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      Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review Translated title: Prevalencia y determinantes de los trastornos mentales perinatales frecuentes en mujeres en países de ingresos bajos y medios-bajos: examen sistemático Translated title: Prévalence et déterminants des troubles mentaux périnataux communs chez les femmes des pays à revenu faible et moyen: une étude systématique

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          Abstract

          OBJECTIVE: 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. METHODS: 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. FINDINGS: 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). CONCLUSION: CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

          Translated abstract

          <img border=0 src="../../../../../img/revistas/bwho/v90n2/a14rs01.jpg">

          Translated abstract

          OBJETIVO: Examinar las pruebas clínicas acerca de la prevalencia y los determinantes de los trastornos mentales perinatales frecuentes (TMPF) no psicóticos en los países de ingresos bajos o medios-bajos según la clasificación del Banco Mundial. MÉTODOS: Se examinaron de forma sistemática bases de datos importantes en busca de publicaciones en inglés acerca de la prevalencia de TMPF no psicóticos, así como sus determinantes y factores de riesgo. Se incluyeron todos los diseños de estudios. RESULTADOS: Trece documentos que abarcaban 17 países de ingresos bajos y medios-bajos proporcionaron resultados para mujeres embarazadas, y 34, para mujeres que acababan de dar a luz. Existían datos acerca de los trastornos durante el periodo prenatal para 9 países (8%), y sobre los trastornos durante el periodo postnatal para 17 países (15%). La prevalencia media ponderada fue del 15,6% (intervalo de confianza [IC] del 95%: 15,4-15,9) en el periodo prenatal y del 19,8% (19,5-20,0) en el periodo postnatal. Los factores de riesgo fueron: desventajas socioeconómicas (razón de posibilidades [OR]: 2,1-13,2); embarazo no deseado (1,6-8,8); juventud de la madre (2,1-5,4); no estar casada (3,4-5,8); ausencia de empatía y apoyo por parte de la pareja (2,0-9,4); familia política hostil (2,1-4,4); sufrir violencia por parte de la pareja (2,11-6,75); apoyo emocional y práctico insuficiente (2,8-6,1); en algunos entornos, dar a luz a una niña (1,8-2,6), y tener antecedentes de problemas de salud mental (5,1-5,6). Los factores de protección fueron: mayor educación (riesgo relativo: 0,5; P=0,03); tener un trabajo estable (OR: 0,64; IC del 95%: 0,4-1,0); pertenecer a una mayoría étnica (OR: 0,2; IC del 95%: 0,1-0,8) y tener una pareja amable y de confianza (OR: 0,52; IC del 95%: 0,3-0,9). CONCLUSIÓN: Los TMPF presentan una prevalencia mayor en países con ingresos bajos y medios-bajos, en particular, entre las mujeres más pobres con riesgos relacionados con el género o con antecedentes psiquiátricos.

          Translated abstract

          OBJECTIF: Étudier la preuve de la prévalence et des déterminants des troubles mentaux périnataux communs (TMPC) non psychotiques dans les pays à revenu faible et moyen, selon les catégories de la Banque mondiale. MÉTHODES: Des recherches systématiques ont été effectuées dans les principales bases de données afin de trouver des publications en anglais sur la prévalence des TMPC non psychotiques et sur leurs facteurs de risque et déterminants. Tous les protocoles d'études ont été inclus. RÉSULTATS: Treize articles, couvrant 17 pays à revenu faible et moyen, ont fourni des résultats sur les femmes enceintes, et 34 sur les femmes qui venaient d'accoucher. Les données sur les troubles pendant la période prénatale étaient disponibles pour 9 pays (8%), et sur les troubles pendant la période postnatale pour 17 pays (15%). La prévalence moyenne pondérée était de 15,6% (intervalle de confiance de 95%, IC: 15,4-15,9) du point de vue prénatal, et de 19,8% (19,5-20,0) du point de vue postnatal. Les facteurs de risque étaient les suivants: des problèmes socioéconomiques (variation du rapport des cotes [RC]: 2,1-13,2); une grossesse non désirée (1,6-8,8); le fait d'être trop jeune (2,1-5,4); le fait de ne pas être mariée (3,4-5,8); le manque de soutien et d'empathie de la part du partenaire (2,0-9,4); des beaux-parents hostiles (2,1-4,4); un partenaire violent (2,11-6,75); un soutien émotionnel et pratique insuffisant (2,8-6,1); et dans certains cas, donner naissance à une fille (1,8-2,6) et avoir des antécédents de problèmes de santé mentale (5,1-5,6). Les facteurs protecteurs étaient les suivants: avoir fait plus d'études (risque relatif: 0,5; P = 0,03); avoir un emploi permanent (RC: 0,64; IC de 95%: 0,4-1,0); être issue de la majorité ethnique (RC: 0,2; IC de 95%: 0,1-0,8) et avoir un partenaire attentionné et digne de confiance (RC: 0,52; IC de 95%: 0,3-0,9). CONCLUSION: Les TMPC ont une prévalence plus élevée dans les pays à revenu faible et moyen, en particulier chez les femmes plus pauvres présentant des antécédents psychiatriques ou des risques liés au genre.

