Open Access
Open Peer Review

This article has Open Peer Review reports available.

How does Open Peer Review work?

Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study

Reproductive Health201512:99

https://doi.org/10.1186/s12978-015-0092-x

Received: 5 June 2015

Accepted: 26 October 2015

Published: 30 October 2015

Abstract

Background

The World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. However, there is a paucity of studies which examined the associated factors of antenatal depression in low-income countries. This study aimed to determine the prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia.

Methods

A cross-sectional study was employed among 393 pregnant women attending antenatal care service in Addis Ababa public health centers, Ethiopia from April 12–26, 2012. The Edinburgh Postnatal Depression Scale (EPDS) was used to detect depressive symptoms. Descriptive statistics and logistic regression were used in the statistical analysis.

Results

Prevalence of antenatal depression was 24.94 % (95 % CI: 20.85–29.30 %). In the final multivariable model, those pregnant women who have previous history of depression were nearly three times at higher odds of having antenatal depression as compared to pregnant women who have no history of depression [AOR = 2.57(95 % CI: 1.48–4.48 )]. Those pregnant women having unplanned pregnancy were nearly three times at higher odds to develop depression as compared to pregnant women whose pregnancy was planned [AOR = 2.78(95 % CI: 1.59–4.85)]. The odd of developing antenatal depression was 89 % higher in those pregnant women who experienced lack of baby’s father support [AOR = 1.89(95 % CI: 1.06–3.36)]. Education level, community’s support, and partner’s feeling on current pregnancy were not significantly associated factors with antenatal depression in the final multivariable model.

Conclusion

Although clinical confirmation for antenatal depression is not conducted, one quarter of the pregnant women attending antenatal care were depressed in Addis Ababa based on EPDS. Unplanned pregnancy, experiencing lack of baby’s father support and previous history of depression were factors independently associated with antenatal depression. Promotion of family planning and integration of mental health service with existing maternal health care as well as strengthening the referral system among public health centers were the recalled interventions to prevent antenatal depression in Addis Ababa Public Health Centers.

Keywords

Antenatal care Depression Maternal health Mental health Low income countries Ethiopia

Introduction

Depression is among the most prevalent psychiatric disorders affecting women [1, 2]. Depressive disorders are predicted to be the second leading cause of global disability burden by 2020 [2]. The risk of depression increased significantly during pregnancy [3, 4] and clinically significant depressive symptoms are common in mid and late trimesters [4]. Several studies have reported that depressive symptoms are more frequent during pregnancy than during the postpartum period [3, 57].

A meta-analysis study done in the developed countries showed that the prevalence rates of depression (95 % confidence interval, CIs) were 7.4 % (2.2–12.6 %), 12.8 % (10.7–14.8 %), and 12.0 % (7.4–16.7 %) for the first, second, and third trimesters, respectively [7]. A systematic review from low- and lower-middle-income countries revealed that the mean weighted prevalence of antenatal common mental disorders was 15.6 % (95 % CI: 15.4–15.9 %) [8]. High prevalence of antenatal depression has been reported from developing countries i.e. 29 % in Bangladesh [9], 25 % in Pakistan [10], 20.2 % in Brazil [11], 39 % in South Africa Cape Town [12], 38.5 % in South Africa KwaZulu-Natal [13] and 39.5 %, in Tanzania [14].

Depressive symptoms during pregnancy may have devastating consequences, not only for the women, but also for the child and family [15]. Depression during pregnancy negatively influences social adjustment and marital relationships [16, 17]. It affects also the mother‐infant interaction through its influences on the occurrence of postnatal depression [18, 19]. Studies also showed that there is a significant associations between antenatal depression and poor infant outcomes (low birth weight, preterm delivery or both, fetal growth restriction) in low [2022] and middle‐income countries [23].

