Antenatal and Postpartum Depression: Prevalence and Associated Risk Factors among Adolescents’ in KwaZulu-Natal, South Africa

Abstract

Background. Maternal depression is a major public health concern as it affects both mothers and their children. Antenatal depression, which is often underdiagnosed, has been associated with preterm labour, low birth weight, and intrauterine growth restriction. Research has demonstrated that postpartum depression is associated with mother-infant bonding impairment, child abuse, child neglect, maternal substance abuse, and self-harm. Globally, the prevalence of depression in pregnant and postpartum adolescents varies. This paper reports on the findings of the prevalence of depression and its associated risk factors among pregnant and postpartum adolescents in KwaZulu-Natal, South Africa. Methods. Data were generated by means of a descriptive cross-sectional study that was conducted between June and November 2017 utilizing a sample of 326 adolescent females accessing maternal health services in a medium-sized rural peripheral district hospital in Ugu, Southern KwaZulu-Natal. The Edinburgh Postnatal Depression Scale questionnaire was used to screen participating pregnant and postnatal adolescents for depression. A cut-off score of ≥13 was used to identify pregnant and postnatal adolescents with symptoms of depression. The data were analysed using R software. Results. The prevalence of depression among the pregnant participants was 15.9% (21/132), whereas it was 8.8% (17/194) among the postpartum participants. Antenatal depression was associated with physical violence (adjusted odds ratio (aOR) 6.47, 95% CI 1.36-30.53, p=0.01) and verbal abuse (adjusted odds ratio (aOR) 4.8, 95% CI 1.5-15.16, p=0.006). The pregnant participants who indicated they received a lot of support from their partners were 0.93% less likely to have depression. Postnatal depression was associated with physical violence (adjusted odds ratio (aOR) 7.32, 95% CI 1.66-29.44, p=0.005), verbal abuse (adjusted odds ratio (aOR) 4.3, 95% CI 1.03-15.79, p=0.03), and intimate partner violence (adjusted odds ratio (aOR) 9.58, 95% CI 1.58-48.82, p=0.008). Conclusion. The prevalence of antenatal depression was higher than postpartum depression in the study sample. In light of the findings, maternal healthcare professionals are cautioned to consider the mental health of pregnant and postpartum adolescents who seek their services at health facilities.

Antenatal Depression and Associated Factors among Pregnant Women Attending Antenatal Care Service in Kochi Health Center, Jimma Town, Ethiopia

“…In this study, social support was associated with antenatal depression; similar findings were reported from the study done in the USA [ 54 ], KwaZulu-Natal, South Africa [ 35 ], and Kenya [ 44 ]; a systematic review and meta-analysis conducted in Ethiopia [ 22 ]; and another systematic review in Ethiopia [ 8 ] and Hawassa, Ethiopia [ 39 ]. This might be explained by social support that has been shown to promote mental health and acts as a buffer against depression [ 55 ], so lack of social support could be implicated for the high risk of depression during pregnancy.…”

“…On the contrary, the finding of this study is higher than 9.18% and 12.3% in the study done in Mumbai and Bengaluru, India, respectively [ 32 , 33 ], and 14.2% in Rio de Janeiro, Brazil [ 34 ]; this may be because a better health service provision of the countries compared to Ethiopia. The finding of this study is almost similar to 15.9% in Southern KwaZulu-Natal, South Africa [ 35 ], 17.9% in the Dubti Hospital Afar region [ 21 ], and 15.2% in Aneded woreda, Amhara Region, Ethiopia [ 36 ]. But the result is lower than 24.3% in a systematic review and meta-analysis in South Asia [ 37 ], 24.5% in Abeokuta North Local Government Area in Nigeria [ 38 ], 21.5% in the findings from, 21.28% in a systematic review and meta-analysis in Ethiopia [ 22 ], and 23.5% in another systematic review and meta-analysis in Ethiopia [ 8 ], Hawassa [ 39 ], and 24.9% in Addis Ababa [ 40 ].…”

Mixed Method Synthesis of Cognitive interviews with Kenyan peripartum adolescents: Testing EPDS and PHQ questionnaires in Nairobi primary care settings

“…Another study conducted in Addis Ababa, Ethiopia by Biratu et al on antenatal depression in pregnant women using EPDS scale (n=393), found prevalence of antenatal depression to be 24.94%(95% CI: 20.85-29.30%) (13). In another Ethiopian study conducted by Dibaba et al pregnant women (n=627); the prevalence of depressive symptoms during pregnancy on EPDS scale was 19.9% (95% CI: 16.8-23.1%) (14) and Govender et al in South Africa found (n=326) the prevalence of depression among the pregnant participants was found to be 15.9% using EPDS (15).…”

“…Scoring is by summation of the boxes on PHQ-9 questionnaire (For every Not at all = 0; Several days = 1; More than half the days = 2; Nearly every day = 3). Interpretation of Total Score: Depression Severity 1) Minimal depression (1-4), 2) Mild depression (5)(6)(7)(8)(9), 3) Moderate depression (10)(11)(12)(13)(14), 4) Moderately severe depression (15)(16)(17)(18)(19), 5) Severe depression (20)(21)(22)(23)(24)(25)(26)(27). It too has been used widely to screen for depressive symptoms globally and widely validated in different patient populations in SSA.…”

Risk factors and experiences of prepartum depression among pregnant women in urban- low income in Nairobi Kenya: a mixed-method study

“…Research evidence reveals that the stresses of life, especially around pregnancy and childbirth, can affect the emotions of women and behavior of many mothers, hence increasing the risk of depression during pregnancy and after childbirth 14 . Socio-determinants, i.e.…”