Mothers in poorer countries more likely to develop maternal depression than their wealthier counterparts
Mothers in low- and middle-income countries are more vulnerable to high rates of depression during pregnancy and following the birth of their babies, according to a study led by researchers from Harvard T.H. Chan School of Public Health.
The researchers found that one in four women experienced antepartum (before birth) depression and one in five experienced postpartum depression—rates significantly higher than in high-income countries.
“Despite its enormous burden, maternal depression in low- and middle-income countries remains under-recognized and undertreated,” said first author Bizu Gelaye, a research scientist in the Department of Epidemiology at Harvard Chan School. “We hope that our findings will help set the stage for subsequent research on maternal depression aimed at accelerating investments in mental health services for mothers during pregnancy and after childbirth.”
Although there is a well-established body of evidence around perinatal (during pregnancy and the first year after birth) depression in high-income countries—where rates are 7%-15% antepartum and about 10% postpartum—few studies have addressed its prevalence, risk factors, and effect on child health outcomes, in low- and middle-income countries.
In the review and meta-analysis of results from 97 previous studies, the researchers identified several risk factors that increase susceptibility to perinatal depression, including intimate partner violence, mothers’ prior exposure to abuse as a child, maternal low educational attainment and socioeconomic status, and little social support. They recommend that programs aimed at addressing perinatal depression take these risk factors into account.
The review also suggests that perinatal depression may have substantial consequences for children’s health, growth, and cognitive development, although causal inferences were hindered by small sample sizes and confounding factors. Rigorously designed longitudinal studies are needed to investigate this association in low- and middle-income countries, according to the researchers.
Previous studies have shown that depression is more prevalent in women during the perinatal period compared with non-pregnancy periods. For many women in low- and middle-income countries, antenatal care may be their first and only interaction with the health care system for any reason. Therefore, the researchers also called for programs integrating mental health care with the regular health care women receive before and after giving birth.
