Depressive symptoms in mothers after perinatal and early infant loss in rural Bangladesh: a population-based study

Abstract

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.

Perinatal death triples the prevalence of postpartum depression among women in Northern Uganda: A community-based cross-sectional study

“…Therefore, it is plausible that women who had had a perinatal death in our study were more likely to experience postpartum depression compared to their counterparts. Our study findings are consistent with findings from Bangladesh and Malaysia [14,30,32].…”

“…Participants whose babies died between 7-50 days could not be included in the non-exposed group because their risk of depression does not reflect that of the source population. Losing a child at whatever age places one at a higher risk of depression compared to the general population [14].…”

“…These can be classified into "biological (change in hormones, age of mother), physical (chronic health problems), psychological (prenatal anxiety, stress, lack of social support, poor marital relationship, stressful life events), obstetrics/pediatrics (unwanted pregnancy, parity, history of loss of pregnancy and poor infant health), and socio-cultural (status of mother, polygamy and poverty)" [12,13]. Evidence associates perinatal death to existence of postpartum depression [14].…”

“…Although extensive studies have been conducted on postpartum depression [ 24 – 29 ], few have focused on women who have experienced a perinatal death [ 14 , 30 – 32 ]. In our study context, the association between perinatal death and postpartum depression has not been established making this evidence scarce in Northern Uganda.…”

Prevalence and associated factors of postpartum depression in Southwest, Ethiopia, 2017: a cross-sectional study

“…Other variables which were significantly associated with post-partum depression were the death of infant and marital problems. This is consistent with studies done in India [ 30 ], Bruit [ 28 ], Uganda [ 31 ], Bangladesh [ 32 ], Spain [ 33 ], Nablus, Palestine [ 34 ]. One of the main cause for depression is loss of significance person in the life.…”