Impact of perinatal somatic and common mental disorder symptoms on functioning in Ethiopian women: The P-MaMiE population-based cohort study

Abstract

BackgroundLittle is known of the relationship between perinatal somatic and common mental disorder (CMD) symptoms and impaired functioning in women from settings where the burden of undernutrition and infectious disease morbidity is high.MethodsA population-based sample of 1065 women from Butajira, Ethiopia, was recruited in pregnancy (86.4% of those eligible) and reassessed two months postnatal (954 with singleton, live infants). At both time-points, women were administered a modified version of the Patient Health Questionnaire-15 and the Self-Reporting Questionnaire (locally-validated) to assess somatic and CMD symptoms, respectively. Negative binomial regression was used to investigate associations of CMD and somatic symptoms with functional impairment (World Health Organisation Disability Assessment Scale, version-II), after adjusting for maternal anthropometric measures, physical ill-health and sociodemographic factors.ResultsIn pregnancy, somatic and CMD symptoms were independently associated with worse maternal functional impairment after adjustment for confounders (WHODAS-II score multiplied by 1.09 (95%CI 1.06, 1.13) and 1.11 (95%CI 1.08, 1.14) respectively for each additional symptom). In the postnatal period, the size of association between somatic symptoms and functional impairment was diminished, but the association with CMD symptoms was virtually unchanged (multiplier value 1.04 (95%CI 1.00, 1.09) and 1.11 (95%CI 1.07, 1.16) respectively).LimitationsUse of largely self-report measures.ConclusionsSomatic and CMD symptoms were independently associated with functional impairment in both pregnancy and the postnatal period, with CMD symptoms showing a stronger and more consistent association. This emphasises the public health relevance of both CMD and somatic symptoms in the perinatal period.

Assessing physical symptoms during the postpartum period: reliability and validity of the primary health questionnaire somatic symptom subscale (PHQ-15)

“…In that study, a modified version of the PHQ-15 was implemented which: 1) eliminated two items regarding feeling tired/having low energy and problems sleeping based on an overlap with another study measure, and 2) modified item wording regarding menstruation to vaginal discharge. This study found the PHQ-15 predicted poorer daily functioning [21], providing initial evidence of suitability for use with perinatal women. However, the generalizability of these findings are limited to women in low-income countries when using a modified version of the PHQ-15.…”

“…(p. 384) [20]. To our knowledge, only one prior study used the PHQ-15 with a perinatal sample and this was in a low-income country "where the burden of undernutrition and infectious disease morbidity is high (p. 340)" [21]. In that study, a modified version of the PHQ-15 was implemented which: 1) eliminated two items regarding feeling tired/having low energy and problems sleeping based on an overlap with another study measure, and 2) modified item wording regarding menstruation to vaginal discharge.…”

Validation of the World Health Organization Disability Assessment Schedule in people with severe mental disorders in rural Ethiopia

“…This version was used previously in the Butajira area [21, 22]. For this version, forward and backward translation was done by four research assistants who are fluent Amharic speakers, trained at masters’ degree level and had experience of translating, adapting and using mental health measures.…”

Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries

“…11 Notably, the prevalence of postpartum depression among women residing in high income countries is reported to be approximately 10% 12 and 20% for women in LAMICs. 3 The high prevalence of perinatal depression is influenced by a number of risk factors including increased somatic symptoms, 13 exposure to intimate partner violence, 14 lack of social support, 15 unintended pregnancy 16 and high rates of relapse of depression during the perinatal period. 17 Antepartum depression has been linked to negative health-related behaviors and adverse outcomes, including poor nutrition, increased substance use, inadequate prenatal care, preeclampsia, low birth weight, preterm delivery, postpartum depression, and suicide.…”