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 5. Determinants of common perinatal mental disorders in women in low- and lower-middle-income countries
| Risk factors | OR rangea |
|
|---|---|---|
| Minimum OR (95% CI) | Maximum OR (95% CI) | |
| Social and economic circumstances | ||
| Socioeconomic disadvantage |
2.1 (95% CI: 1.3–5.2) |
13.2 (95% CI: 5.2–33.5) |
| – insufficient food or inability to pay for essential health care |
||
| – low income or financial difficulties |
||
| – an unemployed partner |
||
| – living in crowded or inadequate housing |
||
| Young age |
2.1 (95% CI: 0.7–6.4) |
5.4 (95% CI: 2.6–10.3) |
| Belonging to an ethnic or religious minority |
2.1 (95% CI: 1.0–4.0)] |
|
| Being unmarried |
3.4 (95% CI: 2.2–5.5) |
5.8 (95% CI: 2.0–16.9) |
| Quality of relationship with intimate partner | ||
| Difficulties in intimate partner relationship |
1.96 (95% CI: 1.0–3.9) |
9.44 (95% CI: 2.4–37.8) |
| – a partner who rejected paternity, was unsupportive, uninvolved, critical and quarrelsome or used alcohol to excess |
||
| – physical violence |
2.11 (95% CI: 1.1–4.0) |
6.75, (95% CI: 2.1–2.0) |
| – polygamous marriage |
7.7; 95% CI: 2.3–25.9 |
|
| Family and social relationships | ||
| No help from, feared or argued with in-laws |
2.14 (95% CI: 1.1–4.3) |
4.4 (95% CI: 1.8–10.8) |
| Insufficient social support |
2.8 (95% CI: 1.2 – 6.4) |
6.1 (95% CI: 1.4 – 26.0) |
| – living in a nuclear family |
2.10 (95% CI: 1.2–3.8) |
4.3 (95% CI: 1.4–13.3) |
| – own mothers lived in a rural area |
||
| – lacked an affectionate and trusting relationship with their own mothers |
||
| Having at least three children |
2.6 (95% CI: 1.1–6.3) |
4.1 (95% CI: 0.9–19.0) |
| Reproductive and general health | ||
| Adverse reproductive outcomes |
||
| Unwanted or unintended pregnancy |
1.6 (95% CI: 1.3–1.9) |
8.8 (95% CI: 4.5–17.5) |
| Nulliparity (in pregnant women) or primiparity (in women who had recently given birth) |
2.73 (95% CI: 1.4–4.2) |
4.16 (95% CI: 2.3 – 7.7) |
| Past spontaneous or induced abortion |
2.87 (95% CI: 1.0–8.0) |
|
| Past stillbirth |
3.4 (95% CI: 1.3–8.7) |
8.0 (95% CI: 1.7–37.6) |
| Coincidental medical problems |
3.43 (95% CI: 1.8–6.6) |
8.3 (95% CI: 4.7–14.5) |
| Antenatal hospital admission |
3.21 (95% CI: 1.8–5.4) |
3.95 (95% CI: 2.6–6.1) |
| Caesarean birth |
2.49 (95% CI: 1.2–5.3) |
3.58 (95% CI: 1.7–7.5) |
| History of mental health problems | ||
| Past mental illness |
5.1 (95% CI: 1.7–15.2) |
5.6 (95% CI: 1.1–27.3) |
| Psychiatric morbidity in the index pregnancy |
3.2 (95% CI: 1.4–6.1) |
6.0 (95% CI: 3.0–12.0) |
| Non-specific psychological symptoms including: | 2.2 (95% CI: 1.4– 3.6) |
19.9 (95% CI: 3.3–122.0) |
| – past premenstrual irritability |
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| – a “distancing coping pattern" |
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| – anxiety about birth |
||
| – perceived pregnancy complications |
||
| – “negative pregnancy attitudes” |
||
| Infant characteristics | ||
| Not having a child of the desired sex |
1.8 (95% CI: 1.4–2.3) |
2.6 (95% CI: 1.2–6.5) |
| Infant cries for prolonged periods |
1.9 (95% CI: 1.2–3.0) |
|
| Infant is ill |
1.1 (95% CI: 0.6–2.3) |
4.5 (95% CI: 3.2–6.4) |
| Grief associated with the death of an infant |
4.5 (95% CI: 3.6–5.8) |
14.1 (95% CI: 2.5–78.0) |
| Protective factors | ||
| More years of education |
Relative risk: 0.5 (P = 0.03) |
|
| Having a permanent or secure job |
0.64 (95% CI: 0.4–1.0) |
|
| Having an employed partner |
0.3 (P = 0.002) |
|
| Being a member of the ethnic majority |
0.2 (95% CI: 0.1–0.8) |
|
| Traditional postpartum care from a trusted person |
0.4 (95% CI: 0.3–0.6) |
1.9 (95% CI: 1.1–3.2) |
CI, confidence interval; OR, odds ratio.
a Only one OR is provided if the data come from a single study.
Add footnote about RR