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 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 disadvantage10,16,18,25,30,37,39,40,45,49 including: 2.1 (95% CI: 1.3–5.2)37 13.2 (95% CI: 5.2–33.5)30
     – insufficient food or inability to pay for essential health care14,17,24,25,54,57
     – low income or financial difficulties10,21,57
     – an unemployed partner16
     – living in crowded or inadequate housing21or a rural area54
Young age9,37,49 2.1 (95% CI: 0.7–6.4)49 5.4 (95% CI: 2.6–10.3)9
Belonging to an ethnic or religious minority22,34 2.1 (95% CI: 1.0–4.0)]34
Being unmarried13,39,55 3.4 (95% CI: 2.2–5.5)13 5.8 (95% CI: 2.0–16.9)39
Quality of relationship with intimate partner
Difficulties in intimate partner relationship8,24,25,27,28,3032,3840,45,48,53including: 1.96 (95% CI: 1.0–3.9)48 9.44 (95% CI: 2.4–37.8)39
     – a partner who rejected paternity, was unsupportive, uninvolved, critical and quarrelsome or used alcohol to excess8,27,28,31,38,39,45,48
     – physical violence24,25,28,3032,40 2.11 (95% CI: 1.1–4.0)25 6.75, (95% CI: 2.1–2.0)28
     – polygamous marriage31,53 7.7; 95% CI: 2.3–25.931
Family and social relationships
No help from, feared or argued with in-laws9,18,25,28,45,48 2.14 (95% CI: 1.1–4.3)48 4.4 (95% CI: 1.8–10.8)45
Insufficient social support14,18 2.8 (95% CI: 1.2 – 6.4)18 6.1 (95% CI: 1.4 – 26.0)14
     – living in a nuclear family45 2.10 (95% CI: 1.2–3.8)25 4.3 (95% CI: 1.4–13.3)45
     – own mothers lived in a rural area38
     – lacked an affectionate and trusting relationship with their own mothers25
Having at least three children22,38,45 2.6 (95% CI: 1.1–6.3)38 4.1 (95% CI: 0.9–19.0)22
Reproductive and general health
Adverse reproductive outcomes8,9,11,13,23,30,3740,49,53 including:
Unwanted or unintended pregnancy23,30,37,39,40 1.6 (95% CI: 1.3–1.9)30 8.8 (95% CI: 4.5–17.5)39
Nulliparity (in pregnant women) or primiparity (in women who had recently given birth)8,9,39 2.73 (95% CI: 1.4–4.2)9 4.16 (95% CI: 2.3 – 7.7)39
Past spontaneous or induced abortion9,49,53 2.87 (95% CI: 1.0–8.0)49
Past stillbirth11,30 3.4 (95% CI: 1.3–8.7)30 8.0 (95% CI: 1.7–37.6)11
Coincidental medical problems30,37,38 3.43 (95% CI: 1.8–6.6)37 8.3 (95% CI: 4.7–14.5)14
Antenatal hospital admission13,57 3.21 (95% CI: 1.8–5.4)57 3.95 (95% CI: 2.6–6.1)13
Caesarean birth13,39,55 2.49 (95% CI: 1.2–5.3)39 3.58 (95% CI: 1.7–7.5)13
History of mental health problems
Past mental illness22,28,30,31,34,40 5.1 (95% CI: 1.7–15.2)31 5.6 (95% CI: 1.1–27.3)28
Psychiatric morbidity in the index pregnancy11,28 3.2 (95% CI: 1.4–6.1)11 6.0 (95% CI: 3.0–12.0)28
Non-specific psychological symptoms including: 2.2 (95% CI: 1.4– 3.6)34 19.9 (95% CI: 3.3–122.0)22
     – past premenstrual irritability34
     – a “distancing coping pattern"22
     – anxiety about birth30
     – perceived pregnancy complications34
     – “negative pregnancy attitudes”34
Infant characteristics
Not having a child of the desired sex18,26,37,45 1.8 (95% CI: 1.4–2.3)45 2.6 (95% CI: 1.2–6.5)18
Infant cries for prolonged periods23 1.9 (95% CI: 1.2–3.0)23
Infant is ill16,37,40,48 1.1 (95% CI: 0.6–2.3)48 4.5 (95% CI: 3.2–6.4)40
Grief associated with the death of an infant28,40 4.5 (95% CI: 3.6–5.8)40 14.1 (95% CI: 2.5–78.0)28
Protective factors
More years of education40 Relative risk: 0.5 (P = 0.03)40
Having a permanent or secure job23 0.64 (95% CI: 0.4–1.0)23
Having an employed partner40 0.3 (P = 0.002)40
Being a member of the ethnic majority22 0.2 (95% CI: 0.1–0.8)22
Traditional postpartum care from a trusted person23,45 0.4 (95% CI: 0.3–0.6)45 1.9 (95% CI: 1.1–3.2)23

CI, confidence interval; OR, odds ratio.

a Only one OR is provided if the data come from a single study.

Add footnote about RR