‘‘I can’t stop worrying about everything’’-experiences of rural Bangladeshi women during the first postpartum months

Over recent years, researchers have found evidence which indicates that the prevalence of postpartum depressive symptoms crosses cultural boundaries and is reported to be at least as high in non-Western countries as inWestern countries. However, qualitative studies about new mothers’ experiences from non-Western countries, such as Bangladesh, are rare, particularly in rural areas. This study aims to describe the experiences and concerns of rural Bangladeshi mothers with postpartum depressive symptoms. Open narrative interviews were conducted with 21 mothers with depressive symptoms 2-3 months postpartum, consecutively selected from a longitudinal study about prevalence and risk factors of perinatal depressive symptoms. Inductive content analysis was used to analyse data and three themes emerged: family dynamics, living at the limits of survival, and role of the cultural context after childbirth. These themes were based on six categories and 15 subcategories. The findings show that troublesome family relationships, including intimate partner violence and violence in the family, influenced the mothers’ mental well-being. They and their families lived at the limit of survival and the mothers expressed fear and worries about their insecure situation regarding economic difficulties and health problems. They felt sorry for being unable to give their infants a good start in life and sad because they could not always follow the traditional norms related to childbirth. Thus, it is important to focus on the depressive symptoms among new mothers and offer counselling to those showing depressive symptoms, as the cultural traditions do not always alleviate these symptoms in the changing Bangladeshi society today

Intimate partner violence and its association with maternal depressive symptoms 6-8 months after childbirth in rural Bangladesh

Background: Intimate partner violence (IPV) is important to be addressed simply because it is a gross violation of human rights. Its prevalence is wide ranging across the world, with higher prevalence reported in low- and middle-income countries. Evidence shows that IPV has both direct and indirect impact on women’s health, mainly related to physical health. Little is known of impact of IPV on mental health of women, particularly after childbirth. Objective: To describe the prevalence of intimate partner violence (IPV) experienced by women 6-8 months after childbirth, and the factors associated with IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design: The study used cross-sectional data at 6-8months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburg Postnatal Depression Scale assessed maternal depressive symptoms. Results: Majority of the women reported experiencing intimate partner violence categorised as physical (52%), sexual (65%) and emotional (84%) violence by spouse. Husband’s education (OR: 0.41, CI: 0.23-0.73), poor relationship with husband (OR: 2.64, CI: 1.07-6.54) and emotional violence by spouse (OR: 1.58, CI: 1.35-1.83) were significantly associated with physical IPV experienced by women. Having a fussy and difficult child (OR: 1.05, CI: 1.02-1.08), poor relationship with husband (OR: 4.95, CI: 2.55-9.62) and experience of physical IPV (OR: 2.83, CI: 1.72-4.64) were found to be significant predictors of maternal depressive symptoms amongst women 6-8 months after childbirth. Neither forced sex nor emotional violence by intimate partner was found to be significantly associated with maternal depressive symptoms 6-8 months after childbirth. Conclusion: It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused intervention at the community level are suggested

Impact of maternal antepartum depressive and anxiety symptoms on birth outcomes and mode of delivery: a prospective cohort study in east and west coasts of Malaysia

Antepartum depressive and anxiety symptoms (ADS and AAS) are prevalent in Malaysia. Prior evidence linking maternal ADS and AAS with adverse birth outcomes and caesarean section (CS) or instrumental delivery is conflicting. There is no research in Malaysia on the association between maternal mental disorders and adverse birth outcomes and mode of delivery. This study aims to investigate the independent effect of maternal ADS and AAS on low birth weight (LBW), preterm birth (PTB) and CS or instrumental delivery among women in east and west coasts of Malaysia. Methods: We used data from a prospective cohort study of 799 pregnant women from health clinics of two states in east and west coasts of Malaysia. Baseline data were measured at the third trimester of pregnancy on ADS, AAS, socioeconomic condition, anthropometric status, reproductive history and intimate partner violence. Birth outcomes and mode of delivery were determined at the time of delivery. Univariate and multiple Cox’s regressions were applied to assess the association between ADS and AAS and LBW, PTB and CS or instrumental delivery. Results: ADS was significantly associated with an increased risk of giving birth to LBW babies in both east coast (RR = 3.64; 95% CI 1.79–7.40) and west coast (RR = 3.82; 95% CI 1.86–7.84), but not with PTB. AAS was associated with increased risk of both LBW (RR = 2.47; 95% CI 1.39–4.38) and PTB (RR = 2.49; 95% CI 1.16–5.36) in the east coast, but not in west coast. The risk of CS or instrumental delivery was evident among women with ADS (RR = 2.44; 95% CI 1.48–4.03) in west coast only. Conclusion: ADS predicts LBW in both coasts, AAS predicts LBW and PTB in east coast, and ADS predicts CS or instrumental delivery in west coast. Policies aimed at detection and management of ADS and AAS during antenatal check-up in health clinics may help improve birth outcomes and reduce obstetric interventions