Pregnant women with depression are also more likely to suffer from obstetrical complications such as pre-eclampsia [2426]. Despite the fact that antenatal depression is a common condition with serious consequences, only a few studies have been conducted in low-income countries like Ethiopia. The first study was a validation study of Edinburgh Postnatal Depression Scale (EDPS) on perinatal mental disorder among rural women. That study found a limited validity of EDPS among rural women [27]. However this tool was again tried among postnatal women in urban residents which showed a good reliability and validity [28]. A more recent study conducted on Southwestern Ethiopia found that the prevalence of depressive symptoms during pregnancy was 19.9 % (95 % CI, 16.8–23.1), using EPDS cut off point of 13 and above [29]. The small number of studies conducted in Ethiopia showed that there is a paucity of evidences on antenatal depression to design appropriate intervention. Thus this study aimed to determine the prevalence of antenatal depression and identify factors associated with antenatal depression in Addis Ababa, Ethiopia.

Methods

Study setting and design

This study was conducted in Addis Ababa which is the capital city of Ethiopia. The population of Addis Ababa was 2,738,248 in 2007, of which 52.4 % are females, and women between 15 and 49 years of age constitute 34.6 % [30]. There were 26 health centers which are eligible for this study. Maternal health services are free of charge in Ethiopia at Public health institutions including those Public Health centers included in this study. Antenatal care is provided in all public health centers of Addis Ababa without any cost like other maternal health services. An institutional based cross sectional study design was employed in six selected public health centers in Addis Ababa. The data collection period was from April 12–26, 2012.

Sample size and sampling procedure

The sample size of 422 was determined based on the formula for a single population proportion by assuming a prevalence of antenatal depression of 50 %, confidence level 95 %, margin of error 5 and 10 % for non-response rate. Six public health centers, namely Addis Ketema, Bole, Gulele, Kotebe, Meshualekia, and Yeka, were selected randomly from the 26 health centers that are under the Addis Ababa Bureau of Health. All consenting women attending for antenatal care during the study period in each health center were taken into the study until the sample size was reached. Any apparently healthy pregnant women at any age of gestation who had come to those health institutions during the study period were included in the study. However pregnant women who came for the treatment of any medical diseases including trauma related illness were excluded from the study by assuming that the medical illness they were experiencing during the data collection might affect their mental status. Pregnant women who unable to hear or speak were also excluded from the study. Pregnant women with clinically identified HIV infection, diabetes mellitus, and tuberculosis who were in care during the time of data collection were excluded from the study.

Measurements

The Edinburgh Postnatal Depression Scale (EPDS) [31] has been used to detect depressive symptoms. The EPDS is a 10 item questionnaire, scored from 0 up to 3 (higher score indicating more depressive symptoms), that has been validated for detecting depression in ante partum and postpartum samples in many countries. The instrument was validated in public health centers in Addis Ababa for postpartum use and showed sensitivity of 84.6 % and specificity of 77.0 % at the cutoff score 7/8 [28]. The cutoff point of EDPS among pregnant women is usually higher than postpartum women [32]. Like other similar studies conducted abroad and in Ethiopia, we used EPDS cutoff point of 13 to identify pregnant women with depressive symptom [29, 33]. Those pregnant women who scored 13 and above were categorized as depressed women while pregnant women who scored below 13 were considered as non depressed women [29]. Partner’s feeling on current pregnancy can be defined as pregnant women feeling about the feeling of her partners regarding the current pregnancy. It was measured by asking the pregnant women to rate whether her partner feels happy or not happy on the current pregnancy. Baby’s father support was measured by asking the pregnant women feeling about the partners support to the health of the fetus and continuation of the pregnancy. Community support is measured by asking the pregnant women feeling about the emotional support of the community. The explanatory variables: baby’s father support (poor vs good), partner’s feeling on current pregnancy (happy vs unhappy), community support (poor vs good), and substance use history (yes vs no) were collected by a structured questionnaire. Socio-demographic characteristics and obstetric variables: trimester (first, second and third), having previous pregnancy (yes vs no), previous pregnancy & labor complication (yes vs no), previous history of stillbirth (yes vs no) , previous history of abortion (yes vs no), is the current pregnancy planned (yes vs no), previous ANC follow up (no follow up , sometimes, regular) and current pregnancy complication (yes vs no) were also collected by a structured questionnaire. The conceptual framework is presented in Fig. 1.
Fig. 1

