Prevalence and Correlates of Depression Among Pregnant Women Enrolled in a Maternal and Newborn Health Program in Rural Northern Ghana: a Cross-sectional Survey

Abstract

Women in many sub-Saharan African countries are at elevated risk of depression during pregnancy. However, there are still gaps in the estimates of antenatal depression and associated risk factors in very low-resource settings such as Northern Ghana. This study describes the prevalence of depression among rural pregnant women, participating in a maternal and child health program, in Ghana, and examines associated risk factors for depression. Pregnant women who were registered for group-based maternal and child health community programs were recruited for study participation from 32 communities in two rural districts in Northern Ghana (n = 374). Baseline surveys were conducted and depression was assessed using the Patient Health Questionnaire (PHQ-9). Bivariate and multivariable analyses used a modified Poisson and generalized estimating equations (GEE) model. Of the women in our study population, 19.7% reported symptoms indicative of moderate to severe depression (PHQ-9 score ≥ 10), with 14.1% endorsing suicidal ideation in the last 2 weeks. Bivariate analyses revealed that lower hopefulness, moderate and severe hunger, experiences of emotional, physical, and/or sexual intimate partner violence (IPV), and insufficient social support from female relatives were associated with symptoms indicating moderate to severe depression. In the multivariable analyses, low hopefulness, household hunger, emotional IPV, physical and/or sexual IPV, and insufficient female relative support remained significantly associated with depression. Antenatal depression is associated with unmet basic needs and safety. Perinatal mental health programming must take an ecological perspective and address personal, familial, and community-level factors.

Prevalence and Correlates of Maternal Early Stimulation Behaviors during Pregnancy in Northern Ghana: A Cross-Sectional Survey

“…This theory is usually used to describe the fetus' relationship to their mother; however, in this case, the expectant mother is seeking comfort from her pregnant belly when she is faced with hardships in her life. One thing is clear-poor mental health, domestic violence, and household hunger are common amongst our study population and have been previously established as correlated with each other (20).…”

“…Mental health was assessed using the Patient Health Questionnaire (PHQ-9), a common depression screener that has been validated for use among pregnant women in Ghana (25). The PHQ-9 has nine items that are summed for a score between 0 and 27 and standard categorization: minimal or no depression (score of 0 to 4), mild depression (5-9), moderate depression (10 to 14), moderately severe depression (15)(16)(17)(18)(19), and severe depression (20)(21)(22)(23)(24)(25)(26)(27) (26). For analysis, we dichotomized the PHQ-9 into none to mild depression (score of less than 10) and moderate to extremely severe (score of 10 or greater), based on those who would have screened for no treatment or treatment in a clinical setting (25,27).…”

“…Participant inclusion criteria included being pregnant at baseline, 16 years or older, planned to attend C-PrES groups at the time of the baseline survey and planned to maintain residence in the community for at least six months. Details on sample size and the survey translation process have been previously published (20).…”

Prevalence and Correlates of Maternal Early Stimulation Behaviors during Pregnancy in Northern Ghana: A Cross-Sectional Survey

“…These behaviors included touching/talking to her belly, singing songs, dancing, and talking to her belly about family. These were example ESB that Catholic Relief Services used in the iMBC sessions and have used in other programmatic materials (17). As part of the original survey, two additional questions were asked regarding whether the father touches/talks to the expectant mothers' belly and if other children touch/talk to the belly (part of CRS program materials).…”

“…This study uses cross-sectional pre-intervention baseline data from a parent study that is a longitudinal, cluster randomized control trial (Clinical Trials # NCT03665246) to evaluate the impact of a maternal mental health/ECD intervention called Integrated Mothers and Babies Course (iMBC) (16,17). The parent trial included 32 communities/clusters with 16 clusters per arm.…”