-item instrument. For this analysis we opted to use scores of 7 or greater as a middle-ground case definition and because this cut point is a widely used threshold in recent reports (Harpham, Grant, & Rodriguez, 2004; Harpham, Huttly, De Silva, & Abramsky, 2005; Ola et al, 2011; Scholte, Verduin, Kamperman, et al, 2011). Psychometric properties of the SRQ-SIB within this same sample, including factor analysis, have been described elsewhere (Bell, Lori, Redman, & Seng, in press).…”

Factors associated with the probability of common mental disorders in pregnant women: a cross-sectional study

“…3 Although the present (9) has felt sad lately (43.5%); (10) has cried more than usual (52.3%); (11) finds it difficult to perform daily activities satisfactorily (43.2%); (12) finds it difficult to make decisions (27.7 %); (13) study did not investigate violence, it should be emphasized that there is scientific evidence indicating that this phenomenon is associated with CMD, especially intimate partner violence. 3,[16][17][18] A prospective cohort study conducted in Ghana and the Ivory Coast with 1,030 women in their 3 rd trimester of pregnancy, in different age groups, revealed high percentages of depression (28.9%) and anxiety (14.2%). Anxiety was directly associated with age and women aged more than 30 years were the most susceptible ones (30.6±5.5).…”

Understanding the Effects of Mental Health on Reproductive Health Service Use: A Mixed Methods Approach

“…The reliability of the 22-item scale was .911. The SRQ-20 has been widely used in the developing world, including studies in Rwanda and Nigeria (Ola et al, 2011; Scholte et al, 2011) and is usually administered by lay interviewers. For this analysis, we used a cut-off score of 7 or greater based on other similar studies among conflict affected African women, which used similar scores (Ola et al, 2011).…”

“…Refugees experience depression and posttraumatic stress disorder (PSTD) at more than double the rate of the United States population (Mollica et al, 2004), but may live in areas where open discussion about mental health issues is stigmatized (Ola et al, 2011). Mental health morbidities have been described as the most pronounced of all health outcomes associated with migration, culture conflict, and resettlement (Carballo, Grocutt, Hadzihasanovic, 1996).…”