Conceptual framework of antenatal depression and associated factors

Data collection tool and process

The same Amharic version of Edinburgh Postnatal Depression Scale which has ten items was used as the previous validation study [27]. The questionnaire was prepared first in English then translated in to Amharic and back to English to check for consistency by two independent bilingual Ethiopian final years mental health postgraduate students. The Amharic version of this questionnaire was also used to collect the data. The questionnaire was pretested among pregnant women attending ANC clinic at Arada Health Center. Data were collected by trained, female and experienced diploma nurse holders with a close supervision of the principal investigator and trained supervisors. Two days training was given to the data collectors on the data collection tool, interview technique, eligible study subjects, sampling techniques and consent.

Statistical analysis

The coded data was checked, cleaned by entering into Epi Info and exported into Statistical Package for the Social Sciences (SPSS window version 16, Chicago Illinois) for analysis. Descriptive statistics was employed to estimate the prevalence of antenatal depression. Bivariate analyses (binary logistic regression) were carried out between the predictors and antenatal depression. Using significant variables (P <0.05) from binary logistic regression models, a multivariable logistic regression model was fitted to identify the independent predictors of antenatal depression. The strength of association was measured by odds ratios with 95 % confidence intervals. All tests were two sided and statistical significance was declared at P <0.05.

Ethical consideration

Ethical clearance was obtained from Institutional Review Board (IRB) of University of Gondar. Letter of permission was obtained from Addis Ababa Health Bureau. All Antenatal clinic attending women were approached and participants who gave written consent were interviewed. All the study participants were with age greater than 18 years. The interview was conducted in a separate room in the antenatal clinic. Personal identifying details were not recorded. Participants identified with depressive symptoms were advised to visit the psychiatric clinic for better evaluation and treatment.

Results

Socio-demographic characteristics

The response rate for this study was 93.13 %. The mean age of the respondent was 25.27 years (Standard Deviation, SD = 4.335). The age of the respondents ranges from 18–38 years. Three hundred fifty four (90.1 %) of the women were married. Almost 337 (85.7 %) of the women had attended formal education. Majority of the respondents were orthodox by religion 279 (71 %) and Amhara by ethnic group 195 (49.6 %). Majority of the respondents 277 (70.5 %) had a monthly income of above 500 Ethiopian birr (ETB) (Table 1).
Table 1

Socio-demographic characteristics of pregnant women’s attending antenatal care at public health centers in Addis Ababa, 2012 (n = 393)

 

Frequency

Percentage (%)

Maternal age

  < 20 Years

34

8.7

 20 – 24 Years

138

35.1

 25 – 29 Years

146

37.2

 30 – 34 Years

62

15.8

  >34 Years

13

3.3

Educational status

 No formal education

56

14.2

 Elementary school

166

42.2

 Secondary school

116

29.5

 Above secondary school

55

14

Religion

 Orthodox

279

71.0

 Muslim

85

21.6

 Protestant

29

7.4

Ethnicity

 Amhara

195

49.6

 Oromo

82

20.9

 Gurage

100

25.4

 Tigre

16

4.1

Occupational status

 Government employee

22

5.6

 Private employee

106

27.0

 Running personal business

60

15.3

 House wife

189

48.1

 Jobless

16

4.1

Monthly income (Ethiopian birra)

 <= 500.00 Birr

116

29.5

 >500.00 Birr

277

70.5

a1 USD = 20.05ETB

Obstetric and clinical characteristics

Most of the pregnant women (366; 93.9 %) were in either their second or third trimester at the time of the study. Near to half of the pregnant women (191; 48.6 %) were primigravidas. One tenth of the pregnant women had a previous obstetric complication and 11 (2.8 %) of the women reported history of still birth. Almost one fifth of the women (71; 18.1 %) had experienced abortion. Near to two thirds (248; 63.1 %) of the respondents reported that their pregnancy was planned (Table 2).
Table 2

