Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh

Abstract

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.

Prevalence and risk factors of postpartum depression within one year after birth in urban slums of Dhaka, Bangladesh

“…PPD was not associated with household economic status within slum areas. This result contradicts the PPD findings within the rural context of Bangladesh [2, 14]. The possible explanation could be the people of slum area were concerned with immediate economic survival [32] rather than long term economic stability (measured by the wealth index).…”

“…Globally, preterm or low birth-weight infants, unemployment, poor social or emotional support, housing problems, first-born child, sleep disturbances, low self-esteem, antenatal depression or anxiety, history of domestic abuse, major adverse life events in preceding one year, perfectionism and level of daily hassles are strong predictors of PPD among women [11, 12]. The risk factors identified in the rural areas of Bangladesh were low economic status, nutritional status, physical violence, domestic quarrels with husband and in laws, stress, past mental and depressive symptoms during pregnancy, perinatal death, poor relationship between husband and in laws, morbidity during pregnancy, and current health condition [1, 2, 13, 14].…”

Maternal Morbidity and Co-morbidity During and After Pregnancy in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…6,18,21,22 Three studies extracted data using secondary data analysis of large databases of hospital admissions, discharges or birth registers. 23,24,25 In these secondary data analyses authors used their own data collection tool, with little details of the variables extracted. One study extracted data from medical case notes retrospectively (Supplementary Table 2).…”

“…The total number of women assessed across the 36 studies was 71,229 (60,911 during and 10,318 after pregnancy). Nine studies assessed <500 women per study ; [22][23][24][25][26][27][28][29][30][31][32][33][34] thirteen studies assessed 500-999 women per study. 13,16,18,19,[35][36][37][38][39][40][41][42] Nine studies assessed 1000-1999 women per study; 17,20,25,26,[43][44][45][46][47] and five studies had a sample size of ≥2000 women ( Supplementary Table 2).…”

“…13,16,18,19,[35][36][37][38][39][40][41][42] Nine studies assessed 1000-1999 women per study; 17,20,25,26,[43][44][45][46][47] and five studies had a sample size of ≥2000 women ( Supplementary Table 2). 6,23,24,48,49…”