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      Maternal mental health in Amhara region, Ethiopia: a cross-sectional survey

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          Abstract

          Poor mental health, including suicidal thoughts, affects a substantial proportion of surveyed women who are up to 2 years postpartum in the Amhara region of Ethiopia. Opportunities for integrating basic psychosocial mental health services into maternal and child health services should be explored.

          Abstract

          Poor mental health, including suicidal thoughts, affects a substantial proportion of surveyed women who are up to 2 years postpartum in the Amhara region of Ethiopia. Opportunities for integrating basic psychosocial mental health services into maternal and child health services should be explored.

          ABSTRACT

          Background:

          Postpartum common mental disorders (CMD) such as depression and anxiety are increasingly recognized for their burden in low-resource countries such as Ethiopia. However, the magnitude of postpartum CMD in Ethiopia is not well-established. This short report describes the mental health status of women who had given birth in the last 24 months in the Amhara region of Ethiopia.

          Methods:

          A cross-sectional survey was conducted among 1,319 women aged 15–49 years old who had a delivery in the previous 24 months from 30 randomly selected kebeles (smallest administrative unit in Ethiopia) across Amhara region. The survey included the Self-Reporting Questionnaire (SRQ-20) developed by the World Health Organization—a CMD screening instrument that includes 20 yes/no questions on depression, anxiety, and somatic symptoms experienced in the last 30 days. We used 2 cutoff scores to determine probable cases of mental disorder: (1) 4/5 (≤ 4 “yes” responses = non-case, ≥ 5 “yes” responses = case) based on a study that validated the SRQ-20 against a diagnostic tool in Butajira, Ethiopia, and (2) a more conservative and commonly used 7/8 cutoff.

          Results:

          Among the 1,294 women who completed the full survey including the SRQ-20, 32.8% had probable CMD using the 4/5 cutoff score versus 19.8% using the more conservative 7/8 cutoff. About 15% of the women responded affirmatively that they had had suicidal thoughts.

          Conclusion:

          Poor mental health was common among the surveyed women who had given birth in the past 24 months in Amhara region, Ethiopia. Integrating mental health care into maternal and child health services could potentially alleviate the burden of CMD among women in the extended postpartum period.

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          Most cited references15

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          Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.

          To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.
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            Detecting perinatal common mental disorders in Ethiopia: validation of the self-reporting questionnaire and Edinburgh Postnatal Depression Scale.

            The cultural validity of instruments to detect perinatal common mental disorders (CMD) in rural, community settings has been little-investigated in developing countries. Semantic, content, technical, criterion and construct validity of the Edinburgh Postnatal Depression Scale (EPDS) and Self-Reporting Questionnaire (SRQ) were evaluated in perinatal women in rural Ethiopia. Gold-standard measure of CMD was psychiatric assessment using the Comprehensive Psychopathological Rating Scale (CPRS). Community-based, convenience sampling was used. An initial validation study (n=101) evaluated both EPDS and SRQ. Subsequent validation was of SRQ alone (n=119). EPDS exhibited poor validity; area under the receiver operating characteristic (AUROC) curve of 0.62 (95%CI 0.49 to 0.76). SRQ-20 showed better validity as a dimensional scale, with AUROC of 0.82 (95%CI 0.68 to 0.96) and 0.70 (95%CI 0.57 to 0.83) in the two studies. The utility of SRQ in detecting 'cases' of CMD was not established, with differing estimates of optimal cut-off score: three and above in Study 1 (sensitivity 85.7%, specificity 75.6%); seven and above in Study 2 (sensitivity 68.4%, specificity 62%). High convergent validity of SRQ as a dimensional measure was demonstrated in a community survey of 1065 pregnant women. Estimation of optimal cut-off scores and validity coefficients for detecting CMD was limited by sample size. EPDS demonstrated limited clinical utility as a screen for perinatal CMD in this rural, low-income setting. The SRQ-20 was superior to EPDS across all domains for evaluating cultural equivalence and showed validity as a dimensional measure of perinatal CMD.
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              Pre- and postnatal psychological wellbeing in Africa: a systematic review.

              Perinatal mental health disorders are recognised as an important public health issue in low-income countries as well as in developed countries. This paper reviews evidence on the prevalence and risk factors of maternal mental health disorders in African women living in Africa. A systematic review of the literature was conducted. Studies were mainly located through computerised databases, and additionally through hand searching references of identified articles and reviews. Thirty-five studies, with a total of 10,880 participants, were identified that reported prevalence rates of maternal psychological health in eight African countries. Depression was the most commonly assessed disorder with a weighted mean prevalence of 11.3% (95% CI 9.5%-13.1%) during pregnancy and 18.3% (95% CI 17.6%-19.1%) after birth. Only a small number of studies assessed other psychological disorders. Prevalence rates of pre- and postnatal anxiety were 14.8% (95% CI 12.3%-17.4%) and 14.0% (95% CI 12.9%-15.2%), respectively; and one study reported the prevalence of PTSD as 5.9% (95% CI 4.4%-7.4%) following childbirth. Lack of support and marital/family conflict were associated with poorer mental health. Evidence relating sociodemographic and obstetric variables to mental health was inconclusive. Most studies included in this review were cross-sectional and measures of mental health varied considerably. This paper demonstrates that maternal mental health disorders are prevalent in African women, and highlights the importance of maternal mental health care being integrated into future maternal and infant health policies in African countries. Copyright 2009 Elsevier B.V. All rights reserved.
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                Author and article information

                Journal
                Glob Health Sci Pract
                Glob Health Sci Pract
                ghsp
                ghsp
                Global Health: Science and Practice
                Global Health: Science and Practice
                2169-575X
                December 2014
                02 December 2014
                : 2
                : 4
                : 482-486
                Affiliations
                [a ]FHI 360, Washington, DC, USA. Now with Duke Global Health Institute at Duke University , Durham, NC, USA
                [b ]University of North Carolina at Chapel Hill, Gillings School of Public Health , Chapel Hill, NC, USA
                [c ]FHI 360, Addis Ababa, Ethiopia
                [d ]Bahir Dar University , Bahir Dar, Ethiopia
                [e ]Amhara Regional Health Bureau , Bahir Dar, Ethiopia
                [f ]FHI 360, Addis Ababa, Ethiopia. Now with Abt Associates, SHOPS Project , Bethesda, MD
                [g ]FHI 360, Livelihoods and Food Security Technical Assistance II (LIFT II) , Durham, NC, USA
                Author notes
                Correspondence to Joy Noel Baumgartner ( joy.baumgartner@ 123456duke.edu ).
                Article
                GHSP-D-14-00119
                10.9745/GHSP-D-14-00119
                4307863
                25611481
                4802fb34-a2b9-4acc-833a-1f9d8cd5fd17
                © Baumgartner et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit http://creativecommons.org/licenses/by/3.0/. When linking to this article, please use the following permanent link: http://dx.doi.org/10.9745/GHSP-D-14-00119.
                History
                : 22 July 2014
                : 12 November 2014
                Categories
                Short Report

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