The Need for Universal Screening for Postnatal Depression in South Africa: Confirmation from a Sub-District in Pretoria, South Africa

Mokwena, Kebogile; Masike, Itumeleng

doi:10.3390/ijerph17196980

Cited by 15 publications

(24 citation statements)

References 37 publications

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“…As PDE may have potentially long-term impact, it is important that maternal depression be identified and addressed early. This is especially pressing in LMIC settings such as our study setting, where rates of depression are much higher than in the general population (Mokwena & Masike, 2020 ), and where psychological interventions may be useful (Gajaria & Ravindran, 2018 ). The rate of depression in our larger DCHS cohort of 28% coincide with the higher rates in LMIC.…”

Section: Discussionmentioning

confidence: 99%

Prenatal depression exposure alters white matter integrity and neurodevelopment in early childhood

Roos

Wedderburn

Fouché

et al. 2022

Brain Imaging and Behavior

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Prenatal exposure to maternal depression increases the risk for onset of emotional and behavioral disorders in children. We investigated the effects of exposure to prenatal depression on white matter microstructural integrity at birth and at 2-3 years, and associated neurodevelopment. Diffusion-weighted images were acquired for children of the Drakenstein Child Health Study at 2-4 weeks postpartum (n=70, 47% boys) and at 2-3 years of age (n=60, 58% boys). Tract-Based Spatial Statistics was used to compare, using an ROI based approach, diffusion tensor metrics across groups defined by presence (>19 on Beck’s Depression Inventory and/or >12 on the Edinburgh Postnatal Depression Scale) or absence (below depression thresholds) of depression, and associations with neurodevelopmental measures at age 2-3 years were determined. We did not detect group differences in white matter integrity at neonatal age, but at 2-3 years, children in the exposed group demonstrated higher fractional anisotropy, and lower mean and radial diffusivity in association tracts compared to controls. This was notable in the sagittal stratum (radial diffusivity: p<0.01). Altered white matter integrity metrics were also observed in projection tracts, including the corona radiata, which associated with cognitive and motor outcomes in exposed 2-3-year-olds (p<0.05). Our findings of widespread white matter alterations in 2-3-year-old children with prenatal exposure to depression are consistent with previous findings, as well as with neuroimaging findings in adults with major depression. Further, we identified novel associations of altered white matter integrity with cognitive development in depression-exposed children, suggesting that these neuroimaging findings may have early functional impact.

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Section: Discussionmentioning

confidence: 99%

Prenatal depression exposure alters white matter integrity and neurodevelopment in early childhood

Roos

Wedderburn

Fouché

et al. 2022

Brain Imaging and Behavior

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“…This indicate that the PND prevalence rate in this study is comparable but slightly higher than that of women attending the public hospitals which is expected since the mothers in this sample were exclusively from the slum settings and therefore extreme poverty. Recent research findings from other African countries show a high PND prevalence rates: Rwanda 63.6%, South Africa (57.14%) [ 35 ] and (38.8%) [ 36 ], Nigeria 35.6% [ 37 ]. Comparable to our finding, a systematic review and meta-analysis revealed a prevalence rate of 26% in Middle-East countries, while European countries had lower rates (8%) [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study

et al. 2022

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Background Postnatal depression (PND) is a universal mental health problem that prevents mothers’ optimal existence and mothering. Although research has shown high PND prevalence rates in Africa, including Kenya, little research has been conducted to determine the contributing factors, especially in low-resource communities. Objective This study aimed to investigate the PND risk factors among mothers attending Lang’ata and Riruta Maternal and Child Health Clinics (MCH) in the slums, Nairobi. Methods This study was cross-sectional. It is part of a large study that investigated the effectiveness of a brief psychoeducational intervention on PND. Postnatal mothers (567) of 6-10 weeks postanatal formed the study population. Depression rate was measured using the original 1961 Beck’s Depression Inventory (BDI). In addition, a sociodemographic questionnaire (SDQ) was used to collect hypothesized risk variables. Multivariable logistic regression analysis was used to explore predictors of PND. Results The overall prevalence of PND in the sample of women was 27.1%. Women aged 18-24 (β = 2.04 95% C.I.[0.02; 4.05], p = 0.047), dissatisfied with body image (β = 4.33 95% C.I.[2.26; 6.41], p < 0.001), had an unplanned pregnancy (β = 2.31 95% C.I.[0.81; 3.80], p = 0.003 and felt fatigued (β = − 1.85 95% C.I.[− 3.50; 0.20], p = 0.028) had higher odds of developing PND. Participants who had no stressful life events had significantly lower depression scores as compared to those who had stressful life events (β = − 1.71 95% C.I.[− 3.30; − 0.11], p = 0.036) when depression was treated as a continuous outcome. Sensitivity analysis showed that mothers who had secondary and tertiary level of education had 51 and 73% had lower likelihood of having depression as compared to those with a primary level of education (A.O.R = 0.49 95% C.I.[0.31-0.78], p = 0.002) and (A.O.R = 0.27 95% C.I.[0.09-0.75], p = 0.013) respectively. Conclusion This study reveals key predictors/risk factors for PND in low-income settings building upon the scanty data. Identifying risk factors for PND may help in devising focused preventive and treatment strategies.

