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 3. Methods of investigating common perinatal mental disorders in women in resource-constrained countries who had recently given birth

Study Study type Setting Qualitya Sample Postpartum assessment time Assessment instrument(s) Prevalence (%) SBAb (%)
Tertiary hospitals
Aderibigbe et al., 199310 Prospective cohort from pregnancy Validation of GHQ 28 University College Hospital, Ibadan, Nigeria 4 277/300 women attending antenatal clinics 6–8 wk C-GHQ 28c > 7 14.0 39
Piyasil, 199842 Cross-sectional survey Rajvithi Teaching Hospital, Thailand 5 Convenience sample of 94 women aged ≥ 21 years in the postnatal wards During postnatal hospital stay Questions to assess DSM-IV criteria for depression and anxiety 11.9 “high depressive scores”; 12.0 “high anxiety scores” 97
Regmi et al., 200244 Cross-sectional survey Validation of EPDS Tribhuvan University Teaching Hospital, Kathmandu, Nepal 5 Convenience sample of 100/100 women attending a postnatal clinic 2–3 mo EPDS > 12 Diagnostic interview for DSM-IV major depression 12.0 19
Uwakwe, 200347 Cross sectional survey Validation of EPDS Nnamdi Aziiwe Teaching Hospital Nigeria 6 225/292 women in postnatal ward for ≥ 7 days, or attending postnatal clinics 6–8 wk ICD-10 SCLc 10.7 depression 39
Faisal-Cury et al., 200422 Cross-sectional survey Sao Paulo University Medical School, Brazil (LALMIC 2004) 6 113/172 uninsured women attending an obstetric clinic 10 d BDIc > 15 15.9 88
Limlomwongse & Liabsuetrakul, 200634 Prospective cohort from pregnancy Songlanagarind University Hospital Thailand 6 525/612 consecutive women attendees at antenatal clinics followed up at postnatal clinics 6–8 wk EPDSc > 10 16.8 97
Xie et al., 200749 Prospective cohort from early postpartum Hunan Maternity Care Hospital; First, Second and Third Affiliated hospitals of Central South University, Hunan, China 7 300/370 primiparous women without psychiatric histories and with singleton infants 6 wk EPDSc > 12 17.3 95
Pitanupong et al., 200741 Prospective cohort from pregnancy University hospital, southern Thailand 7 351/450 consecutive women attendees at antenatal clinic without psychiatric histories 6–8 wk EPDS > 6 11.0 97
Ebeigbe and Akhigbe, 200820 Cross-sectional survey University of Benin Teaching Hospital, Benin City, Nigeria 7 206/215 women attendees at postpartum clinic who could speak English 6 wk EPDSc > 9 27.2 39
Wan et al., 200948 Cross-sectional survey Peking University First Hospital, Beijing, China 7 365/395 women postpartum clinic attendees 6–8 wk EPDSc > 12 15.5 95
Pollock et al., 200943 Cross-sectional survey Urban hospital(s) Ulaanbataar, Mongolia 7 1044/1274 women with healthy babies in follow-up home visits 5–9 wk SRQc 20 > 8 9.1 100
Tertiary hospital and community clinics
Fisher et al., 200423 Cross-sectional survey Hung Vuong Hospital and MCH and family planning clinic, Ho Chi Minh City Viet Nam 8 506/516 consecutive women attendees at six-week infant health clinic 6 wk EPDS > 12 32.9 88
Adewuya et al., 200513 Cross-sectional survey validation of the EPDS Wesley Guild Hospital and Obafemi Awolowo Hospital health centres, Ilesa East and West MCH centres, Ilesa Nigeria 7 876/928 women attendees at infant immunization clinics 6–8 wk EPDSc ≥ 9 + BDI + SCID-NP 14.6 depression 39
Provincial or district hospitals
Patel et al., 200240 Prospective cohort study from pregnancy Asilo Hospital, Mapusa, Goa, India 7 252/270 women attending antenatal clinics 235/270 6–8 wk EPDSc > 11 23.0 47
6 mo EPDSc > 11 22.0
Edwards et al., 200621 Prospective cohort study from late pregnancy Soetomo, Saint Paulo and Griya Husada Hospitals, Indonesia 7 434/472 healthy married women, literate in Indonesian and without a psychiatric history 4–6 wk EPDS > 10 22.4 73
Owoeye et al., 200639 Prospective cohort study from 5 days postpartum Postnatal wards at Lagos Island Maternity Hospital, Nigeria 7 252/280 women “in maternity hospital” 4–6 wk EPDSc > 11, depression confirmed in most by clinical interview for ICD-10 criteria 23.0 39
Ho-Yen et al., 200731 Cross-sectional survey Patan Hospital, Lalitpur District health services, Nepal 6 426/447 women with living babies 5–10 wk EPDSc > 12 4.9 19
Gao et al., 200926 Cross-sectional survey Two regional hospitals in Guangzhou, China 7 Convenience sample of 130/139 married primiparous couples with healthy babies and no psychiatric history 6 – 8 wk EPDSc > 12 13.8 95
Provincial or district health services
Nhiwatiwa et al., 199838 Prospective cohort from late pregnancy Periurban primary care clinics Zimbabwe 6 95 “high risk” women (pregnancy SSQ > 7) and 110 “low risk” women (SSQ ≤ 6) 6–8 wk Shona RCISc > 13 16.0, CMD 69
Affonso et al., 200015 Prospective cohort studies in 9 countries: India and Guyana LALMIC Community and health clinics accessible to “nurse researchers” 7 Convenience samples in each country
India 110 1–2 wk EPDSc > 9 35.5 47
106 BDIc > 12 32.7
102 4– 6 wk EPDSc > 9 32.4
101 BDIc > 12 24.5
Guyana 106 1–2 wk EPDSc > 9 50 NA
102 BDIc > 12 29.8
93 4– 6 wk EPDSc > 9 57
97 BDI > 12 24.6
Adewuya & Afolabi, 200512 Prospective cohort from early postpartum 5 urban health centres, Ilesa, Nigeria 5 632/674 healthy women who had spontaneous vaginal births and were literate in local languages, recruited consecutively 1 wk Zung SDSc 48 CMD symptoms 39
Zung SASc
4 wk 28.2
8 wk 25.5
12 wk 24.7
24 wk 18.3
36 wk 14.4
Agoub et al., 200516 Prospective cohort from early postpartum Primary MCH unit, Casablanca, Morocco 6 144/144 married women, recruited consecutively 2 wk MINIc (DSM-IV) 18.7 63
EPDSc > 12 20.1
6 wk MINIc (DSM-IV) 6.9
6 mo MINIc (DSM-IV) 11.8
9 mo MINIc (DSM-IV) 5.6
Abiodun, 20069 Cross-sectional survey Validation EPDS 3 primary health-care clinics, Kwara Nigeria 6 360/379 women literate in local languages, recruited consecutively 6 wk EPDS > 8 + PSE 18.6 39
Adewuya, 200611 Prospective cohort from early postpartum 5 urban health centres Ilesa Nigeria 7 478/582 healthy women who had spontaneous vaginal births and were literate in local languages, recruited consecutively 5 d EPDSc > 9 20.9 39
4 wk SADS 10.7 depression
8 wk SADS 16.3 depression
Nakku et al., 200637 Cross-sectional survey Periurban health centre, Kampala, Uganda 7 544/544 women attending a postnatal clinic 6 wk SRQ 25c > 5 + MINIc for F scoring > 5, but F scoring < 5 6.1 depression 42
Gausia et al., 200729 Cross-sectional survey Validation of the EPDS Immunisation clinic Dhaka, Bangladesh 4 Convenience sample of 100/126 women 6–8 wk SCID (DSM-IV) 9.0 depression NA
Montazeri et al., 200735 Cross-sectional survey Validation of EPDS Urban health care centres, Isfahan, Islamic Republic of Iran 6 Consecutive samples of 50/50 women after vaginal and 50/50 after caesarean births 6–8 wk EPDS 10 – 12 15.0 NA
EPDS > 12 22
12–14 wk EPDS > 12 18.0
Stewart et al., 200846 Cross-sectional survey Child health clinic, Thyolo District Hospital, Malawi 7 501/519 women attending the clinic with their infants and recruited consecutively 9–10 mo SRQ > 7 29.9 57
Gausia et al., 200928 Prospective cohort from late pregnancy Primary MCH clinics Matlab DSS, Bangladesh 4 346/410 women identified from computer records as pregnant and assessed at postpartum follow-up 6–8 wk EPDSc > 9 22 NA
Fisher et al., 201025 Cross-sectional Randomly selected urban and rural commune health centres in northern Viet Nam 8 65/70 women who had given birth in Ha Noi 6 – 8 wk SCID 26.1, CMD 88
100/107 eligible women who had given birth in Hanoi SCID 34, CMD
Community
Rahman et al., 200345 Prospective cohort from late pregnancy Households visited by Lady Health Workers in Tehsil Kahuta, a rural low-income subdistrict, Pakistan 7 541/632 women recruited consecutively 10–12 wk SCAN 28 depression 39
Husain et al., 200632 Cross-sectional survey Households visited by Lady Health Workers in Kaller Syedan, a subdistrict of Rawalpindi, Pakistan 7 149/175 women recruited consecutively 12 wk EPDS > 11 36.0 39
Black et al., 200717 Cross-sectional survey DSS identified participants in Matlab, rural Bangladesh 8 221/346 DSS identified eligible women 12 mo CES-D > 16 52.0 NA
Nagpal et al., 200836 Cross-sectional survey Validation of the Mother Generated Index House to house recruitment in randomly selected colonies, New Delhi, India 6 195/249 women identified as eligible by surveyors Up to 6 mo EPDS > 9 59.4 47

