Factors Associated With Prenatal Depression Among Women Attending the Antenatal Clinic at Coast Provincial General Hospital, Mombasa County, Kenya

Abstract

Background: Prenatal depression is a form of clinical depression that affects a woman during pregnancy. Despite being a public health burden and the major predictor of postnatal depression, prenatal depression has not been given as much attention as postnatal depression globally in research and policy. There is limited evidence on the factors associated with prenatal depression yet the adverse effects not only affect the mother but also the offspring. Study objective: The aim of the study was to establish the risk factors associated with prenatal depression among pregnant women who were attending the antenatal clinic at Coast Provincial General Hospital (CPGH) in Mombasa County, Kenya. Methodology: A hospital-based case control study design was employed to identify factors associated with prenatal depression. The outcome (prenatal depression) was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Cases were pregnant women ≥15 years who had an EPDS score of ≥13 while controls were pregnant women ≥15 years but with an EPDS score of <13. All cases were recruited into the study while the controls were a simple random sample of prenatal depression free women. Data on the socio-demographic, social network and family factors, lifestyle and obstetric characteristics were collected using a semi structured questionnaire. 170 participants were enrolled over a study period of two months with the ratio of cases to controls being 1:4. Logistic regression was used to evaluate relationship between the risk factors and prenatal depression. 20% and 5% levels of significance were used for the univariable and multivariable analysis respectively. Results: In the univariable analysis, age, marital status, occupation, alcohol and drug abuse, unplanned pregnancy, gestational age, social support and domestic violence were significantly associated with prenatal depression. From the multivariable analysis, only marital status (aOR=17.1; 95% CI:4.0-73.0), occupation (aOR=2.4; 95% CI:1.4-4.2), social support (aOR=0.2; 95% CI:0.05-0.8) and domestic violence (aOR=18.3; 95% CI: 5.7-58.7) were identified as statistically significant risk factors for prenatal depression. Conclusion and recommendations: In this setting, marital status, occupation, domestic violence experience and lack of social support were the major predictors of prenatal depression among pregnant women. Therefore, this necessitates for preventive and supportive interventions which include screening for prenatal depression in antenatal clinics to enable early detection and management, creation of employment opportunities and encouraging the youth to start income generating activities, enforcement of laws relating to gender-based violence to ensure perpetrators are punished and communities sensitized to deter new cases of gender-based violence and formation of social support networks by hospital psychiatry departments to provide an avenue for the prenatally depressed women to meet, share challenges and coping mechanisms.