Objectives
Depression following pregnancy is common, but its extent and
association with maternal morbidity in the first six months postpartum have
not been well described in low resource settings such as rural
Bangladesh.
Methods
We used data from a population-based, community trial of
approximately 39,000 married rural Bangladeshi women aged 13-44 between 2001
and 2007 to examine the relation between women's reported morbidity
symptoms from childbirth to three months postpartum, and subsequent
depressive symptoms assessed at six months postpartum. We calculated crude
and adjusted risk ratios for depressive symptoms following women's
reports of reproductive, urinary, neurologic, nutrition and other illness
measures constructed based on symptomatic reporting.
Results
In models adjusted for sociodemographic factors and co-morbidities,
all postpartum illnesses were associated with an increased relative risk
(RR, with 95% confidence intervals [CI] excluding 1)
of depressive symptoms by six months postpartum. These morbidities included
uterine prolapse (RR=1.20, 95% CI:1.04-1.39), urinary tract
infection (RR=1.24, 95% CI:1.11-1.38), stress related
incontinence (SRI) (RR 1.49, 95% 1.33-1.67), simultaneous SRI and
continuously dripping urine (RR=1.60-2.96), headache
(RR=1.20 (95% CI:1.12-1.28), convulsions (RR=1.67,
95%CI 1.36-2.06), night blindness (RR=1.33, 95%
CI:1.19-1.49), anemia (RR=1.38, 95% CI:1.31-1.46), pneumonia
(RR 1.24, 95% CI:1.12-1.37), gastroenteritis (RR=1.24,
95% CI 1.17-1.31) and hepatobiliary disease (RR=2.10,
96% CI:1.69-2.60).
Conclusions for Practice
Illnesses during the first three postpartum months were risk factors
for depressive symptoms, with the strongest associations noted for
convulsions and hepatobiliary disease. Symptoms of depression may be of
particular concern among women suffering from physical illnesses.