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 (%) SANCa (%)
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 30b > 4 19.1 58
PSE 12.5
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-28b > 7 27.1 58
PAS 14.4 CMD
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 AKUADSb > 31.5 11.5 64
How I feel scale > 83.5 13.5
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
EPDS > 12 5.2
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
EPDS > 12 1.6
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 SISb 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 SSQb 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-Rb 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 EPDSb > 5 41.6 58
MINI (DSM-IV) 8.3 depression
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 SCIDb (DSM-IV) 21.5 CMD 91
134/148 > 28 weeks pregnant registered with the CHC in Hanam (rural) SCIDb (DSM-IV) 32.9 CMD
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 SCANb (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-Bb > 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-20b 1–5 “low symptoms” 59.5 28
SRQ-20b > 5 “high symptoms” 12.0

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.