Obstetric and clinical characteristics of pregnant women’s attending Public health centers ANC clinic in Addis Ababa, April, 2012 (n = 393)

Explanatory variables

Categories

Frequency

Percentage

Trimester

First trimester

27

6.1

Second trimester

132

34.4

Third trimester

234

59.5

Having previous pregnancy

No

191

48.6

Yes

202

51.4

Previous pregnancy & labor complication

No

352

89.6

Yes

41

10.4

Previous number of children

0

239

60.8

1

101

25.7

2

40

10.2

≥3

15

3.4

Previous history of still birth

Yes

11

2.8

No

382

97.2

Previous history of abortion

No

321

81.9

Yes

72

18.1

Type of abortion

Spontaneous

37

48.61

Induced

35

51.39

Is the current pregnancy planned

No

145

36.9

Yes

248

63.1

Previous ANC follow up

No follow up

134

34.1

Sometimes

10

2.5

Regular

58

14.0

Current pregnancy complication

Yes

24

6.1

No

369

93.9

History of chronic illness

   
 

Yes

367

93.4

No

26

6.6

Psychiatric history and substance use

In considering the psychiatric characteristics 96 (24.4 %) of the participant reported a previous history of depression and 21 (5.3 %) of the women reported presence of history of depression in the family. Among the respondents 4 (1 %) had used tobacco while 99 (25.2 %) had used alcohol at least once in the last twelve months. The proportion of pregnant women who had used cannabis and khat at least once in the last twelve months were 2 (0.5 %) and 7 (1.8 %), respectively.

Prevalence of antenatal depression

The internal consistency of EPDS tool was acceptable (Cronbach’s α =0.77). The prevalence of antenatal depression (≥13 on EPDS score) was 24.94 % (95 % CI: 20.85–29.30 %). The prevalence of antenatal depression among first trimester women was 5.1 % while it was 27.6 and 67.3 % among second and third trimester women respectively.

Factors associated with antenatal depression (Logistic regression analysis)

The following variables were not significantly associated with antenatal depression in the bivariate analysis: Trimester, having previous pregnancy, previous pregnancy & labor complication, number of ever born children, previous history of still birth, previous history of abortion, history of chronic illness, age of the respondent and substance use in the last 12 months. As shown in Table 3 marital status, educational level, planned pregnancy, partners’ feeling about the pregnancy, fathers’ support, community support, and history of depression were statistically associated with depression in the bivariate analysis. However unplanned pregnancy, pregnant women experienced lack of baby’s father support, and previous history of depression were the associated factors with antenatal depression among pregnant women in the multivariable model.
Table 3

Factors associated with antenatal depression among pregnant women attending public health centers ANC clinic in Addis Ababa, April 2012. (n = 393)

Explanatory variables

COR (95 % CI)

AOR (95 % CI)

Current marital status

 Non married (Single, divorced and widowed)

4.734 (2.394–9.361)

1.799 (0.728–4.441)

 Married

1

1

Educational status

 No formal education

3.316 (1.256–8.750)

2.46 (0.849–7.114)

 Elementary school

2.625 (1.108–6.221)

2.0 (0.783–5.11)

 Secondary school

2.227 (0.907–5.472)

1.652 (0.63–4.332)

 College and above

1

1

Planned pregnancy

 No

3.901 (2.418–6.292)

2.779 (1.594–4.846)

 Yes

1

1

Partner’s feeling on current pregnancy

 Unhappy

5.496 (3.081–9.805)

1.605 (0.708–3.642)

 Happy

1

1

Baby’s fathers support

 Poor

3.680 (2.266–6.002)

1.89 (1.064–3.358)

 Good

1

1

Community’s support

 Poor

2.107 (1.074–4.136)

