Perinatal depression in Pakistan: A systematic review and meta‐analysis

Abstract

Objective To estimate the prevalence and associated risk factors of perinatal depression in Pakistan. Methods We conducted a systematic search of Medline, PsycINFO, CINAHL, EMBASE, and Global health, up through May 31, 2019. Studies reporting on the prevalence of perinatal depression in Pakistan with or without associated risks factors were included. Results Forty‐three studies reporting data from 17 544 women met the eligibility criteria and were included. Overall, the pooled prevalence of antenatal depression was 37% (95% CI: 30‐44), while that of postnatal depression was 30% (95% CI: 25‐36). The prevalence of perinatal depression in women residing in urban areas and those living in rural settings was not significantly different. The most frequently reported risk factors for antenatal depression were intimate partner violence and poor relationship with spouse, and that reported for postnatal depression was low‐income level. An unintended pregnancy was significantly associated with perinatal depression in Pakistan. Conclusions We identified variability in prevalence rate of perinatal depression in Pakistan. It is difficult to gauge the true magnitude of this problem potentially due to differing risk factors between the antenatal and postnatal periods and the lack of uniformity of data collection protocols and procedures. The high prevalence rates of 30%‐37% compared to global estimates suggest policy makers and stakeholders should direct additional resources toward improving perinatal mental health in Pakistan.

Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan

“…The prevalence of prenatal depression in the study population was estimated to be around 27%, which is significantly higher than the pooled prevalence of 15.6% in low and middle income countries (29,53). These statistics are in consonance recent meta-analytical estimates for perinatal depression reported by Atif et al (10). The range of prevalence of prenatal depression in Pakistan, is reported from a minimum of 11.5-75% (9,27,(54)(55)(56)(57)(58)(59).…”

“…Prenatal depression is a major public health concern in the Pakistani populace, as evident in recent literature, demonstrating a prevalence of prenatal depression of 65% in Lahore (9). According to a recent pooled analyses of 43 studies in Pakistan, the prevalence of perinatal depression is estimated at 37% during the antenatal period and 30% during the postpartum period (10). This high prevalence of prenatal depression in Pakistan has been associated with poor social network (11)(12)(13), social conflicts (12), poor economic support (14,15), intimate partner violence, which includes psychological, physical, and sexual abuse (16), and poor dietary intake among mothers from lower socioeconomic classes (17).…”

“…Although several studies have presented prevalence estimates on perinatal depression in Pakistan, most of these studies were limited to urban regions and hospital settings. And there is a paucity of data reported from rural settings in Pakistan (10,29). Therefore, this study was designed to identify the risk factors of prenatal depression among rural Pakistani women.…”

Scalable Screening and Treatment Response Monitoring for Perinatal Depression in Low- and Middle-Income Countries

“…Perinatal depression (PND) is a public health concern in low and middle income countries (LMIC), especially Pakistan, where its prevalence is estimated at 32.4% (95% CI: 25.4–40.3%) [ 1 ]. It is associated with both poor maternal physical and mental health outcomes and poor child health [ 2 ].…”

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“…In Pakistan, the estimates are far higher i.e. 37% for antenatal depression and 30% of postnatal depression (Atif et al, 2021). Presumably, the use of antidepressants during pregnancy is increasing with time and an estimated 1 in 10 women use them, especially fluoxetine (Cooper et al, 2007).…”