Study finds alarming rates of postpartum depression among mothers in six countries

In a recently published study in the journal of BMC Public Health, researchers determined the incidence of postpartum depression (PPD) and identified associated predictors and coping strategies among mothers in six countries since June until August 2023.

Postpartum depression is a common mental health problem that affects about 10% of women after childbirth. Some studies suggest that PPD may affect one in seven women. PPD can develop within the first year after birth and persist for several years, which is quite different from the short-term “postpartum blues” that many mothers experience.

The study assessed the incidence of PDD among mothers in Egypt, Ghana, India, Syria, Yemen and Iraq. The study included mothers who gave birth within the previous 18 months, citizens of one of the specified countries, aged 18 to 40 years.

The study excluded multiple pregnancies, illiteracy, serious illness in the child, stillbirth or intrauterine fetal death, and mothers with medical, mental or psychological disorders that prevented completion of the questionnaire. Mothers who did not have access to the Internet or did not speak Arabic or English were also excluded.

Participants were recruited using a multistage approach. Two governorates in each country were selected, with one rural and one urban zone identified in each governorate. Mothers were surveyed through online platforms and in public places such as clinics, primary health centers and family planning units. All participants completed questionnaires using tablets or mobile phones provided by data collectors, or scanned a QR code.

The questionnaire, originally developed in English and translated into Arabic, was validated by medical experts and tested for clarity and understandability in a pilot study. The final questionnaire included sections on demographic and health-related factors, obstetric history, assessment of PPD using the Edinburgh Postnatal Depression Scale (EPDS), and psychological and social characteristics.

The incidence of PDD in the overall sample, as determined by the Edinburgh scale, was 13.5%, but this frequency varied significantly across countries. PDD was most common among mothers in Ghana (26.0%), followed by India (21.7%), Egypt (19.1%), Yemen (8.5%), Iraq (7.7%) and Syria (2.3%).

The average age of study participants was 27 years, 60.3% of whom were between 25 and 40 years old. About 96% of the study participants were married, while 67% had sufficient monthly income and at least a high school education.

Of health-related factors, 40% of participants were smokers, 54.2% had received a COVID-19 vaccine, and 44.1% had previously had COVID-19. About 83% of study participants had no comorbidities, and 92.4% had no history of mental illness or family history of mental illness.

PPD was significantly higher among women who were single or widowed (56.3%), as well as in 66.7% of women with medical, mental health, or psychological problems and 35.7% of women with a history of smoking or drinking. Mothers who paid for their own health care had higher rates of PPD.

Most mothers were not taking hormonal medications or birth control pills, 46.1% had experienced an unplanned pregnancy, and 68.6% had gained 10 kg or more during pregnancy. About 61% of study participants gave birth vaginally, while 90.9% and 48.2% of mothers had healthy children and breastfed, respectively.

Significant associations were found between PPD and contraceptive use, the number of children born (one or two), and an interval between pregnancies of less than two years. Mothers with a history of stillbirth and postpartum problems had higher rates of PPD. About 75% of mothers were unaware of the symptoms of PDD, and 35.3% experienced cultural stigma or judgment. Only 6.2% of affected women were diagnosed with PDD and received medication treatment.

Mothers with PDD often had a history of PDD, financial and family problems, and cultural stigma. Despite receiving more support, 43.3%, 45.5%, 48.4% and 70% of mothers felt uncomfortable discussing mental health with doctors, husbands, family and community, respectively.

Social norms, cultural beliefs, personal barriers, geographical differences, language barriers and financial restrictions were among the reasons for not receiving treatment, as reported by 65.7%, 60.5%, 56.5%, 48.5%, 47.4% and 39.7% of mothers, respectively. Logistic regression analysis identified several significant predictors of PPD, including marital status, child health, postpartum problems, ethnicity, pregnancy status, and psychological factors.