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Open Access 01-12-2018 | Research article

The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study

Authors: Yitbarek Kidane Woldetensay, Tefera Belachew, Hans Konrad Biesalski, Shibani Ghosh, Maria Elena Lacruz, Veronika Scherbaum, Eva Johanna Kantelhardt

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Abstract

Background

Depression during pregnancy has far-reaching adverse consequences on mothers, children and the whole family. The magnitude and determinants of prenatal depressive symptoms in low-resource countries are not well established. This study aims to describe the prevalence of prenatal depressive symptoms and whether it is associated with maternal nutrition, intimate partner violence and social support among pregnant women in rural Ethiopia.

Methods

This study is based on the baseline data from a large prospective, community-based, birth cohort study conducted in the South Western part of Ethiopia from March 2014 to March 2016. A total of 4680 pregnant women were recruited between 12 and 32 weeks of gestation. Depressed mood was assessed using the Patient Health Questionnaire (PHQ-9) scale and a cut off of ≥8 was taken to define prenatal depressive symptoms. Data collection was conducted electronically on handheld tablets and submitted to a secured server via an internet connection. Bivariate and multivariate logistic regression analyses were computed using IBM SPSS version 20 software.

Result

The community based prevalence of depressive symptoms during pregnancy was 10.8% (95%Confidence Interval (CI): 9.92–11.70). Adjusting for confounding variables, moderate household food insecurity (OR 1.74; 95% CI: 1.31–2.32), severe household food insecurity (OR 7.90; 95% CI: 5.87–10.62), anaemia (OR = 1.30; 95% CI: 1.04–1.61) and intimate partner violence (OR 3.08; 95% CI: 2.23–4.25) were significantly associated with prenatal depressive symptoms. On the other hand, good social support from friends, families and husband reduced the risk of prenatal depressive symptoms by 39% (OR 0.61; 95% CI: 0.50–0.76).

Conclusion

Prenatal depressive symptomatology is rather common during pregnancy in rural Ethiopia. In this community based study, household food insecurity, anaemia and intimate partner violence were significantly associated with prenatal depressive symptoms. Good maternal social support from friends, families and spouse was rather protective. The study highlights the need for targeted screening for depression and intimate partner violence during pregnancy. Policies aimed at reducing household food insecurity, maternal anaemia and intimate partner violence during pregnancy may possibly reduce depression.

Gilbert BJ, Patel V, Farmer PE, Lu C. Assessing development assistance for mental health in developing countries: 2007–2013. PLoS Med. 2015;12:e1001834. https://doi.org/10.1371/journal.pmed.1001834.CrossRefPubMedPubMedCentral

Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3:973–82. https://doi.org/10.1016/S2215-0366(16)30284-X.CrossRefPubMedPubMedCentral

Wachs TD, Black MM, Engle PL. Maternal depression: a global threat to Children’s health, development, and behavior and to human rights. Child Dev Perspect. 2009;3:51–9. https://doi.org/10.1111/j.1750-8606.2008.00077.x.CrossRef

Hanlon C, Medhin G, Alem A, Tesfaye F, Lakew Z, Worku B, et al. Impact of antenatal common mental disorders upon perinatal outcomes in Ethiopia: the P-MaMiE population-based cohort study. Trop Med Int Health TM IH. 2009;14:156–66.CrossRefPubMed

Ayele T, Azale T, Alemu K, Abdissa Z, Mulat H, Fekadu A. Prevalence and associated factors of antenatal depression among women attending antenatal Care Service at Gondar University Hospital, Northwest Ethiopia. PLoS One. 2016;11:e0155125. https://doi.org/10.1371/journal.pone.0155125.CrossRefPubMedPubMedCentral

Biratu A, Haile D. Prevalence of antenatal depression and associated factors among pregnant women in Addis Ababa, Ethiopia: a cross-sectional study. Reprod Health. 2015;12. https://doi.org/10.1186/s12978-015-0092-x.

Tefera TB, Erena AN, Kuti KA, Hussen MA. Perinatal depression and associated factors among reproductive aged group women at Goba and robe town of bale zone, Oromia region, south East Ethiopia. Matern Health Neonatol Perinatol. 2015;1. https://doi.org/10.1186/s40748-015-0013-6.

Rahman A, Creed F. Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan. J Affect Disord. 2007;100:115–21.CrossRefPubMedPubMedCentral

Hartley M, Tomlinson M, Greco E, Comulada WC, Stewart J, le Roux I, et al. Depressed mood in pregnancy: prevalence and correlates in two Cape Town peri-urban settlements. Reprod Health. 2011;8. https://doi.org/10.1186/1742-4755-8-9.

