Trajectories of maternal ante- and postpartum depressive symptoms and their association with child- and mother-related characteristics in a West African birth cohort study

Barthel, Dana; Kriston, Levente; Fordjour, Daniel; Mohammed, Yasmin; Kra-Yao, Esther Doris; Kotchi, Carine Esther Bony; Armel, Ekissi Jean Koffi; Eberhardt, Kirsten Alexandra; Feldt, Torsten; Hinz, Rebecca; Mathurin, Koffi; Schoppen, Stefanie; Bindt, Carola; Ehrhardt, Stephan

doi:10.1371/journal.pone.0187267

Cited by 17 publications

(24 citation statements)

References 43 publications

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“…Altogether, the four trajectories identified support previous findings using similar modelling techniques [30,33]. First, the chronic low trajectory identified was reported in a previous study conducted in Africa [32], suggesting that, despite the high number and ongoing stressors experienced in LMICs, the majority of women remain at low risk of developing depressive symptoms during the perinatal period. Second, the early postpartum and late postpartum trajectories identified are also similar to those reported by Barthel et al [32].…”

Section: Discussionsupporting

confidence: 85%

“…Studies which have used more complex longitudinal analyses, such as growth curve mixture modelling (GCMM), have enabled the identification of latent subgroups of women with both chronic and transient symptom trajectories during the perinatal period, in both HICs [30] and LMICs [31,32]. This allowed investigators to disentangle severity from chronicity and moving away from the dichotomisation of depressive symptoms.…”

Section: Introductionmentioning

confidence: 99%

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Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

Garman

Cois

Tomlinson

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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Purpose Latent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed. Methods This is a secondary analysis of data collected among women living in Cape Town settlements (N = 446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socioemotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes. Results Four trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-forage z-scores at 18 months, and weight-forage z-scores, length-forage z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories. Conclusions Severe depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

Garman

Cois

Tomlinson

et al. 2019

Soc Psychiatry Psychiatr Epidemiol

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“…It is difficult to compare the present findings to those reported by Barthel et al [33]‘s, the only other study using growth curve mixture models (GCMM) to assess perinatal depressive symptoms among women living in two LMICs. In their study of West African perinatal women, the authors are likely to have excluded a high-risk group by excluding women whose children were born prematurely or had a low birth weight from their study.…”

Section: Discussioncontrasting

confidence: 82%

“…Unfortunately, as both reviews highlight, there is a dearth of evidence from LMICs. Only one LMIC study was conducted, among West African perinatal women [33]. The inclusion criteria meant, however, that the sample was a particularly low-risk group, and neither chronically severe or initially severe trajectories were identified.…”

Section: Introductionmentioning

confidence: 99%

Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors

Garman

Schneider

Lund

2019

BMC Pregnancy Childbirth

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Background The aim of the study was to identify trajectories of perinatal depressive symptoms and their predictors among women living in a low-resource setting in South Africa, and who present with a risk of depression during pregnancy. Methods This is a secondary analysis of a randomised controlled trial among 384 women living in Khayelitsha, a low income setting in South Africa, recruited at their first antenatal visit if they scored 13 or above on the Edinburgh Postnatal Depression Scale, were at least 18 years of age, less than 29 weeks pregnant and spoke isiXhosa. Participants were followed up at 8 months gestation, 3 and 12 months postpartum. Latent trajectories of depressive symptoms were identified using growth mixture modelling, based on the Hamilton Depression Rating Scale (HDRS). There were no differences in HDRS scores between the control and intervention arms, so all participants were assessed together. Health, social and economic predictors of trajectories were investigated to identify high-risk groups with greater or more chronic depressive symptoms, using univariate logistic regression. Results Two trajectories were identified: antenatal only (91.4%), with moderate to severe symptoms at baseline which later subside; and antenatal and postnatal (8.6%), with severe depressive symptoms during pregnancy and later in the postpartum period, which subside temporarily to moderate levels at 3 months postpartum. Predictors for the antenatal and postnatal trajectory include severe food insecurity, intimate partner violence, lower social support, greater functional impairment, problematic drinking and suicide risk. Conclusions A small proportion of women who are at risk for depression antenatally remain at risk throughout the perinatal period, and can be differentiated from those who show a natural remission. Identification and referral strategies should be developed with these findings in mind, especially given the limited mental health resources in low-income settings. Electronic supplementary material The online version of this article (10.1186/s12884-019-2355-y) contains supplementary material, which is available to authorized users.

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“…Maternal psychological well‐being has been understudied among maternal risk factors for child feeding practices, including food intake and diet quality (de Jong, Visscher, HiraSing, Seidell, & Renders, ; Gillman et al, ; Woo Baidal et al, ). Most studies investigating the association between maternal psychosocial well‐being and diet‐related behaviours among infants and young children have focused on maternal depressive symptoms (Barthel et al, ; Benton, Skouteris, & Hayden, ; Morrissey & Dagher, ; Savage & Birch, ). Longitudinal relations have been described between maternal depression reported 1 year post‐partum and higher child body mass index (BMI; Benton et al, ), low physical activity levels (Duarte, Shen, Wu, & Must, ), and age‐inappropriate child feeding practices (Thompson & Bentley, ).…”

Section: Introductionmentioning

confidence: 99%

Maternal anxiety and diet quality among mothers and toddlers from low‐income households

Trude

Black

Surkan

et al. 2020

Maternal & Child Nutrition

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We evaluated the association between maternal anxiety score and diet quality over time among mothers and toddlers in low‐income families. Longitudinal data were collected from 267 mother–toddler dyads in an obesity prevention trial. Participants were recruited from the Special Supplemental Nutrition Program for Women, Infants and Children and paediatric clinics between 2007 and 2010. Dyads were assessed at study enrolment (Time 1), 6‐month (Time 2), and 12‐month follow‐up (Time 3). On the basis of a 1‐day 24‐hr dietary recall, we estimated maternal and toddler diet quality using the Healthy Eating Index 2015. Anxiety, a time‐varying variable, was assessed via the State–Trait Anxiety Inventory. Associations between maternal anxiety score and maternal and toddler diet quality over time were assessed in adjusted mixed models. Maternal and toddler diet quality were positively correlated (r = .48, p < .001). Higher maternal anxiety scores were related to lower toddler Healthy Eating Index scores (b = −0.51, 95% confidence interval, CI [−0.87, −0.15]) with no significant variation over time. The relation between maternal diet quality and anxiety score varied over time (b = 0.28, p = .03, for time–anxiety interaction). Higher maternal anxiety scores were associated with lower maternal diet quality at Time 1 (b = −0.71, 95% CI [−1.09, 0.34]) and at Time 2 (b = −0.51, 95% CI [−0.97, −0.05]), but not at Time 3 (b = −0.14, 95% CI [−0.54, 0.26]). Findings suggest that mothers and toddlers exhibited similar low‐quality dietary patterns and that lower diet quality was associated with higher maternal anxiety scores. Approaches to enhance diet quality may consider incorporating anxiety‐reducing strategies into maternal and toddler care and feeding behaviour guidelines.

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Trajectories of maternal ante- and postpartum depressive symptoms and their association with child- and mother-related characteristics in a West African birth cohort study

Cited by 17 publications

References 43 publications

Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

Perinatal depressive symptoms among low-income South African women at risk of depression: trajectories and predictors

Maternal anxiety and diet quality among mothers and toddlers from low‐income households

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