Purpose
We examined stillbirth and neonatal death as predictors of depressive symptoms in women experiencing these events during the first six months postpartum.
Methods
We performed secondary analyses using data from 41,348 married women ages 13–44, originally collected for the JiVitA-1 study (2001 to 2007) in northwest Bangladesh. Adjusted relative risk ratios were estimated to determine the associations between stillbirth and early infant death and women’s risk of reported depressive symptoms (trichotomized 0, 1–2, 3–5) up to six months after the death. Adjusted risk ratios, comparing 0–2 versus 3–5 depressive symptoms, were used in stratified analyses.
Results
Women having fetal/infant deaths had elevated risk of experiencing 1–2 postpartum depressive symptoms (Adj. RRRs between 1.2 and 1.7) and of experiencing 3–5 postpartum depressive symptoms (Adj.RRRs between 1.9 to 3.3), relative to women without a fetal/infant death. Notably, those whose infants died in the early post-neonatal period had over a three-fold risk of 3–5 depressive symptoms (Adj RRR=3.3, 95% CI 2.6–4.3) compared to a two-fold risk for women experiencing a stillbirth (Adj RRR=1.9, 95% CI 1.7–2.1). Following early postneonatal deaths, women with higher levels of education were more likely to suffer 3–5 depressive symptoms (Adj RR=10.6, 95% CI 5.2–21.7, ≥10 years of education) compared to women with lower levels of education (Adj RR=2.0, 95% CI 1.6–2.4, no education; Adj RR=2.2, 95% CI 1.6–2.9, 1–9 years of education).
Conclusions
Women’s mental health needs should be prioritized in low-resource settings, where these outcomes are relatively common and few mental health services are available.