Research PaperAntenatal depression and adversity in urban South Africa
Section snippets
Background
Depressive disorders account for almost half of the burden of disease presented by mental disorders, followed by anxiety disorders, and drug and alcohol use disorders (WHO Department of Health Statistics and Informatics, 2008). Globally, the lifetime prevalence of major depressive disorder is estimated to be between 10% and 15% (Lépine and Briley, 2011) and in South Africa, it is estimated that 9.8% adults will experience a major depressive episode (MDE) at least once during their lifetime (
Setting
This cross-sectional study was undertaken at the Hanover Park Midwife Obstetric Unit (MOU), which provides primary level maternity services in an urban area of Cape Town, South Africa. Hanover Park has a population of about 35,000 people (Statistics South Africa, 2013), and is a community characterized by high levels of poverty and community-based gang violence. Hanover Park is regarded as one of the most violent parts of Cape Town with high rates of alcohol and substance abuse, physical and
Training
A research assistant and a mental health officer were appointed to conduct the study.5 A clinical psychologist, with research experience, trained and supervised both these staff. The research assistant was trained to recruit women, administer the demographics questionnaire and manage the study database. The
Description of the sample
A total of 376 women were recruited and completed the screening process (Table 1). Most women were in their mid-twenties, and in the second trimester of their second pregnancy. Although 90% of women were in an intimate relationship, only 56% were cohabiting with their partner. The average highest level of education achieved was Grade 10. Only 27% of women were employed on a full time basis, 18% had informal, contract or part time employment and 55% were unemployed. Only 5% were earning over
Discussion
This study used a clinical diagnostic tool to determine the prevalence of antenatal MDE in a low resource urban area. The prevalence of MDE in this sample is 22%, approximately double that of HIC settings but lower than some of the highest rates found in LMIC (Fisher et al., 2012). The wide range of prevalence rates reported in LMIC settings has been attributed to the limited local evidence available compared to HIC settings. According to Fisher et al. (2012), only 8% of LMIC have reliable
Conclusion
The high prevalence of depression amongst pregnant women in this study was significantly associated with multiple risk factors. Many of these have been cited in previous studies, but some were novel for the setting. The experience of multiple risk factors may elicit a significant stress response in the form of MDE, which has consequences for maternal and child health and well-being (Morgan et al., 2012). An integrated approach is recommended to provide mental health care as part of antenatal
Contributers
Thandi van Heyningen, Simone Honikman and Sally Field designed the study and wrote the protocol. Thandi van Heyningen supervised the study, the data collection, and managed the literature searches. Thandi van Heyningen, Landon Myer and Michael Onah undertook the statistical analyses. Thandi van Heyningen wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.
Role of the funding source
This research study was funded by the Medical Research Council of South Africa and Cordaid. The preparation of the article was funded by the National Research Foundation of South Africa and the Harry Crossley Foundation, South Africa. None of the funding sources were involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.
Conflict of interest
The authors declare no conflict of interest.
Acknowledgments
The authors would like to acknowledge Bronwyn Evans, Liezl Hermanus and Sheily Ndwayana for their assistance with data collection, as well as the staff and patients of Hanover Park MOU.
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