Background

There are gaps in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy to 9 months post partum among Kenyan women.

Methods

In this prospective cohort study, we analysed data from the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study in which HIV-negative women were enrolled in pregnancy and followed up to 9 months post partum in 20 public sector maternal–child health clinics in western Kenya. Pregnant women were eligible for enrolment if they were not infected with HIV, aged 15 years or older, and were able to provide consent. Eligible participants were screened and enrolled between Jan 15, 2018, and July 31, 2019, and followed up to 9 months post partum, with the last participant study visit conducted on Jan 15, 2021. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalised estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (CESD-10 score ≥10) and group-based trajectory modelling identified discrete trajectories of perinatal depressive symptoms.

Findings

Among 4447 participants in the main PrIMA study, 3555 had complete depressive symptom data in pregnancy and depressive symptom data post partum and were included in the primary analysis. Median age was 24·0 years (IQR 21·0–28·7), 1330 (38%) participants had low social support, and 278 (8%) reported intimate partner violence in pregnancy. All participants (100%) were female and all (100%) were of African Kenyan ethnicity. Prevalence of moderate-to-severe depressive symptoms was higher in pregnancy than post partum (870 [24·5%; 95% CI 23·1–25·9] vs 597 [6·8%; 15·6–18·1]; p<0·0001). Five patterns of depressive symptoms were identified; persistent moderate-to-severe depressive symptoms in pregnancy and post partum (295 [8·3%]), moderate-to-severe depressive symptoms in pregnancy that resolved post partum (139 [3·9%]), moderate-to-severe depressive symptoms that emerged post partum (40 [1·1%]), chronically mild symptoms (2709 [76·2%]), and no depressive symptoms (372 [10·5%]). Emergent moderate-to-severe depressive symptoms were associated with older age. Emergent, persistent, and resolving moderate-to-severe depressive symptoms were associated with intimate partner violence during pregnancy; and persistent and resolving moderate-to-severe depressive symptoms were associated with low social support and high HIV risk (all p<0·05). Moderate-to-severe depressive symptom risk was significantly increased with intimate partner violence (adjusted odds ratio 2·07 [95% CI 1·81–2·31]; p<0·0001), low social support (1·74 [1·56–1·95]; p<0·0001), and partner HIV-positive status (1·48 [1·22–1·78]; p<0·0001). 23·34% (95% CI 18·77–27·65) of cases of perinatal moderate-to-severe depressive symptoms were attributable to low social support.

Interpretation

One third of women had perinatal moderate-to-severe depressive symptoms; nearly half of these had higher severity phenotypes of resolving, persistent, and emerging moderate-to-severe depressive symptoms that might require tailored interventions. Perinatal women with comorbid psychosocial stressors such as intimate partner violence and previous pregnancy loss should be prioritised for mental health services that augment social support within routine maternal–child health care.

Funding

National Institutes of Health.

Translation

For the Kiswahili translation of the abstract see Supplementary Materials section.

中文翻译：

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肯尼亚妇女围产期抑郁症状的轨迹和预测因素：一项前瞻性队列研究

 背景

对撒哈拉以南非洲地区围产期抑郁症状的纵向模式和预测因素的理解存在差距。本研究旨在探讨肯尼亚女性从怀孕到产后 9 个月的抑郁症状轨迹和相关因素。

 方法

在这项前瞻性队列研究中，我们分析了产前护理中母亲 PrEP 实施 (PrIMA) 研究的数据，该研究中，艾滋病毒阴性妇女在怀孕期间入组，并在 20 个公共部门母婴保健诊所进行产后 9 个月的随访。肯尼亚西部。孕妇如果未感染艾滋病毒、年满 15 岁或以上并且能够提供同意，则有资格参加。符合条件的参与者在2018年1月15日至2019年7月31日期间进行了筛选和入组，并进行了产后长达9个月的随访，最后一次参与者研究访问于2021年1月15日进行。研究护士使用抑郁症中心对抑郁症状进行了系列评估。流行病学研究抑郁量表 (CESD-10)，亲密伴侣暴力的伤害、侮辱、威胁、尖叫量表以及社会支持的医疗结果研究量表。广义估计方程用于确定中度至重度抑郁症状（CESD-10 评分≥10）的相关性，基于组的轨迹模型确定了围产期抑郁症状的离散轨迹。

 发现

在 PrIMA 主要研究的 4447 名参与者中，3555 名拥有完整的妊娠期抑郁症状数据和产后抑郁症状数据，并被纳入主要分析。中位年龄为 24·0 岁（IQR 21·0–28·7），1330 名参与者（38%）的社会支持较低，278 名参与者（8%）报告了怀孕期间亲密伴侣的暴力行为。所有参与者 (100%) 均为女性，且全部 (100%) 均为非洲肯尼亚裔。妊娠期中度至重度抑郁症状的患病率高于产后（870 [24·5%；95% CI 23·1–25·9] vs 597 [6·8%；15·6–18·1]） ]；p<0·0001)。确定了五种抑郁症状模式；妊娠期和产后持续存在中度至重度抑郁症状 (295 [8·3%])，妊娠期中度至重度抑郁症状在产后缓解 (139 [3·9%])，中度至重度抑郁症状产后出现严重抑郁症状 (40 [1·1%])，长期轻度症状 (2709 [76·2%])，无抑郁症状 (372 [10·5%])。出现的中度至重度抑郁症状与年龄较大有关。突发、持续和缓解的中度至重度抑郁症状与怀孕期间亲密伴侣暴力有关；持续且缓解的中重度抑郁症状与低社会支持和高 HIV 风险相关（所有 p<0·05）。中度至重度抑郁症状风险因亲密伴侣暴力而显着增加（调整后的比值比 2·07 [95% CI 1·81–2·31]；p<0·0001）、低社会支持（1·74 [ 1·56–1·95]；p<0·0001），以及伴侣 HIV 阳性状况（1·48 [1·22–1·78]；p<0·0001）。 23·34% (95% CI 18·77–27·65) 的围产期中度至重度抑郁症状病例可归因于低社会支持。

 解释

三分之一的女性有围产期中度至重度抑郁症状；其中近一半具有较严重的表型，即缓解、持续和新出现的中度至重度抑郁症状，可能需要量身定制的干预措施。患有亲密伴侣暴力和既往流产等共病心理社会压力源的围产期妇女应优先接受心理健康服务，以增强常规母婴保健中的社会支持。

 资金

美国国立卫生研究院。

 翻译

有关摘要的斯瓦希里语翻译，请参阅补充材料部分。