          Translated abstract

          <img border=0 src="../../../../../img/revistas/bwho/v90n2/a14rs03.jpg">

          Translated abstract

          <img border=0 src="../../../../../img/revistas/bwho/v90n2/a14rs02.jpg">

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          Most cited references113

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          Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale

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            No health without mental health.

            About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, alcohol-use and substance-use disorders, and psychoses. Such estimates have drawn attention to the importance of mental disorders for public health. However, because they stress the separate contributions of mental and physical disorders to disability and mortality, they might have entrenched the alienation of mental health from mainstream efforts to improve health and reduce poverty. The burden of mental disorders is likely to have been underestimated because of inadequate appreciation of the connectedness between mental illness and other health conditions. Because these interactions are protean, there can be no health without mental health. Mental disorders increase risk for communicable and non-communicable diseases, and contribute to unintentional and intentional injury. Conversely, many health conditions increase the risk for mental disorder, and comorbidity complicates help-seeking, diagnosis, and treatment, and influences prognosis. Health services are not provided equitably to people with mental disorders, and the quality of care for both mental and physical health conditions for these people could be improved. We need to develop and evaluate psychosocial interventions that can be integrated into management of communicable and non-communicable diseases. Health-care systems should be strengthened to improve delivery of mental health care, by focusing on existing programmes and activities, such as those which address the prevention and treatment of HIV, tuberculosis, and malaria; gender-based violence; antenatal care; integrated management of childhood illnesses and child nutrition; and innovative management of chronic disease. An explicit mental health budget might need to be allocated for such activities. Mental health affects progress towards the achievement of several Millennium Development Goals, such as promotion of gender equality and empowerment of women, reduction of child mortality, improvement of maternal health, and reversal of the spread of HIV/AIDS. Mental health awareness needs to be integrated into all aspects of health and social policy, health-system planning, and delivery of primary and secondary general health care.
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              World development indicators

              (2012)
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                Author and article information

                Journal
                bwho
                Bulletin of the World Health Organization
                Bull World Health Organ
                World Health Organization (Genebra, Genebra, Switzerland )
                0042-9686
                February 2012
                : 90
                : 2
                : 139-149
                Affiliations
                [02] Geneva orgnameWorld Health Organization orgdiv1Department of Child and Adolescent Health and Development Switzerland
                [06] Melbourne orgnameBurnet Institute orgdiv1Centre for International Health Australia
                [03] London orgnameLondon School of Hygiene and Tropical Medicine orgdiv1Centre for Global Mental Health England
                [04] Liverpool orgnameUniversity of Liverpool orgdiv1Institute of Psychology, Health & Society England
                [01] Melbourne orgnameMonash University orgdiv1School of Public Health and Preventive Medicine orgdiv2Jean Hailes Research Unit Australia
                [05] Hanoi orgnameResearch and Training Centre for Community Development Viet Nam
                Article
                S0042-96862012000200014 S0042-9686(12)09000214
                10.1590/S0042-96862012000200014
                6f91515a-6078-4736-be61-d6e0e15a7848

                History
                : 24 October 2011
                : 23 October 2011
                : 09 June 2011
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 62, Pages: 11
                Product

                SciELO Public Health

                Self URI: Full text available only in PDF format (EN)
                Categories
                Systematic Reviews

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