10.

Brody BD, Chaudhry SK, Penzner JB, Meltzer EC, Dubin M. A woman with major depression with psychotic features requesting a termination of pregnancy. Am J Psychiatry. 2016;173:12–5. https://doi.org/10.1176/appi.ajp.2015.15030380.CrossRefPubMed

11.

Rahman A, Patel V, Maselko J, Kirkwood B. The neglected “m” in MCH programmes - why mental health of mothers is important for child nutrition: The neglected “m” in MCH programmes. Trop Med Int Health. 2008;13:579–83. https://doi.org/10.1111/j.1365-3156.2008.02036.x.CrossRefPubMed

12.

Jebena MG, Taha M, Nakajima M, Lemieux A, Lemessa F, Hoffman R, et al. Household food insecurity and mental distress among pregnant women in southwestern Ethiopia: a cross sectional study design. BMC Pregnancy Childbirth. 2015;15. https://doi.org/10.1186/s12884-015-0699-5.

13.

Khambalia AZ, Collins CE, Roberts CL, Morris JM, Powell KL, Tasevski V, et al. Iron deficiency in early pregnancy using serum ferritin and soluble transferrin receptor concentrations are associated with pregnancy and birth outcomes. Eur J Clin Nutr. 2016;70:358–63. https://doi.org/10.1038/ejcn.2015.157.CrossRefPubMed

14.

Rodríguez MA, Valentine J, Ahmed SR, Eisenman DP, Sumner LA, Heilemann MV, et al. Intimate partner violence and maternal depression during the perinatal period: a longitudinal investigation of Latinas. Violence Women. 2010;16:543–59. https://doi.org/10.1177/1077801210366959.CrossRef

15.

Van Parys A-S, Deschepper E, Michielsen K, Galle A, Roelens K, Temmerman M, et al. Intimate partner violence and psychosocial health, a cross-sectional study in a pregnant population. BMC Pregnancy Childbirth. 2015;15. https://doi.org/10.1186/s12884-015-0710-1.

16.

Wani AL, Bhat SA, Ara A. Omega-3 fatty acids and the treatment of depression: a review of scientific evidence. Integr Med Res. 2015;4:132–41. https://doi.org/10.1016/j.imr.2015.07.003.CrossRefPubMedPubMedCentral

17.

Fontein-Kuipers Y, van Limbeek E, Ausems M, de Vries R, Nieuwenhuijze M. Responding to maternal distress: from needs assessment to effective intervention. Int J Public Health. 2016. https://doi.org/10.1007/s00038-016-0910-0.CrossRefPubMed

18.

Sparling TM, Henschke N, Nesbitt RC, Gabrysch S. The role of diet and nutritional supplementation in perinatal depression: a systematic review: review of dietary intake and perinatal depression. Matern Child Nutr. 2017;13. https://doi.org/10.1111/mcn.12235.

19.

Semahegn A, Mengistie B. Domestic violence against women and associated factors in Ethiopia; systematic review. Reprod Health. 2015;12. https://doi.org/10.1186/s12978-015-0072-1.

20.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentral

21.

Woldetensay YK, Belachew T, Tesfaye M, Spielman K, Biesalski HK, Kantelhardt EJ, et al. Validation of the patient health questionnaire (PHQ-9) as a screening tool for depression in pregnant women: Afaan Oromo version. PLoS One. 2018;13:e0191782. https://doi.org/10.1371/journal.pone.0191782.CrossRefPubMedPubMedCentral

22.

Ververs M, Antierens A, Sackl A, Staderini N, Captier V. Which anthropometric indicators identify a pregnant woman as acutely malnourished and predict adverse birth outcomes in the humanitarian context? PLoS Curr. 2013. https://doi.org/10.1371/currents.dis.54a8b618c1bc031ea140e3f2934599c8.

23.

Nestel P. Adjusting Hemoglobin Values in Program Surveys. 2002. https://dokumen.tips/documents/adjusting-hemoglobin-values-in-program-hemoglobin-values-in-programsurveys-.html.

24.

Coates J, Swindale A, Bilinsky P. Household food insecurity access scale (HFIAS) for measurement of food access: Indicator guide. Washington, D.C.; 2007. http://www.fao.org/fileadmin/user_upload/eufao-fsi4dm/doc-training/hfias.pdf.

25.

Deshpande NA, Lewis-O’Connor A. Screening for intimate partner violence during pregnancy. Rev Obstet Gynecol. 2013;6:141–8.PubMedPubMedCentral

26.

