Maternal depression significantly higher in low- and middle-income countries

Mothers in low- and middle-income countries experience high rates of depression during pregnancy and following the birth of their babies, according to a new study led by researchers from Harvard T.H. Chan School of Public Health. They found that one in four women experienced antepartum (before birth) depression and one in five experienced postpartum depression—rates significantly higher than in high-income countries.

The study, a systematic review and meta-analysis of previous studies focused on perinatal (antepartum and postpartum) depression, will be published online September 17, 2016 in The Lancet Psychiatry.

“Despite its enormous burden, maternal depression in low- and middle-income countries remains under-recognized and undertreated,” said first author Bizu Gelaye, a research scientist in the Department of Epidemiology at Harvard Chan School. “We hope that our findings will help set the stage for subsequent research on maternal depression aimed at accelerating investments in mental health services for mothers during pregnancy and after childbirth.”

Although there is a well-established body of evidence around perinatal (during pregnancy and the first year after birth) depression in high-income countries—where rates are 7%-15% antepartum and about 10% postpartum—few studies have addressed its prevalence, risk factors, and effect on child health outcomes, in low- and middle-income countries.

In the review and meta-analysis of results from 97 previous studies, the researchers identified several risk factors that increase susceptibility to perinatal depression, including intimate partner violence, mothers’ prior exposure to abuse as a child, maternal low educational attainment and socioeconomic status, and little social support. They recommend that programs aimed at addressing perinatal depression take these risk factors into account.

The review also suggests that perinatal depression may have substantial consequences forchildren’s health, growth, and cognitive development, although causal inferences were hindered by small sample sizes and confounding factors. Rigorously designed longitudinal studies are needed to investigate this association in low- and middle-income countries, according to the researchers.

Previous studies have shown that depression is more prevalent in women during the perinatal period compared with non-pregnancy periods. For many women in low- and middle-income countries, antenatal care may be their first and only interaction with the health care system for any reason. Therefore, the researchers also called for programs integrating mental health care with the regular health care women receive before and after giving birth.

Michelle A. Williams, Dean of the Faculty at Harvard Chan School, was the study’s senior author.

Funding for this study came from grants R01-HD-059835 and T37-MD000149 from the National Institutes of Health.

“Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries, Bizu Gelaye, Mara B. Rondon, Ricardo Araya, Michelle A. Williams, The Lancet, online September 17, 2016, doi: 10.1016/S2215-0366(16)30284-X

An accompanying review in this two-part series examined the biological mechanisms that may link perinatal depression to compromised child development.

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