The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study

Abstract

BackgroundDepression during pregnancy has far-reaching adverse consequences on mothers, children and the whole family. The magnitude and determinants of prenatal depressive symptoms in low-resource countries are not well established. This study aims to describe the prevalence of prenatal depressive symptoms and whether it is associated with maternal nutrition, intimate partner violence and social support among pregnant women in rural Ethiopia.MethodsThis study is based on the baseline data from a large prospective, community-based, birth cohort study conducted in the South Western part of Ethiopia from March 2014 to March 2016. A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9) scale and a cut off of ≥8 was taken to define prenatal depressive symptoms. Data collection was conducted electronically on handheld tablets and submitted to a secured server via an internet connection. Bivariate and multivariate logistic regression analyses were computed using IBM SPSS version 20 software.ResultThe community based prevalence of depressive symptoms during pregnancy was 10.8% (95%Confidence Interval (CI): 9.92–11.70). Adjusting for confounding variables, moderate household food insecurity (OR 1.74; 95% CI: 1.31–2.32), severe household food insecurity (OR 7.90; 95% CI: 5.87–10.62), anaemia (OR = 1.30; 95% CI: 1.04–1.61) and intimate partner violence (OR 3.08; 95% CI: 2.23–4.25) were significantly associated with prenatal depressive symptoms. On the other hand, good social support from friends, families and husband reduced the risk of prenatal depressive symptoms by 39% (OR 0.61; 95% CI: 0.50–0.76).ConclusionPrenatal depressive symptomatology is rather common during pregnancy in rural Ethiopia. In this community based study, household food insecurity, anaemia and intimate partner violence were significantly associated with prenatal depressive symptoms. Good maternal social support from friends, families and spouse was rather protective. The study highlights the need for targeted screening for depression and intimate partner violence during pregnancy. Policies aimed at reducing household food insecurity, maternal anaemia and intimate partner violence during pregnancy may possibly reduce depression.

Antenatal depression and its potential causal mechanisms among pregnant mothers in Gondar town: application of structural equation model

“…In contrast, a lack of partner or social support has been stated to give rise to a sense of worthlessness and hopelessness, a stage of depression that could ultimately result in maternal suicide or irreversible psychiatric conditions [102]. In summary, a high level of marital agreement, and/or partner and social support significantly reduced the risk of depression, while their absence (in addition to other stressors) increased the risk, consistent with findings from an Ethiopian community-based cohort study in Jimma [81]. Together, these findings support the psychosocial stress theories that acknowledge social and partner support as mediators of a reduced risk of depression and anxiety symptoms [103][104][105].…”

“…In this study, 6.9% of participants in their second and third trimester had depression with the highest risk being in the third trimester of pregnancy. This prevalence was slightly lower than that estimated for Debretabor Town, which had a very similar context to the current study (11.8%), [62] and for the rural areas of Jimma (10.8%) [81]. However, the current study excluded participants with an EPDS score above 17 for ethical reasons and only included mothers in their second and third trimesters.…”

Household food insecurity associated with gestacional and neonatal outcomes: a systematic review

“…The analysis of these results allows us to verify the importance of minimizing stress factors in pregnant women's. FI, in turn, was shown to increase chances of depression [30,36,42,44,53,58,60], stress [45,61] and anxiety [33]. In addition to the mental health complications of pregnant women, symptoms of stress and depression increased the release of hormones such as corticotropin [13] and could lead to clinical complications such as hyperglycaemia and hypertension [45,55].…”

The Effect of Maternal Depressive Symptoms on Infant Feeding Practices in Rural Ethiopia: Community Based Birth Cohort Study

“…There are many pathways that intimate partner violence can affect maternal health and behavior [49]. Through its biological pathway, intimate partner violence is a stressor to which the autonomic nervous system, the hypothalamic-pituitary-adrenal (HPA) axis, and the cardiovascular, metabolic, and immune systems respond and hence leads to depression [50][51][52]. As stated above, maternal depression leads to poor IFPs.…”