Bulletin of the World Health Organization

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

Jane Fisher, Meena Cabral de Mello, Vikram Patel, Atif Rahman, Thach Tran, Sara Holton & Wendy Holmes

Volume 90, Number 2, February 2012, 139-149H

Table 2. Methods of investigating common perinatal mental disorders in pregnant women in low- and lower-middle-income countries, as per World Bank country income classification

Study	Study type	Setting	Quality	Sample	Gestational age	Assessment instrument	Prevalence (%)	SANC^a (%)
Tertiary hospitals
Abiodun et al., 1993⁸	Cross-sectional survey Validation of GHQ-30	University of Ilorin Teaching Hospital, Nigeria	7	240/250 consecutive attendees at antenatal clinics fluent in English or Yoruba	Trimester 1 (20.8%) Trimester 2 (33.3%) Trimester 3 (45.95%)	GHQ 30^b > 4	19.1	58
Abiodun et al., 1993⁸	Cross-sectional survey Validation of GHQ-30	University of Ilorin Teaching Hospital, Nigeria	7			PSE	12.5	58
Aderibigbe et al., 1993¹⁰	Prospective cohort Validation of GHQ-28	University College Hospital, Ibadan, Nigeria	6	277/300 consecutive attendees at antenatal clinics	Trimester 2	C-GHQ-28^b > 7	27.1	58
Aderibigbe et al., 1993¹⁰	Prospective cohort Validation of GHQ-28	University College Hospital, Ibadan, Nigeria	6	277/300 consecutive attendees at antenatal clinics	Trimester 2	PAS	14.4 CMD	58
Karmaliani et al., 2006³³	Cross-sectional survey	Civil Hospital, Hyderabad, Pakistan	8	1000 first recruited women 20–26 weeks pregnant and living locally, identified during routine household visits of 1368/1879 in larger study	Trimester 2	AKUADS^b > 31.5	11.5	64
Karmaliani et al., 2006³³	Cross-sectional survey	Civil Hospital, Hyderabad, Pakistan	8		Trimester 2	How I feel scale > 83.5	13.5	64
Limlomwongse and Liabsuetrakul, 2006³⁴	Prospective cohort	Antenatal clinics Songlanagarind University Hospital, Thailand	8	612/833 women, consecutive attendees at antenatal clinics	Trimester 3	EPDS > 10	20.5	98
Limlomwongse and Liabsuetrakul, 2006³⁴	Prospective cohort		8	612/833 women, consecutive attendees at antenatal clinics	Trimester 3	EPDS > 12	5.2	98
Fisher, Tran & Tran, 2007²⁴	Cross-sectional survey	National Obstetric Hospital, Hanoi, Viet Nam	6	Convenience sample of 61/74 women attending antenatal clinics	Trimester 3	EPDS 10–12	13.1	91
Fisher, Tran & Tran, 2007²⁴	Cross-sectional survey	National Obstetric Hospital, Hanoi, Viet Nam	6		Trimester 3	EPDS > 12	1.6	91
Provincial or district health services
Cox et al., 1979¹⁹	Cross-sectional	Antenatal clinics at semi-rural teaching health centres, Uganda	6	263 antenatal clinic attendees		SIS^b	16 CMD	94
Nhiwatiwa et al., 1998³⁸	Prospective cohort	Periurban primary care clinics, Zimbabwe	5	500/500 consecutive attendees ≥ 32 weeks pregnant at antenatal and primary-health-care clinics	Trimester 3	SSQ^b	19.0 high risk	94
Nhiwatiwa et al., 1998³⁸	Prospective cohort	Periurban primary care clinics, Zimbabwe	5		Trimester 3	CIS-R	19.0 high risk	94
Chandran et al., 2002¹⁸	Prospective cohort	Christian Medical College, Vellore community health service, India	5	384/991 consecutive attendees at antenatal clinics intending to live locally after giving birth	Trimester 3	CIS-R^b	16.2 depression	74
Adewuya et al., 2007¹⁴	Cross-sectional survey Validation of EPDS	Semi-urban health centres in Ilesa, Nigeria	5	180 consecutive attendees at antenatal clinics who were well and could speak English or Yoruba	Trimester 3	EPDS^b > 5	41.6	58
Adewuya et al., 2007¹⁴	Cross-sectional survey Validation of EPDS	Semi-urban health centres in Ilesa, Nigeria	5		Trimester 3	MINI (DSM-IV)	8.3 depression	58
Fisher et al., 2010²⁵	Cross-sectional clinical and structured interviews	Randomly selected urban and rural commune health centres, Viet Nam	8	65/70 women > 28 weeks pregnant registered with the CHC in Hanoi (urban)	Trimester 3	SCID^b (DSM-IV)	21.5 CMD	91
Fisher et al., 2010²⁵	Cross-sectional clinical and structured interviews		8	134/148 > 28 weeks pregnant registered with the CHC in Hanam (rural)		SCID^b (DSM-IV)	32.9 CMD
Community
Rahman et al., 2003⁴⁵	Prospective cohort	Kaller Syedan QH and Choha Khalsa QH, a rural low-income subdistrict, Pakistan	8	632/701 women > 28 weeks pregnant in households visited by Lady Health Workers or identified by vaccinators or TBAs who did not have psychotic or chronic illness or intellectual disability	Trimester 3	SCAN^b (ICD-10)	25.0 depression	64
Gausia et al., 2009²⁷	Prospective cohort	Demographic Surveillance Site, Matlab, Bangladesh	6	361/410 women > 33 weeks pregnant registered with MCH programme	Trimester 3	EPDS-B^b > 9	33.0	60
Hanlon et al., 2009³⁰	Prospective cohort	Demographic Surveillance Site Butajira Rural Health Program, Ethiopia	8	1065/1234 women > 28 weeks pregnant, residing in DHSS and identified by Butajira Rural Health Program enumerators in household visits	Trimester 3	SRQ-20^b 1–5 “low symptoms”	59.5	28
Hanlon et al., 2009³⁰	Prospective cohort		8		Trimester 3	SRQ-20^b > 5 “high symptoms”	12.0	28

AKUADS, Aga Khan University Anxiety Depression Scale; CHC, commune health centre; CIS-R Clinical Interview Schedule-Revised; C-GHQ, conventional scoring method; CMD, common mental disorder; DHSS, Demographic and Health Surveillance System; DSM-IV, Diagnostic and statistical manual of mental disorders, 4th edition; EPDS, Edinburgh Postnatal Depression Scale; GHQ, General Health Questionnaire; ICD-10, International Classification of Diseases, tenth revision; MCH, Maternal and Child Health; MINI, Mini-International Neuropsychiatric Interview; PAS, Psychiatric Assessment Schedule; PSE, Present State Examination; QH, Qanungo Halqa (an administrative subdistrict); SANC, skilled antenatal care; SCAN, Schedule for Clinical Assessment in Neuropsychiatry; SCID, Structured Clinical Interview for DSM-IV; SIS, Standardised Interview Schedule; SRQ-20, World Health Organization Self Reporting Questionnaire; SSQ, Shona Symptom Questionnaire; TBA, traditional birth attendant.

^a Proportion of pregnant women given skilled antenatal care.

^b Instrument locally validated.