Prevalence of perinatal depression among HIV-positive women: a systematic review and meta-analysis

Abstract

BackgroundIncreasing attention has been paid to differences in the prevalence of perinatal depression by HIV status, although inconsistent results have been reported. The aim of this systematic review and meta-analysis was to assess the relationship between perinatal depression and HIV infection. A comprehensive meta-analysis of comparative studies comparing the prevalence of antenatal or postnatal depression between HIV-infected women and HIV-negative controls was conducted.MethodsStudies were identified through PubMed/Medline, Scopus, Web of Science, Cochrane Library, Embase and PsycINFO, and the reading of complementary references in August 2019. Subgroup analyses were performed for anticipated explanation of heterogeneity using methodological quality and pre-defined study characteristics, including study design, geographical location and depression screening tools for depression. The overall odds ratio (OR) and mean prevalence of each group were calculated.ResultsTwenty-three studies (from 21 publications), thirteen regarding antenatal depression and ten regarding postnatal depression were included, comprising 3165 subjects with HIV infection and 6518 controls. The mean prevalence of antenatal depressive symptoms in thirteen included studies was 36% (95% CI: 27, 45%) in the HIV-positive group and 26% (95% CI: 20, 32%) in the control group. The mean prevalence of postnatal depressive symptoms in ten included studies was 21% (95% CI: 14, 27%) in the HIV-positive group and 16% (95% CI: 10, 22%) in the control group. Women living with HIV have higher odds of antenatal (OR: 1.42; 95% CI: 1.12, 1.80) and postnatal depressive symptoms (OR: 1.58; 95% CI: 1.08, 2.32) compared with controls. Publication bias and moderate heterogeneity existed in the overall meta-analysis, and heterogeneity was partly explained by the subgroup analyses.ConclusionsWomen with HIV infection exhibit a significantly higher OR of antenatal and postnatal depressive symptoms compared with controls. For the health of both mother and child, clinicians should be aware of the significance of depression screening before and after delivery in this particular population and take effective measures to address depression among these women.

Mental Health in Women Living With HIV: The Unique and Unmet Needs

“… 49 Two international meta-analyses of perinatal depression in WLWH found 36-44% prevalence of antenatal depression and 21-31% prevalence of postnatal depression, assessed by positive screening or diagnostic clinical measures. 95 , 96 A study of 273 pregnant and postpartum WLWH at a HIV Perinatal Center in Los Angeles, found that women with a CD4 nadir less than 200 cells/mm 3 were 3 times more likely to have a perinatal depression diagnosis than mothers with a CD4 count above 500 cells/mm 3 . 94 Depression and anxiety during the perinatal period have implications for self-care, care of the neonate, and prevention of perinatal HIV transmission.…”

The Prevalence of and Factors Associated With Antenatal Depression Among All Pregnant Women Attending the Obstetrics Clinic for the First Time in A Comprehensive Teaching Hospital

“…It was shown that pregnant women with serious physical and mental disease had a higher incidence of antenatal depression. For example, several studies have shown that the prevalence of antenatal depression in HIV-positive pregnant women is higher [25][26] and that a history of mental health problems increases the risk of developing antenatal depression [27] . Third, gestational weeks might affect the prevalence of antenatal depression, and a study reported that the incidence of depression varied in the three trimesters during pregnancy [5] .…”

“I Found Out I was Pregnant, and I Started Feeling Stressed”: A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

“…Poor mental health, including depression, is a pressing global health issue among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) [1][2][3], particularly in sub-Saharan Africa (SSA) where the prevalence of HIV among women is disproportionately high [4]. Currently, 36% and 21% of WLWH experience depressive symptoms during pregnancy and the postpartum period, respectively [1].…”

“…Poor mental health, including depression, is a pressing global health issue among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) [1][2][3], particularly in sub-Saharan Africa (SSA) where the prevalence of HIV among women is disproportionately high [4]. Currently, 36% and 21% of WLWH experience depressive symptoms during pregnancy and the postpartum period, respectively [1]. Depression among perinatal WLWH has substantial implications for maternal and child health [5], as depression is associated with HIV disease progression [6,7] as well as non-adherence to antiretroviral therapy (ART) [8,9], and reduced exclusive breastfeeding (EBF) [10,11], critical components of the prevention of mother to child transmission of HIV (PMTCT) strategies [12,13].…”