Antenatal depression: a growing but underdiagnosed phenomenon
Antenatal depression is a mood disorder that affects pregnant women from conception until they give birth. It is characterised by symptoms such as changes in eating and sleep patterns, persistent sadness, feelings of guilt, worthlessness and hopelessness, recurrent thoughts of death or suicide, anxiety and loss of interest in activities that are usually enjoyed.
Even though depression affects about 10% of pregnant women worldwide and 16% in low to middle income countries, very little has been done to address maternal mental health. This is because much of the focus is on addressing the physical causes of maternal and infant mortality and morbidity, such as infections, hypertension and haemorrhages, maternal mortality. In Zimbabwe, infant mortality is a high of 600 per 100,000 births.
In addition, there is paucity of information about antenatal depression in Zimbabwe. As such, antenatal depression remains underdiagnosed and undertreated. This may be attributed to lack of knowledge about the condition among healthcare providers whose focus is on the well-known postnatal depression. It may also be due to the stigma attached to mental illness in general. Since pregnancy is usually a celebrated event, especially among married people, depressed women will not voluntarily talk about it for fear of being stigmatised.
Another contributing factor is that symptoms of antenatal depression often mask normal physiological changes in pregnancy. The lack of simple, validated screening tools that are easy to administer in resource-constrained and short-staffed settings can also hamper early identification of antenatal depression.
Who is affected by depressed?
Depression can affect women from all walks of life and at any point during gestational period. Previous history or family history of depression is the most important predictor of antenatal depression.
However, hormonal changes that occur during pregnancy, interpersonal conflicts, particularly intimate partner violence, poor obstetric history and stressful life events are all predisposing risk factors of antenatal depression.
In addition, learning about one’s HIV positive status in pregnancy can be traumatic to a woman who not only has to think of her own health but also what it means for her unborn baby. With an increased high rate of migration in Zimbabwe, especially among men who have to seek for employment in neighbouring countries, the burden of taking care of the family is the sole responsibility of the woman. The risks of developing depression are very high for women who have migrated to the urban areas and have no support from extended family members.
The impact of depression
Addressing antenatal depression is important as it may affect the mother’s ability to make decisions leading to poor health seeking behaviours, poor adherence to medical prescription and risky behaviours such as smoking and having unprotected sex. This not only affects the mother but the baby as well, thereby contributing to poor maternal and infant outcomes.
Validated screening tools for resource-constrained and short-staffed settings are necessary to identify antenatal depression.
African Mental Health Research Initiative (AMARI), PhD Fellow
University of Zimbabwe, College of Health Sciences, Department of Nursing
AMARI is one of the 11 programmes funded through the Developing Excellence in Leadership, Training and Science (DELTAS) Africa, which supports the Africa-led development of world-class researchers and scientific leaders in Africa.