Antenatal Depressive Symptoms in Rwanda: Rates, Predictors, and Social Support

Abstract

BackgroundPrevalence of perinatal depression is high in Rwanda and has been found to be associated with the quality of relationship with partners. This study extends this work to examine the relationship between antenatal depressive symptoms and social support across several relationships among women attending antenatal care services. Methods Structured survey interviews were conducted with 396 women attending antenatal care services in 4 health centers in the Southern Province of Rwanda. The Edinburgh Postnatal Depression Scale (EPDS) and Maternity Social Support Scale (MSSS) were used to assess antenatal depressive symptoms and the level of support respectively. Socio-demographic and gestational information, pregnancy intentions, perceived general health status, and experience of violence were also collected. Univariate, bivariate analyses and a multivariate logistic regression model were performed to determine the relationship between social support and predictors of antenatal depressive symptoms. ResultsMore than half of respondents were married (55.1%) or living with a partner in a common-law relationship (28.5%). About a third (35.9%) were in their 6th month of pregnancy; the rest were in their third term. The prevalence of antenatal depressive symptoms was 26.6% (EPDS ≥ 12). Bivariate analyses suggested that partner and peer support negatively predict depression level symptoms.Adjusting for confounding variables such as unwanted pregnancy (AOR: 0.415, CI: 0.221- 0.778), parity (AOR): 0.336, C.I: 0.113–1.000) and exposure to extremely stressful life events (Odds Ratio = 2.300, C.I. = 1.263–4.189), husband/partner support (AOR: 4.458, CI: 1.833- 10.842) was strongly significantly associated with antenatal depressive symptoms such that women reporting good support were less likely to report depression level symptoms than those reporting poor support or those with no partner. Peer support was no longer significant.Conclusion The study revealed that social support may be a strong protector against antenatal depressive symptoms but only support from the partner. This suggests that strengthening support to pregnant women may be a successful strategy for reducing the incidence or severity of maternal mental health problems, but more work is required to assess whether support from peers can compensate for absent or unsupportive partners.

Risco de depressão na gravidez na assistência pré-natal de risco habitual

“…Este fato tornase importante, pois ferramentas de avaliação diversas, aliadas às diferenças socioeconômicas e culturais, podem contribuir para a variabilidade nos resultados em relação à depressão pré-natal entre as diferentes populações. Assim, estudos anteriores apresentaram taxas de depressão de 5,4% no Egito (14) ; 14% na Nigéria (24) , 26,6% em Ruanda (25) e 16% no Brasil (26) , evidenciando que há considerável heterogeneidade nos índices devido às diferenças nos tamanhos das amostras, ao desenho do estudo e ao instrumento de avaliação.…”

“…Na análise bivariada, as características socioeconômicas não mostraram associação significativa com risco de depressão na gravidez. Em contraste, estudo anterior sugeriu associação entre ausência de apoio social e a depressão entre gestantes (25) .…”

“…Na análise multivariada, evidenciou-se que gestantes sem emprego apresentaram maior risco de depressão na gravidez. Corroborando este achado, estudo desenvolvido na Nigéria mostrou que possuir emprego diminuiu as chances de depressão pré-natal (25) . Em contraste, estudo da África do Sul demonstrou que a ocupação não tem impacto significativo sobre o sintoma depressivo durante o segundo e terceiro trimestres (31) .…”

Riesgo de depresión durante el embarazo en la atención prenatal de riesgo habitual

“…Este hecho se vuelve importante, ya que las diferentes herramientas de evaluación, combinadas con las diferencias socioeconómicas y culturales, pueden contribuir a la variabilidad en los resultados con respecto a la depresión prenatal entre diferentes poblaciones. Así, estudios previos mostraron tasas de depresión del 5,4% en Egipto (14) ; 14% en Nigeria (24) , 26,6% en Ruanda (25) y 16% en Brasil (26) , lo que demuestra que existe una heterogeneidad considerable en las tasas debido a las diferencias en los tamaños de muestra, el diseño del estudio y el instrumento de evaluación.…”

“…En contraste, un estudio anterior sugirió una asociación entre la falta de apoyo social y la depresión entre las mujeres embarazadas (25) .…”