The theme of this year’s World Mental Health Day is “psychological first aid,” a call to action for those in helping roles (health care staff, community workers, teachers, etc.) to provide psychological and social support to those in need. In order for the global maternal health community to do our part, we first need to identify the women who suffer from perinatal mental health issues, as well as those at highest risk of developing them in the future.
Research from high-income countries has revealed that 7%-15% of women suffer from antepartum depression, and about 10% of women experience postpartum depression. The limited evidence we have suggests that about twice as many women in low- and middle-income countries (LMICs) suffer from depression during pregnancy or within the first year after giving birth. However, few studies have examined the prevalence and determinants of perinatal depression in LMICs. In a recent study in The Lancet Psychiatry, Gelaye and colleagues published a systematic review of existing research to estimate the prevalence of antepartum and postpartum depression among women in LMICs and identify the associated risk factors and child health outcomes.
Based on studies from countries in Africa, Asia and South America, the authors estimate that about one in four women in LMICs experience antepartum depression, and about one in five women experience postpartum depression. These results support previous estimates that women in LMICs are about twice as likely to suffer from perinatal depression compared to women in high-income countries.
The authors found that, consistent with previous findings, women in LMICs with low educational attainment, low socioeconomic status or limited social support are at greater risk of experiencing perinatal depression. Women with a history of childhood abuse, intimate partner violence or mental illness are also particularly vulnerable. Additional research is needed to assess potential sociocultural risk factors in diverse local contexts.
Child health outcomes
Based on their review of 25 studies, the authors concluded that perinatal depression is associated with the following maternal and child health outcomes in LMICs:
- Preterm delivery
- Infants with low birth weight
- Impaired postnatal infant growth
- Insecure infant-mother attachments
- Suboptimal breastfeeding practices
A call to action
Women in LMICs are faced with a double burden: they are at greater risk of experiencing perinatal depression compared to women in high-income countries, and they are also less likely to get the care they need. Even in high-income countries, many women with antepartum or postnatal depression are not screened, diagnosed or treated. In low-resource settings, many women cannot access health facilities for antepartum, intrapartum or postnatal care at all, and those who do often receive poor quality care. To effectively address perinatal depression in LMICs, we the global maternal health community need to develop validated measurements tools, create guidelines for screening, prevention and treatment and design integrated antenatal care programs that can be adapted to local contexts. Simultaneously, we need to gather more evidence and gain a better understanding of the risk factors for perinatal depression in diverse sociocultural settings in order to identify the most vulnerable women. Public health researchers, clinicians, policymakers and program implementers have a duty to provide women around the world with the mental health support they need and deserve.
Join the conversation on World Mental Health Day using #WorldMentalHealthDay.
Read more about this study in the Harvard T.H. Chan School of Public Health news.
Explore the archives: How to Close the Mental Health Gap in Low- and Middle-Income Countries.
Learn more about gaps in perinatal mental health research on the MHTF blog.
Check out the MHTF blog series highlighting the importance of maternal mental health.