Low birth weight in offspring of women with depressive and anxiety symptoms during pregnancy: results from a population based study in Bangladesh

<p>Abstract</p> <p>Background</p> <p>There is a high prevalence of antepartum depression and low birth weight (LBW) in Bangladesh. In high- and low-income countries, prior evidence linking maternal depressive and anxiety symptoms with infant LBW is conflicting. There is no research on the association between maternal mental disorders and LBW in Bangladesh. This study aims to investigate the independent effect of maternal antepartum depressive and anxiety symptoms on infant LBW among women in a rural district of Bangladesh.</p> <p>Methods</p> <p>A population-based sample of 720 pregnant women from two rural subdistricts was assessed for symptoms of antepartum depression, using the Edinburgh Postpartum Depression Scale (EPDS), and antepartum anxiety, using the State Trait Anxiety Inventory (STAI), and followed for 6-8 months postpartum. Infant birth weight of 583 (81%) singleton live babies born at term (≥37 weeks of pregnancy) was measured within 48 hours of delivery. Baseline data provided socioeconomic, anthropometric, reproductive, obstetric, and social support information. Trained female interviewers carried out structured interviews. Chi-square, Fisher's exact, and independent-sample <it>t </it>tests were done as descriptive statistics, and a multiple logistic regression model was used to identify predictors of LBW.</p> <p>Results</p> <p>After adjusting for potential confounders, depressive (OR = 2.24; 95% CI 1.37-3.68) and anxiety (OR = 2.08; 95% CI 1.30-3.25) symptoms were significantly associated with LBW (≤2.5 kg). Poverty, maternal malnutrition, and support during pregnancy were also associated with LBW.</p> <p>Conclusions</p> <p>This study provides evidence that maternal depressive and anxiety symptoms during pregnancy predict the LBW of newborns and replicates results found in other South Asian countries. Policies aimed at the detection and effective management of depressive and anxiety symptoms during pregnancy may reduce the burden on mothers and also act as an important measure in the prevention of LBW among offspring in Bangladesh.</p

Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: A population based study in rural Bangladesh

<p>Abstract</p> <p>Background</p> <p>Few studies have examined the associated factors of antepartum depressive and anxiety symptoms (ADS and AAS) in low-income countries, yet the World Health Organization identifies depressive disorders as the second leading cause of global disease burden by 2020. There is a paucity of research on mental disorders and their predictors among pregnant women in Bangladesh. This study aims to estimate the prevalence of depressive and anxiety symptoms and explore the associated factors in a cross-section of rural Bangladeshi pregnant women.</p> <p>Methods</p> <p>The study used cross-sectional data originating from a rural community-based prospective cohort study of 720 randomly selected women in their third trimester of pregnancy from a district of Bangladesh. The validated Bangla version of the Edinburgh Postnatal Depression Scale was used to measure ADS, and a trait anxiety inventory to assess general anxiety symptoms. Background information was collected using a structured questionnaire at the respondents' homes.</p> <p>Results</p> <p>Prevalence of ADS was 18% and AAS 29%. Women's literacy (OR 0.59, 95% CI 0.37-0.95), poor partner relationship (OR 2.23, 95% CI 3.37-3.62), forced sex (OR 1.95, 95% CI 1.01-3.75), physical violence by spouse (OR 1.69, 95% CI 1.02-2.80), and previous depression (OR 4.62 95% CI 2.72-7.85) were found to be associated with ADS. The associated factors of AAS were illiteracy, poor household economy, lack of practical support, physical partner violence, violence during pregnancy, and interaction between poor household economy and poor partner relationship.</p> <p>Conclusion</p> <p>Depressive and anxiety symptoms are found to occur commonly during pregnancy in Bangladesh, drawing attention to a need to screen for depression and anxiety during antenatal care. Policies aimed at encouraging practical support during pregnancy, reducing gender-based violence, supporting women with poor partner relationships, and identifying previous depression may ameliorate the potentially harmful consequences of antepartum depression and anxiety for the women and their family, particularly children.</p

Postpartum depressive symptoms in a family perspective : Some indicators, experiences and consequences