0.819 (0.370–1.814)

 Good

1

1

History of depression

 Yes

3.347 (2.036–5.503)

2.569 (1.475–4.475 )

 No

1

1

As shown in Table 3 antenatal depression was significantly higher among women who had not planned their current pregnancy. Those women who had not planned their current pregnancy were 2.78 times more likely to have antenatal depression than those who had planned their pregnancy [AOR = 2.78(95 % CI: 1.59–4.85)]. Absence of support from baby’s father was also associated with higher odds of having antenatal depression. Pregnant women who experienced lack of support from the baby’s father were 89 % higher odds of having antenatal depression when compared with women who got support from the baby’s father [AOR = 1.89(95 % CI: 1.06–3.36)]. History of depression was found one of the factors associated with antenatal depression. Those pregnant women who had previous history of depression were nearly three times at higher odds of having depression as compared to pregnant women who had no history of depression [AOR = 2.57(95 % CI: 1.48–4.48 )]. Educational level, community’s support and partner’s feeling on the current pregnancy were not significantly associated with depression during pregnancy in the multivariable logistic regression model.

Discussion

This study showed that there was a high prevalence of antenatal depression among pregnant women who have ANC follows up at public Health centers in Addis Ababa. The finding showed that 24.94 % (95 % CI: 20.85-29.30) of the antenatal care attendee pregnant women had depression based on the EDPS. Many studies reported higher prevalence of antenatal depression such as 39.5 % in Tanzania [11], 39 % in two Cape Town peri-urban settlements [12] and 56 % in Jamaica [34]. A relatively similar prevalence was reported from Brazil (20.2 %) [11] and Rural Bangladesh (18 %) [9]. The methodological differences between studies and different measurement tools might attribute to the difference in the prevalence of depression among these countries. The socio demographic and economic differences might also attribute for the difference in prevalence of antenatal depression between this study and the studies from other developing countries.

Antenatal depression was significantly higher among women who were not planned on their current pregnancy. Those women who were not planned on their current pregnancy were 2.58 times more likely to have antenatal depression than those pregnant women who had planned the pregnancy. This is possibly because pregnancy causes physical, psychological and hormonal changes [35] that is why pregnancy needs physical, psychological and financial preparation. A consistent finding was also reported from rural Southwestern Ethiopia [29]. Other supporting findings regarding the importance of planning pregnancy for prevention of antenatal depression were reported from different part of the world [13, 3639]. Unintended pregnancy was found as risk factor perinatal mental disorders in women in low- and lower-middle-income countries [8]. However, a study done in two Cape Town peri-urban settlements did not found a significant association between unwanted pregnancy and antenatal depression [12].

Experiencing lack of baby’s father support was found to be a statistically significant factor associated with depression during pregnancy. This is possibly because those women who receive partner’s support during their pregnancy well empowered to deal with their pregnancy and their home responsibility. This finding agreed with many studies conducted in different countries [8, 9, 12, 33]. It is also possible that depressed women might feel that the support they receive is not sufficient.

A previous history of depression was a significant factor that associated with the development of antenatal depression. Those pregnant women might be more biologically vulnerable to depression, and the hormonal changes of pregnancy increase vulnerability to depression, or their psycho-social context may make them vulnerable to recurrent depression. This is also consistent with many other studies [8, 9, 12, 40, 41].

The mental health services are not adequate in Ethiopia. However this study implicates that the problem of antenatal depression is rampant even in the capital of the country. This recalled the importance of integrating mental health services with maternal health program. In the context of low- and middle-income countries, designing both treatment and preventive interventions are important to reduce the burden of mental health problem. A systematic review study concluded that in low and middle income countries, the burden of common perinatal mental disorders can be reduced through mental health interventions delivered by supervised non-specialists [42].

