First trimester antenatal depression and anxiety: prevalence and associated factors in an urban population in Soweto, South Africa.

摘要

Background: The prenatal environment, including maternal mental health, is increasingly recognised as having an important influence on foetal development and later offspring outcomes. Maternal mental health can lead to adverse child outcomes through altered placental function, epigenetic changes in the foetus, and stress reactivity. Depression and anxiety are the most common mental health disorders in pregnancy. Despite this both disorders are under-researched in the first trimester of pregnancy, and especially in Africa. We examine the prevalence of first trimester antenatal depression and anxiety in a cohort of South African women and investigate associated risk factors. Methods: Data was collected from 946 women (2014-2016) in the Soweto First 1000 Days Cohort (S1000), a prospective pregnancy cohort in Soweto, South Africa. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) with a score of ≥ 13 indicating probable depression. Anxiety was assessed using the short-form of the State Trait Anxiety Index (STAI) with a score ≥12 indicating probable anxiety. Results: Prevalence of antenatal depression was 27% (95% CI 24.2-29.8) and anxiety 15.2% (95% CI 12.9-17.5). Factors associated with antenatal depression and anxiety were predominantly relationship- and family-centred. Women who perceived that their partner made life harder for them had threefold increased odds for depression (OR 3.33 [2.28-4.85] p = 0.000) while those with family stressors had almost double the odds for depression (OR 1.78 [1.22-2.59] p = 0.003) and anxiety (OR 1.75 [1.44-2.69] p = 0.0011). Conclusions: Antenatal depression and anxiety are reported by a third of women are common early in pregnancy, and partner and family relationship stressors are central. Longitudinal analysis is needed to determine if this is a phase of adjustment to pregnancy or onset of persistent symptomology. Early intervention may have secondary preventative effects and should involve the partner and family.