Aim: The aim of this thesis was to examine the 1) consequences of maternal depressive symptoms 2-3 months postpartum on parents experiences of parenthood at one year and on parent-child interactions15-18 months postpartum, and the 2) circumstances in the early postpartum, which might predict depressive symptoms 2 months postpartum. Method: A community sample of 574 women was screened for depressive symptoms, using the Edinburgh Postnatal Depression Scale (EPDS) two months postpartum. Forty-two women (7%) showed signs of depression, and 24 of these women and 11 of their partners consented to be videotaped during a parent-child interaction observation at 15-18 months. Twenty-one women showing no signs of depression, and 14 of their partners were selected as a comparison group. At one year, parents reported on their experiences of parenthood. To study early indicators for depressive symptoms parents were approached at the maternity clinic, Karolinska University Hospital, Solna, One hundred and six couples filled out all questionnaires about their maternity blues during a period of five consecutive days in the first week after birth, and additionally completed an EPDS, along with a questionnaire about their bonds to the child. At two months postpartum, follow-up questionnaires about the parents mood and bonding to the child were filled out. Twenty-two mothers showing signs of depression at this occasion were interviewed about their experiences of the first months with the child. Results: The videotaped parent-child interactions15-18 months postpartum showed that children of mothers who demonstrated signs of depression at 2 months exhibited less interest in and attention to an explorative play situation with their mothers. Fathers in the families with a mother showing signs of depression were, however, more positively involved with their children and, in turn, their children showed less negative affect in the interaction with their fathers than children in families where the mother did not show signs of depression. In the interviews with mothers having depressive symptoms at 2 months, it was found that the mothers expressed strong feelings of guilt, failure, and unfulfilled expectations. They struggled with life as it related to the self, with the relations with partner and with the child. At one-year postpartum, women with signs of depression at 2 months, experienced motherhood more stressfully than did mothers without signs of depressive symptoms. However, no difference was found in their respective partners experiences of fatherhood. Severe blues, bonding problems and a partner with depressed mood were found to be early indicators for depressive symptoms in both mothers and fathers. For mothers, previous depression and an emergency Caesarean section were also predictive for depressive symptoms. Conclusions: The results indicate that self-reported depressive mood in mothers might affect the child negatively, but also that fathers might compensate for the mother s mood. Postpartum depressive symptoms still seems to be a hidden condition, since mothers do not easily talk about their feelings. It is important to identify these women early. Thus, to be attentive to severe blues and bonding problems during the first week and to give the mothers an opportunity to speak about their feelings, maybe through active listening without giving advise. This may alleviate depressive symptoms and possibly prevent negative interactions between mother and child in the future

Intimate partner violence and its association with maternal depressive symptoms 6–8 months after childbirth in rural Bangladesh

Background: The prevalence of intimate partner violence (IPV), a gross violation of human rights, ranges widely across the world with higher prevalence reported in low- and middle-income countries. Evidence related mainly to physical health shows that IPV has both direct and indirect impacts on women's health. Little is known about the impact of IPV on the mental health of women, particularly after childbirth. Objective: To describe the prevalence of IPV experienced by women 6–8 months after childbirth in rural Bangladesh and the factors associated with physical IPV. The study also aims to investigate the association between IPV and maternal depressive symptoms after childbirth. Design: The study used cross-sectional data at 6–8 months postpartum. The sample included 660 mothers of newborn children. IPV was assessed by physical, emotional, and sexual violence. The Edinburgh Postnatal Depression Scale assessed maternal depressive symptoms. Results: Prevalence of physical IPV was 52%, sexual 65%, and emotional 84%. The husband's education (OR: 0.41, CI: 0.23–0.73), a poor relationship with the husband (OR: 2.64, CI: 1.07–6.54), and emotional violence by spouse (OR: 1.58, CI: 1.35–1.83) were significantly associated with physical IPV experienced by women. The perception of a fussy and difficult child (OR: 1.05, CI: 1.02–1.08), a poor relationship with the husband (OR: 4.95, CI: 2.55–9.62), and the experience of physical IPV (OR: 2.83, CI: 1.72–4.64) were found to be significant predictors of maternal depressive symptoms among women 6–8 months after childbirth. Neither forced sex nor emotional violence by an intimate partner was found to be significantly associated with maternal depressive symptoms 6–8 months postpartum. Conclusions: It is important to screen for both IPV and depressive symptoms during pregnancy and postpartum. Since IPV and spousal relationships are the most important predictors of maternal depressive symptoms in this study, couple-focused interventions at the community level are suggested

Prevalence and associated factors of depressive symptoms among disadvantaged adolescents: results from a population-based study in Bangladesh.

