Study finds alarming rates of postpartum depression among mothers in six countries

In a newly published study in the journal BMC Public Health, researchers determined the incidence of postnatal depression (PND) and identified associated predictors and coping strategies among mothers in six countries from June to August 2023.

Postpartum depression is a common mental health issue that affects around 10% of women after giving birth. Some studies suggest that PND may affect up to one in seven women. PND can develop within the first year after giving birth and persist for several years, which is quite different from the short-term “baby blues” that many mothers experience.

The study assessed the incidence of PND among mothers in Egypt, Ghana, India, Syria, Yemen and Iraq. The study included mothers who had given birth in the previous 18 months, citizens of one of the countries, and aged 18 to 40 years.

Excluded from the study were multiple pregnancies, illiteracy, serious illness in the child, stillbirth or intrauterine fetal death, and mothers with medical, mental or psychological disorders that prevented completion of the questionnaire. Also excluded were mothers who did not have access to the Internet or did not speak Arabic or English.

Participants were recruited using a multi-stage approach. Two governorates in each country were selected, with one rural and one urban zone identified in each governorate. Mothers were interviewed through online platforms and in public settings such as clinics, primary health care centres and family planning units. All participants completed questionnaires using tablets or mobile phones provided by data collectors or by scanning a QR code.

The questionnaire, originally developed in English and translated into Arabic, was validated by medical experts and tested for clarity and comprehensibility in a pilot study. The final questionnaire included sections on demographic and health-related factors, obstetric history, assessment of PND using the Edinburgh Postnatal Depression Scale (EPDS), and psychological and social characteristics.

The incidence of PND in the overall sample, as determined by the Edinburgh scale, was 13.5%, but this incidence varied considerably across countries. PND was most common among mothers in Ghana (26.0%), followed by India (21.7%), Egypt (19.1%), Yemen (8.5%), Iraq (7.7%) and Syria (2.3%).

The average age of the study participants was 27 years, 60.3% of whom were between 25 and 40 years old. About 96% of the study participants were married, while 67% had sufficient monthly income and at least a high school education.

Among the health-related factors, it was found that 40% of the participants were smokers, 54.2% had received the COVID-19 vaccine, and 44.1% had previously had COVID-19. About 83% of the study participants had no comorbidities, and 92.4% had no history of mental illness or family history of mental illness.

The PRD was significantly higher among single or widowed women (56.3%), as well as 66.7% of women with medical, mental or psychological problems and 35.7% of women with a history of smoking or alcohol use. Mothers paying for their own health care had higher PRD rates.

Most mothers did not take hormonal drugs or birth control pills, 46.1% had an unplanned pregnancy, and 68.6% gained 10 kg or more during pregnancy. About 61% of the study participants gave birth vaginally, while 90.9% and 48.2% of mothers had healthy babies and breastfed, respectively.

A significant association was found between PND and contraceptive use, number of children born (one or two), and interval between pregnancies of less than two years. Mothers with a history of stillbirth and postpartum problems had higher rates of PND. About 75% of mothers were unaware of the symptoms of PND, 35.3% experienced cultural stigma or judgment. Only 6.2% of affected women were diagnosed with PND and received medication.

Mothers with PDD often had a history of PDD, financial and family problems, and cultural stigma. Despite receiving more support, 43.3%, 45.5%, 48.4%, and 70% of mothers felt uncomfortable discussing mental health with doctors, husbands, family, and community, respectively.

Social norms, cultural beliefs, personal barriers, geographic differences, language barriers and financial constraints were among the reasons for not receiving treatment, reported by 65.7%, 60.5%, 56.5%, 48.5%, 47.4% and 39.7% of mothers, respectively. Logistic regression analysis identified several significant predictors of PND, including marital status, child health, postpartum problems, ethnicity, pregnancy status and psychological factors.