Mercer RT, Ferketich SL. Stress and social support as predictors of anxiety and depression during pregnancy. ANS Adv Nurs Sci. 1988;10:26–39.CrossRefPubMed

27.

WHO. Mental Health Atlas 2011-Ethiopia. 2011.

28.

Schumacher JA, Feldbau-Kohn S, Smith Slep AM, Heyman RE. Risk factors for male-to-female partner physical abuse. Aggress Violent Behav. 2001;6:281–352. https://doi.org/10.1016/S1359-1789(00)00027-6.CrossRef

29.

Stith SM, Smith DB, Penn CE, Ward DB, Tritt D. Intimate partner physical abuse perpetration and victimization risk factors: a meta-analytic review. Aggress Violent Behav. 2004;10:65–98. https://doi.org/10.1016/j.avb.2003.09.001.CrossRef

30.

Coyne JC, Thompson R, Palmer SC. Marital quality, coping with conflict, marital complaints, and affection in couples with a depressed wife. J Fam Psychol. 2002;16:26–37.CrossRefPubMed

31.

Du Rocher Schudlich TD, Papp LM, Cummings EM. Relations of husbands’ and wives’ dysphoria to marital conflict resolution strategies. J Fam Psychol. 2004;18:171–83. https://doi.org/10.1037/0893-3200.18.1.171.CrossRefPubMed

32.

Hernandez DC, Marshall A, Mineo C. Maternal depression mediates the association between intimate partner violence and food insecurity. J Women's Health. 2014;23:29–37. https://doi.org/10.1089/jwh.2012.4224.CrossRef

33.

Jewkes R. Intimate partner violence: causes and prevention. Lancet. 2002;359:1423–9.CrossRefPubMed

34.

Kollannoor-Samuel G, Wagner J, Damio G, Segura-Pérez S, Chhabra J, Vega-López S, et al. Social support modifies the association between household food insecurity and depression among Latinos with uncontrolled type 2 diabetes. J Immigr Minor Health. 2011;13:982–9. https://doi.org/10.1007/s10903-011-9499-9.CrossRefPubMedPubMedCentral

35.

Maharaj V, Tomita A, Thela L, Mhlongo M, Burns JK. Food insecurity and risk of depression among refugees and immigrants in South Africa. J Immigr Minor Health. 2016. https://doi.org/10.1007/s10903-016-0370-x.CrossRef

36.

Muldoon KA, Duff PK, Fielden S, Anema A. Food insufficiency is associated with psychiatric morbidity in a nationally representative study of mental illness among food insecure Canadians. Soc Psychiatry Psychiatr Epidemiol. 2013;48:795–803. https://doi.org/10.1007/s00127-012-0597-3.CrossRefPubMed

37.

Hadley C, Patil CL. Food insecurity in rural Tanzania is associated with maternal anxiety and depression. Am J Hum Biol. 2006;18:359–68.CrossRefPubMed

38.

Barbara AL, Anna MS, Craig G, Nancy D. Psychosocial Factors and Socioeconomic Indicators Are Associated with Household Food Insecurity among Pregnant Women. 2006.

39.

Tofoli SMSM, Von Werne Baes C, Martins CMS, Juruena M. Early life stress, HPA axis, and depression. Psychol Neurosci. 2011;4:229–34. https://doi.org/10.3922/j.psns.2011.2.008.CrossRef

40.

Oladapo AL. Nutrition in pregnancy: mineral and vitamin supplements. Am J Clin Nutr. 2000;72(suppl):280S–90S.

41.

Sánchez-Villegas A, Henríquez-Sánchez P, Ruiz-Canela M, Lahortiga F, Molero P, Toledo E, et al. A longitudinal analysis of diet quality scores and the risk of incident depression in the SUN project. BMC Med. 2015;13. https://doi.org/10.1186/s12916-015-0428-y.

42.

Noonan K, Corman H, Reichman NE. Effects of maternal depression on family food insecurity. Econ Hum Biol. 2016;22:201–15. https://doi.org/10.1016/j.ehb.2016.04.004.CrossRefPubMed

43.

Coad J, Pedley K. Iron deficiency and iron deficiency anemia in women. Scand J Clin Lab Invest. 2014;74:82–9. https://doi.org/10.3109/00365513.2014.936694.CrossRef

44.

Swain, Penland, Johnson, Hunt. Energy, mood and attention did not consistenly improve with iron status in non-anemic women with moderate to low iron stores. FASEB J. 2006.

45.

Kim J, Wessling-Resnick M. Iron and mechanisms of emotional behavior. J Nutr Biochem. 2014;25:1101–7. https://doi.org/10.1016/j.jnutbio.2014.07.003.CrossRefPubMedPubMedCentral

46.

