Predictors of maternal psychological distress in rural India: A cross-sectional community-based study

Abstract

BackgroundMaternal common mental disorders are prevalent in low-resource settings and have far-reaching consequences for maternal and child health. We assessed the prevalence and predictors of psychological distress as a proxy for common mental disorders among mothers in rural Jharkhand and Orissa, eastern India, where over 40% of the population live below the poverty line and access to reproductive and mental health services is low.MethodWe screened 5801 mothers around 6 weeks after delivery using the Kessler-10 item scale, and identified predictors of distress using multiple hierarchical logistic regression.Results11.5% (95% CI: 10.7–12.3) of mothers had symptoms of distress (K10 score > 15). High maternal age, low asset ownership, health problems in the antepartum, delivery or postpartum periods, caesarean section, an unwanted pregnancy for the mother, small perceived infant size and a stillbirth or neonatal death were all independently associated with an increased risk of distress. The loss of an infant or an unwanted pregnancy increased the risk of distress considerably (AORs: 7.06 95% CI: 5.51–9.04 and 1.49, 95% CI: 1.12–1.97, respectively).LimitationsWe did not collect data on antepartum depression, domestic violence or a mother's past birth history, and were therefore unable to examine the importance of these factors as predictors of psychological distress.ConclusionsMothers living in underserved areas of India who experience infant loss, an unwanted pregnancy, health problems in the perinatal and postpartum periods and socio-economic disadvantage are at increased risk of distress and require access to reproductive healthcare with integrated mental health interventions.

Maternal Morbidity and Estimates from Community Studies in India

“…39 In other parts of India the proportion postpartum depression was about 11%. 40,41 In the state of Maharashtra one study was conducted in Nashik district with financial support from UNFPA.…”

A Systematic Review of Psychosocial Interventions for Women with Postpartum Stress

“…They also presented the evidence that providing nurseto-parent support can influence parents positively. It is well documented that lower household income, socioeconomic disadvantage, stressful life events, and poor social and family support during the perinatal period are associated with higher levels of postnatal distress (Bener et al, 2012;Gausia, Fisher, Ali, & Oosthuizen, 2009;Prost et al, 2012). These vulnerable mothers are at an increased risk for postpartum mental distress and have more difficulty adjusting to their parenting roles than affluent postpartum women (Kurtz Landy, Sword, & Ciliska, 2008;Leigh & Milgrom, 2008;Milgrom, Schembri, Ericksen, Ross, & Gemmill, 2011).…”

Maternal Multimorbidity During Pregnancy and After Childbirth in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…In nine studies <500 women were assessed; [24][25][26][27][28][29][30][31][32][33] thirteen assessed 500-999 women each. 15,18,20,21,[35][36][37][38][39][40][41][42][43][44] In nine studies 1000-1999 women were assessed; 19,22,27,28,[45][46][47][48][49] and ve had sample sizes of ≥2000 women (Supplementary Table 2). 6,25,26,50,51 Stages of pregnancy assessed A total of 23 studies collected data from women during pregnancy: in the second trimester; 16,19,32,41,48 in the third trimester; 20,24,38 or at any time during pregnancy.…”

“…29,33,35,43 In 12 studies, this took place in the community or at women's homes (Supplementary Table 2). 6,19,20,22,24,30,34,43,46,50,51 Maternal multimorbidity All three types of maternal morbidity including physical, psychological and social ill-health were assessed in 12 studies; 6,15,16,20,40,42,43,44,47,49 psychological and social ill-health were assessed in nine studies; 18,25,29,31,32,35,36,40,43 physical and psychological ill-health in 11; 6,18,19,21,22,24,27,29,32,33,50 and physical and social ill-health in six (Supplementary Table 2). 17,…”

“…The most commonly reported physical morbidities were anaemia in six studies (prevalence range 5.0-57.7%), 6,20,22,23,32,50 and HIV in nine (prevalence range 3.0 -16.0%). 6,16,29,33,36,37,44,49,51 There was a variety of other types of physical morbidities, with wide ranges for some conditions such as antepartum haemorrhage; nausea and vomiting; preterm birth; malaria; reproductive or sexually transmitted infection; urinary tract infection (Supplementary Table 3). Some authors used summative aggregated measures, for example "gynaecological and obstetric problems" as occurring in 10-22% of women; "multiple morbidities" in 60% of women or "at least one reported symptom" (44% occurrence).…”