BDI, Beck Depression Inventory; CES-D, Center for Epidemiologic Studies – Depression Scale; C-GHQ, conventional scoring method; CIS-R, Revised Clinical Interview Schedule; CMD, common mental disorder; DSM-IV, Diagnostic and statistical manual of mental disorders, 4th edition; DSS, Demographic Surveillance System; EPDS, Edinburgh Postnatal Depression Scale; GHQ, General Health Questionnaire; ICD-10, International Classification of Diseases, tenth revision; LALMIC, low- and lower-middle-income country; MBS, Maternity Blues Scale; MCH, Maternal and Child Health; MINI, Mini International Neuropsychiatric Interview; NA, not available; PSE, Present State Examination; SADS, Schedule for Affective Disorders and Schizophrenia; SBA, skilled birth attendant; SCAN, Schedule for Clinical Assessment in Neuropsychiatry; SCID, Structured Clinical Interview; SCID-NP, Structured Clinical Interview - Non-patient Edition; SCL, ICD-10 Symptom Checklist for Mental Disorders; SDS, Zung Self-Rating Depression Scale; Shona R-CIS, SRQ, Self-Reporting Questionnaire; SSQ, Shona Symptom Questionnaire, TBA, traditional birth attendant..

a Two studies included structured interviews using DSM-III or DSM-IV criteria.10,46

b Proportion of births with a skilled birth attendant.

c Instrument locally validated.