This study has limitations. EDPS is not a diagnostic aid, it is a screening method. Making a diagnosis of antenatal depression based on EDPS scale without psychiatric examination is difficult. Women in the sample were recruited from Public Health Centers in Addis Ababa who attended during the study period. They might not be representative of all antenatal care clients, and the sample did not include pregnant women who did not attend for antenatal care and those attended ANC at private health institutions. Majority of public health center users in Addis Ababa are people from low socioeconomic status which question the representativeness of this study across all socioeconomic groups. The other limitation is that major life events and possible co-morbid diagnosis such as HIV status, gender violence, anxiety or dysthymia were not assessed. The effect of nutritional status such as anemia was also not investigated in this study.

Conclusion

One quarter of the pregnant women attending Addis Ababa Public Health Centers ANC clinic were depressed based on the EPDS. Further examination of these pregnant women by a psychiatrist to confirm such diagnosis is recommended. Unplanned pregnancy, experiencing lack of baby’s father support and previous history of depression were factors independently associated with antenatal depression.

Health care professionals need to enquire about the relevant risk factors as part of their overall assessment giving attention to those pregnant women who had unplanned pregnancy, who have poor partner support, and who had a previous history of depression. Promotion of family planning, male involvement in maternal health especially during pregnancy and integration of mental health service with existing maternal health care as well as strengthening the referral system among public health centers were the recommended interventions.

Declarations

Acknowledgement

We thank to university of Gondar and Amaneul Specialized Mental Hospital. We are also grateful to the study participants, data collectors and supervisors.

Funding

This study was funded by university of Gondar. The funder has no role in design, analysis, data interpretation and publication of the finding.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Department of Nursing, College of Medicine and Health sciences, Madwalabu University
(2)
Department of Reproductive Health, College of Medicine and Health sciences, Bahir Dar University