Jeon S, Kim YK. Molecular neurobiology and promising new treatment in depression. Int J Mol Sci. 2016;17:381. https://doi.org/10.3390/ijms17030381.CrossRefPubMedPubMedCentral

47.

McGahan MC. Iron alters glutamate secretion by regulating cytosolic aconitase activity. AJP Cell Physiol. 2005;288:C1117–24. https://doi.org/10.1152/ajpcell.00444.2004.CrossRef

48.

Sanacora G, Treccani G, Popoli M. Towards a glutamate hypothesis of depression. Neuropharmacology. 2012;62:63–77. https://doi.org/10.1016/j.neuropharm.2011.07.036.CrossRefPubMed

49.

Mahenge B, Likindikoki S, Stöckl H, Mbwambo J. Intimate partner violence during pregnancy and associated mental health symptoms among pregnant women in Tanzania: a cross-sectional study. BJOG Int J Obstet Gynaecol. 2013;120:940–7. https://doi.org/10.1111/1471-0528.12185.CrossRef

50.

Ellsberg M, Peña R, Herrera A, Liljestrand J, Winkvist A. Candies in hell: women’s experiences of violence in Nicaragua. Soc Sci Med 1982. 2000;51:1595–610.

51.

Campos B, Schetter CD, Abdou CM, Hobel CJ, Glynn LM, Sandman CA. Familialism, social support, and stress: positive implications for pregnant Latinas. Cultur Divers Ethnic Minor Psychol. 2008;14:155–62. https://doi.org/10.1037/1099-9809.14.2.155.CrossRefPubMedPubMedCentral

52.

Giesbrecht GF, Poole JC, Letourneau N, Campbell T, Kaplan BJ. The Buffering Effect of Social Support on Hypothalamic-Pituitary-Adrenal Axis Function During Pregnancy. Psychosom Med. 2013;75:856–62. https://doi.org/10.1097/PSY.0000000000000004.CrossRefPubMed

53.

Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychol Bull. 1985;98:310–57.CrossRefPubMed

54.

Gelaye B, Williams M, Lemma S, Deyessa N, Bahretibeb Y, Shibre T, et al. Validity of the patient health questionnaire-9 for depression screening and diagnosis in East Africa. Psychiatry Res. 2013;210:653–61. https://doi.org/10.1016/j.psychres.2013.07.015.CrossRefPubMed

55.

Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA. 1999;282:1737–44.CrossRefPubMed

56.

National Collaborating Centre for Mental Health. The treatment and management of depression in adults (Updated edition) National Clinical Practice Guideline 90. London: The British Psychological Society and The Royal College of Psychiatrists; 2010.

57.

Bromet E, Andrade LH, Hwang I, Sampson NA, Alonso J, de Girolamo G, et al. Cross-national epidemiology of DSM-IV major depressive episode. BMC Med. 2011;9. https://doi.org/10.1186/1741-7015-9-90.

58.

Patel V, Araya R, de Lima M, Ludermir A, Todd C. Women, poverty and common mental disorders in four restructuring societies. Soc Sci Med. 1999;49:1461–71. https://doi.org/10.1016/S0277-9536(99)00208-7.CrossRefPubMed

59.

Havenaar JM, Geerlings MI, Vivian L, Collinson M, Robertson B. Common mental health problems in historically disadvantaged urban and rural communities in South Africa: prevalence and risk factors. Soc Psychiatry Psychiatr Epidemiol. 2008;43:209–15. https://doi.org/10.1007/s00127-007-0294-9.CrossRefPubMed

60.

Gureje O. Lifetime and 12-month prevalence of mental disorders in the Nigerian survey of mental health and well-being. Br J Psychiatry. 2006;188:465–71. https://doi.org/10.1192/bjp.188.5.465.CrossRefPubMed

61.

World Health Organization. World Health Organization. Putting women first: Ethical and safety recommendations for research on domestic violence against women. Geneva. 2001. http://www.who.int/gender/violence/womenfirtseng.pdf. Accessed 1 Feb 2017.

62.

World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013;310:2191. https://doi.org/10.1001/jama.2013.281053.

Title: The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study
Authors: Yitbarek Kidane Woldetensay
Tefera Belachew
Hans Konrad Biesalski
Shibani Ghosh
Maria Elena Lacruz
Veronika Scherbaum
Eva Johanna Kantelhardt
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI: https://doi.org/10.1186/s12884-018-2009-5

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study

Abstract

Background

Methods

Result

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Result

Conclusion

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