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“…47,48 The validity in the study was enhanced by the use of the EPDS, which is an already valid, reliable, and standardised tool for screening of PND. 22 The EPDS tool has been used in previous South African studies. 13,30,49 Nonetheless, the tool was validated through content and face validity and a pilot study.…”

Section: Data Collection Tool and Recruitmentmentioning

confidence: 99%

“…20 Although the negative impact of PND on both mother and child is well documented, 21 this area of maternal mental health has not enjoyed adequate attention in many countries, including South Africa. 22 The symptoms of PND can be easily identified by the use of the EPDS, a well-validated screening tool that is used in many countries. 23 Although this tool is economical and easy to use, PND is not routinely screened for in primary healthcare settings in South Africa.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa

Mokwena

Modjadji

2022

Afr. j. prim. health care fam. med.

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Background: The factors contributing to probable postnatal depression (PND), a type of clinical depression that can affect woman after childbirth, are socially derived. Therefore, variations among groups of women necessitate studies in different communities.Aim: This study compared the prevalence of PND and associated factors among women attending postnatal services facilities.Setting: The study setting included Tshwane Municipal district in Gauteng province (GP) and Fezile Dabi District (FS) in Free State province (FSP), South Africa.Methods: A total of 477 mothers within 12 weeks of giving birth were recruited by convenient sampling in health facilities. A self-developed questionnaire was used to obtain information on socio-demographics, obstetric history, and children’s characteristics. The Edinburgh Postnatal Depression Scale (EPDS) was used to collect data on depression symptoms, with a score of ≥ 13 used as a cut-off for probable PND. Data were analysed using STATA 14. Multivariate logistic regression was used to determine association between probable PND and various covariates.Results: The overall mean age of women was 28 ± 6 years. The overall prevalence rate of PND was 22%, slightly higher in FS (23%) than in GP (21%). Most participants living in GP were married, had tertiary education, were employed and from the households with income of more than R8000.00. A chi-square test showed that planned pregnancy was significantly higher in GP compared with FS (p ≤ 0.001). Multivariate logistic regression showed that support from a partner or husband decreased the odds of a probable PND in GP (adjusted odd ratio [AOR] 0.37; 95% confidence interval [CI] [95%CI: 0.14–0.96; p = 0.041] and in the FS [AOR = 0.14, 95%CI: 0.05–0.40; p ≤ 0.001]). Significant associations of probable PND with several factors – planned pregnancy, baby age, support in difficult times, partner or husband drinking alcohol and stressful events – were more common in the FSP than in the GP.Conclusion: The prevalence of probable PND and its associated risk factors in the GP and the FS indicates the need for routine screening and targeted interventions in both urban and rural settings.Contribution: The results confirm that the prevalence of PND is similar in both rural and urban areas, and that pregnancy planning remains a challenge in the FS, which calls for increased efforts to revive family planning programmes in primary health care facilities.

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The Need for Universal Screening for Postnatal Depression in South Africa: Confirmation from a Sub-District in Pretoria, South Africa

Cited by 15 publications

References 37 publications

Prenatal depression exposure alters white matter integrity and neurodevelopment in early childhood

Prenatal depression exposure alters white matter integrity and neurodevelopment in early childhood

Predictors of postnatal depression in the slums Nairobi, Kenya: a cross-sectional study

A comparative study of postnatal depression and associated factors in Gauteng and Free State provinces, South Africa

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