PROBLEM: Few studies have examined the adolescents' depression in low-income countries and no research has yet been carried out in Bangladesh. This study estimated the prevalence of depressive symptoms and explored the associated factors and help seeking behavior among adolescents in Bangladesh. METHODS: Data originated from a cross section of 2,440 randomly selected boys and girls aged 13-19 years in a rural district and urban slums of Dhaka city, Bangladesh, during October-November 2012. Beck Depression Inventory (BDI), a 21-item scale, measured the prevalence of depressive symptoms using a cut-off 16 or higher. FINDINGS: The prevalence of depressive symptoms among adolescents was 14%, with predominance in urban slums and among girls. Older age (15-19 years), poverty, and poor parental relation were found to be associated with depressive symptoms of both sexes; family history of depressive symptoms for boys; and reproductive illness and sexual abuse for girls. More than 80% of depressed adolescents sought no help. CONCLUSIONS: Adolescent depressive symptoms are common and largely undetected public health problem in Bangladesh. Policies aimed at concerted efforts for implementing a school-based counseling program with components of cognitive behavioral therapy and developing referral systems for those who scored at least 30 at BDI may ameliorate the potential harmful consequences of depressive symptoms in adolescents

Impact of intimate partner violence on infant temperament

Intimate partner violence (IPV) during the first year postpartum is common in Bangladesh, and many infants are exposed to hostile and aggressive environment. The aim of the current study was to investigate how IPV (physical, emotional, and sexual) impacts on the mother’s perception of her infant’s temperament 6 to 8 months postpartum, and whether maternal depressive symptom at 6 to 8 months postpartum is a mediator in this association. A total of 656 rural Bangladeshi women and their children 6 to 8 months postpartum were included in this study. Data were collected by structured interviews. The women were asked about physical, sexual, and emotional IPV; depressive symptoms (Edinburgh Postnatal Depressive Symptoms [EPDS]); and their perception of infant temperament assessed by the Infant Characteristic Questionnaire (ICQ). Descriptive analyses were conducted for prevalence of IPV and maternal depressive symptoms. Mediation analysis was conducted with a series of linear regressions with types of IPV as independent variables, ICQ including its subscales as dependent variables and maternal depressive symptoms as potential mediator. All the analyses were adjusted for the woman’s and her husband’s ages and number of children of the couple. Nearly 90% of the mothers reported some kind of IPV at 6 to 8 months postpartum. All types of IPV were directly associated with the mother’s perception of her infant as unadaptable. Maternal depressive symptom was a mediating factor between physical IPV and the ICQ subscales fussy-difficult and unpredictable. In addition, depressive symptoms mediated between sexual and emotional IPV, and the mother’s perception of the infant as unpredictable. The results showed that IPV influenced how mothers perceived their infant’s temperament. It is important that health care professionals at maternal and child health services enquire about IPV with possibilities to refer the family or the mother and infant for appropriate support

Impact of maternal depressive symptoms and infant temperament on early infant growth and motor development: results from a population based study in Bangladesh

Background: Evidence linking maternal depressive symptoms with infant's growth and development in low-income countries is inadequate and conflicting. This study investigated the independent effect of maternal perinatal depressive symptoms on infant's growth and motor development in rural Bangladesh. Methods: A cohort of 720 pregnant women was followed from the third trimester of pregnancy to 6-8 months postpartum. For growth and developmental outcomes, 652 infants at 2-3 months and 6-8 months were assessed. Explanatory variables comprised maternal depressive symptoms, socioeconomic status, and infant's health and temperament. Outcome measures included infant's underweight, stunting and motor development. Multiple linear regression analyses identified predictors of infant growth and development. Results: Maternal postpartum depressive symptoms independently predicted infant's underweight and impaired motor development, and antepartum depressive symptoms predicted infant's stunting. Infant's unadaptable temperament was inversely associated with infant's weight-for-age and motor development, and fussy and unpredictable temperament with height-for-age and motor development. Limitations: Repeated measures design might threaten the internal validity of the results 8.3% of the participant does not participate in the measurements at different times. As the study was conducted in two sub-districts of rural Bangladesh, it does not represent the urban scenario and cannot be generalized even for other rural areas of the country. Conclusion: This study provides evidence that maternal ante- and postpartum depressive symptoms predict infant's growth and motor development in rural Bangladesh. It is recommended to integrate psychosocial components in maternal and child health interventions in order to counsel mothers with depressive symptoms