Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

Abstract

Purpose Latent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed. Methods This is a secondary analysis of data collected among women living in Cape Town settlements (N = 446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socioemotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes. Results Four trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-forage z-scores at 18 months, and weight-forage z-scores, length-forage z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories. Conclusions Severe depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential.

Perinatal depression among mothers in a South African birth cohort study: Trajectories from pregnancy to 18 months postpartum

“…Group 3 exhibits an interesting pattern, with mild levels of depressive symptoms during pregnancy that decrease and then increasing postpartum, peaking at 12 months postpartum and then dissipating by 18 months postpartum. This pattern has also been recently found among a different cohort of South African women (Garman et al, 2019). Their study used four time points (during pregnancy, 2 weeks postpartum, 6 months postpartum, and 18 months postpartum).…”

“…Both Groups 2 and 4 display opposing transient patterns of depressive symptoms; in Group 2 depressive symptoms are mild during pregnancy and increase postpartum whereas in Group 4 depressive symptoms are moderate during pregnancy and decrease to minimal levels during postpartum. Both of these trajectory types have been seen in previous studies (Baron et al, 2017; Christensen, Stuart, Perry & Le, 2011; Garman et al, 2019; Vänskä et al, 2009). Among the group with depressive symptoms that increase postpartum we do not know if beyond 18 months postpartum these symptoms become chronic and require intervention or if they dissipate.…”

“…In our study, none of the measured variables predicted the pattern found in Group 3. In Garman et al (2019), they found that both HIV status and unemployment predicted this group trajectory. However, in our study we could not test the association between HIV status and group trajectory because no HIV positive women appeared in Group 5, precluding the use of the HIV status variable in the multinomial multivariate regression model, thus, we do not know whether HIV status is a predictor of this type of trajectory in our sample.…”

“…Given the longitudinal nature of perinatal depression, understanding patterns of depression across the transition from pregnancy to postpartum and throughout the postpartum period is paramount. However, merely assessing the average longitudinal trajectory across a cohort masks cohort heterogeneity as well as important nuances related to timing, chronicity, and severity (Garman, Cois, Tomlinson, Rotheram-Borus, & Lund, 2019; Santos, Tan, & Salomon, 2017). Depressive symptoms tend to be cyclical and episodic, making it important to understand the trajectory of patient’s depressive symptoms over time.…”

Understanding Mental Health in the Context of Adolescent Pregnancy and HIV in Sub-Saharan Africa: A Systematic Review Identifying a Critical Evidence Gap

“…A further six studies included populations aged ≥18 years [72][73][74][75][76][77]. As such, some older adolescents (18-19 years) may have been included within the sample.…”