References

  1. Pillay B, Cassimjee M. Anxiety and depression in an urban general practice. J Anxiety Depress. 2000;3(2):4–5.Google Scholar
  2. World Health Organization (WHO). DEPRESSION: A Global Public Health Concern. 2012. Available at http://www.who.int/mental_health/management/depression/who_paper_depression_wfmh_2012.pdf. Accessed May 11, 2012.
  3. Evans J, Heron J, Francomb H, Oke S, Golding J. Cohort study of depressed mood during pregnancy and after childbirth. BMJ. 2001;323:257–60.View ArticlePubMedPubMed CentralGoogle Scholar
  4. Fatoye FO, Adeyemi AB, Oladimeji B. Emotional distress and its correlates among Nigerian women in late pregnancy. J Obstet Gynecol. 2004;24:504–9.View ArticleGoogle Scholar
  5. Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol. 1989;57(2):269–74.View ArticlePubMedGoogle Scholar
  6. O’Keane V, Marsh MS. Depression during pregnancy. BMJ. 2007;334:1003–5.View ArticlePubMedPubMed CentralGoogle Scholar
  7. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103(4):698–709.View ArticlePubMedGoogle Scholar
  8. Fisher J, Mello MC, Patel V, Rahman A, Tran T, Holton S, et al. Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review. Bull World Health Organ. 2012;90(2):139G–49G.View ArticlePubMedGoogle Scholar
  9. Nasreen HE, Kabir ZN, Forsell Y, Edhborg M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: a population based study in rural bangladesh. BMC Womens Health. 2011;11:22.View ArticlePubMedPubMed CentralGoogle Scholar
  10. Rahman A, Iqbal Z, Harrington R. Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychol Med. 2003;33:1161–7.View ArticlePubMedGoogle Scholar
  11. Faisal-Cury A, Menezes P, Araya R, Zugaib M. Common mental disorders during pregnancy: prevalence and associated factors among low-income women in São Paulo, Brazil. Arch Women Ment Health. 2009;120:335–43.View ArticleGoogle Scholar
  12. Hartley M, Tomlinson M, Greco E, Comulada WS, Stewart J, Roux I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8:9.View ArticlePubMedPubMed CentralGoogle Scholar
  13. Manikkam L, Burns JK. Antenatal depression and its risk factors: an urban prevalence study in KwaZulu-Natal. S Afr Med J. 2012;102(12):940–4.View ArticlePubMedGoogle Scholar
  14. Kaaya SF, Mbwambo JK, Kilonzo GP, Van Den Borne H, Leshabari MT, Fawzi MC, et al. Socio-economic and partner relationship factors associated with antenatal depressive morbidity among pregnant women in Dar es Salaam, Tanzania. Tanzan J Health Res. 2010;12(1):23–35.PubMedGoogle Scholar
  15. Alder J, Fink V, Bitzer J, Hosli I, Holzgreve W. Depression and anxiety during pregnancy: a risk factor for obstetric, fetal and neonatal outcome? A critical review of the literature. J Matern Fetal Med. 2007;20:189–209.View ArticleGoogle Scholar
  16. Kazi A, Fatmi Z, Hatcher J, Kadir MM, Niaz U, Wasserman GA. Social environments and depression among pregnant women in urban areas of Pakistan: Importance of social relations. Soc Sci Med. 2006;63:1466–76.View ArticlePubMedGoogle Scholar
  17. Hart R, McMahon CA. Mood state and psychological adjustment to pregnancy. Arch Womens Ment Health. 2006;9:329–37.View ArticlePubMedGoogle Scholar
  18. Sawyer A, Ayers S, Smith H. Pre and postnatal psychological well being in Africa: a systematic review. J Affect Disord. 2010;123(1-3):17–29.View ArticlePubMedGoogle Scholar
  19. Koubovec D, Geerts L, Odendaal HJ, Stein DJ, Vythilingum B. Effects of psychological stress on fetal development and pregnancy outcome. Curr Psychiatry Rep. 2005;7:274–80.View ArticlePubMedGoogle Scholar
  20. Rahman A, Bunn J, Lovel H, Creed F. Association between antenatal depression and low birth weight in a developing country. Acta Psychiatr Scand. 2007;115:481–6.View ArticlePubMedPubMed CentralGoogle Scholar
  21. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24.View ArticlePubMedPubMed CentralGoogle Scholar
  22. Stewart RC, Umar E, Kauye F, Bunn J, Vokhiwa M, Fitzgerald M, et al. Maternal common mental disorder and infant growth--a cross-sectional study from Malawi. Matern Child Nutr. 2008;4(3):209–19.View ArticlePubMedGoogle Scholar
  23. Rondó PHC, Ferreira RF, Nogueira F, Ribeiro MCN, Lobert N, Artes R. Maternal psychological stress and distress as predictors of low birth weight, prematurity and intrauterine growth retardation. Eur J Clin Nutr. 2003;57:266–72.View ArticlePubMedGoogle Scholar
  24. Evans J, Heron J, Patel RR, Wiles N. Depressive symptoms during pregnancy and low birth weight at term. Br J Psychiatry. 2007;191:84–5.View ArticlePubMedGoogle Scholar
  25. Wisner KL, Sit DK, Hanusa BH, Moses-Kolko EL, Bogen DL, Hunker DF, et al. Major depression and antidepressant treatment: impact on pregnancy and neonatal outcomes. Am J Psychiatry. 2009;166(5):557–66.View ArticlePubMedPubMed CentralGoogle Scholar
  26. Field T, Diego M, Hernandez-Reif M. Prenatal depression effects on the fetus and newborn: a review. Infant Behav Dev. 2006;29(3):445–55.View ArticlePubMedGoogle Scholar
  27. Hanlon C, Medhin G, Alem A, Araya M, Abdulahi A, Hughes M, et al. Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale. J Affect Disord. 2008;108:251–62.View ArticlePubMedGoogle Scholar
  28. Tesfaye M, Hanlon C, Wondimagegn D, Alem A. Detecting postnatal common mental disorders in Addis Ababa, Ethiopia: validation of the Edinburgh Postnatal Depression Scale and Kessler Scales. J Affect Disord. 2010;122(1-2):102–8.View ArticlePubMedGoogle Scholar
  29. Dibaba Y, Fantahun M, Hindin MJ. The association of unwanted pregnancy and social support with depressive symptoms in pregnancy: evidence from rural Southwestern Ethiopia. BMC Pregnancy Childbirth. 2013;13:135.View ArticlePubMedPubMed CentralGoogle Scholar
  30. Central Statistics Agency (Ethiopia). Summary and Statistical Report of the 2007 Population and Housing Census, Population Census Commission. Addis Ababa: Federal Democratic Republic of Ethiopia; 2007.Google Scholar
  31. Murray D, Cox JL. Screening for depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). J Reprod Infant Psychol. 1990;8:99–106.View ArticleGoogle Scholar
  32. Gibson J, McKenzie-McHarg K, Shakespeare J, Price J, Gray R. A systematic review of studies validating the Edinburgh Postnatal Depression Scale in antepartum and postpartum women. Acta Psychiatr Scand. 2009;119:350–64.View ArticlePubMedGoogle Scholar
  33. Senturk V, Abas M, Berksun O, Stewart R. Social support and antenatal depression in extended and nuclear family environments in Turkey: a cross-sectional survey. BMC Psychiatry. 2011;11:48.View ArticlePubMedPubMed CentralGoogle Scholar
  34. Wissart J, Parshad O, Kulkarni S. Prevalence of pre- and postpartum depression in Jamaican women. BMC Pregnancy Childbirth. 2005;5:15.View ArticlePubMedPubMed CentralGoogle Scholar
  35. Hickey CA, Cliver S, Goldenberg RL, McNeal SF, Hoffman HJ. Relationship of psychosocial status to low prenatal weight gain among non‐obese black and white women delivering at term. Obstet Gynaecol. 1995;86:177–83.View ArticleGoogle Scholar
  36. Karmaliani R, Asad N, Bann C, Moss N, Mcclure EM, Pasha O, et al. Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. Int J Soc Psychiatry. 2009;55:414–24.View ArticlePubMedGoogle Scholar
  37. Silva RA, Jansen K, Souza LDM, Moraes IGS, Tomasi E, Silva Gdel G, et al. Depression during pregnancy in the Brazilian public health care system. Rev Bras Psiquiatr. 2010;32(2):139–44.PubMedGoogle Scholar
  38. Rich-Edwards JW, Kleinman K, Abrams A, Harlow BL, Thomas J, McLaughlin TJ, et al. Sociodemographic predictors of antenatal and postpartum depressive symptoms among women in a medical group practice. J Epidemiol Community Health. 2006;60:221–7.View ArticlePubMedPubMed CentralGoogle Scholar
  39. Bunevicius R, Kusminskas L, Bunevicius A, Nadisaukiene RJ, Jureniene K, Pop VJ. Psychosocial risk factors for depression during pregnancy. Acta Obstet Gynecol Scand. 2009;88(5):599–605.View ArticlePubMedGoogle Scholar
  40. Johanson R, Chapman G, Murray D, Johnson I, Cox J. The North Staffordshire Maternity Hospital prospective study of pregnancy-associated depression. J Psychosom Obstet Gynaecol. 2000;21(2):93–7.View ArticlePubMedGoogle Scholar
  41. Dayan J, Creveuil C, Dreyfus M, Herlicoviez M, Baleyte J-M, O'Keane V. Developmental model of depression apply to prenatal depression: role of present and past life events, past emotional disorders and pregnancy stress. PLoS One. 2010;5(9):e12942.View ArticlePubMedPubMed CentralGoogle Scholar
  42. Rahman A, Fisher J, Bower P, Luchters S, Tran T, Yasamy MT, et al. Interventions for common perinatal mental disorders in women in low-and middle-income countries: a systematic review and meta-analysis. Bull World Health Organ. 2013;91:593–601.View ArticlePubMedPubMed CentralGoogle Scholar

Copyright

© Biratu and Haile. 2015

Advertisement