Trajectories of maternal ante- and postpartum depressive symptoms and their association with child- and mother-related characteristics in a West African birth cohort study

TY - JOUR

T1 - Trajectories of maternal ante- and postpartum depressive symptoms and their association with child- and mother-related characteristics in a West African birth cohort study

AU - Barthel, Dana

AU - Kriston, Levente

AU - Fordjour, Daniel

AU - Mohammed, Yasmin

AU - Kra-Yao, Esther Doris

AU - Bony Kotchi, Carine Esther

AU - Koffi Armel, Ekissi Jean

AU - Eberhardt, Kirsten Alexandra

AU - Feldt, Torsten

AU - Hinz, Rebecca

AU - Mathurin, Koffi

AU - Schoppen, Stefanie

AU - Bindt, Carola

AU - Ehrhardt, Stephan

AU - International CDS Study Group

PY - 2017/11/6

Y1 - 2017/11/6

N2 - BACKGROUND: The vast majority of research on mental health has been undertaken in high income countries. This study aimed at investigating the long-term course of maternal depressive symptoms and its association with various mother- and child-related characteristics in two West African lower middle income countries with focus on the relationship with long-term anxiety symptoms.METHODS: In the Child Development Study, a prospective birth cohort study in Côte d'Ivoire and Ghana, the 9-item Patient Health Questionnaire (PHQ-9) was answered by N = 776 women 3 months antepartum, and 3, 12, and 24 months postpartum between April 2010 and March 2014. Growth mixture modeling was used to identify distinct trajectories of depressive symptoms. Several psychosocial, obstetric, and sociodemographic characteristics were assessed and multinomial regression analysis was performed to investigate the influence of these variables on the different depression trajectories.RESULTS: We found three distinct classes of depressive symptoms that were characterized by an asymptomatic trajectory (91.5%), by recurrent risk (4.3%) and by postnatal risk (4.3%). The longitudinal course of depressive symptoms was strongly associated with anxiety symptoms (χ2 = 258.54, df = 6, p < 0.001; φ = .577). Among other factors, higher levels of anxiety, new pregnancy 2 years after birth, economic stress, and family stress were associated with the risk classes.CONCLUSIONS: A substantial proportion of West African women in our sample developed unfavorable patterns of depressive symptoms during the vulnerable phase of pregnancy and early motherhood. Psychosocial factors, especially antepartum anxiety symptoms, played a decisive role in this process. Perceived economic hardship further exaggerated the mental health burden.

AB - BACKGROUND: The vast majority of research on mental health has been undertaken in high income countries. This study aimed at investigating the long-term course of maternal depressive symptoms and its association with various mother- and child-related characteristics in two West African lower middle income countries with focus on the relationship with long-term anxiety symptoms.METHODS: In the Child Development Study, a prospective birth cohort study in Côte d'Ivoire and Ghana, the 9-item Patient Health Questionnaire (PHQ-9) was answered by N = 776 women 3 months antepartum, and 3, 12, and 24 months postpartum between April 2010 and March 2014. Growth mixture modeling was used to identify distinct trajectories of depressive symptoms. Several psychosocial, obstetric, and sociodemographic characteristics were assessed and multinomial regression analysis was performed to investigate the influence of these variables on the different depression trajectories.RESULTS: We found three distinct classes of depressive symptoms that were characterized by an asymptomatic trajectory (91.5%), by recurrent risk (4.3%) and by postnatal risk (4.3%). The longitudinal course of depressive symptoms was strongly associated with anxiety symptoms (χ2 = 258.54, df = 6, p < 0.001; φ = .577). Among other factors, higher levels of anxiety, new pregnancy 2 years after birth, economic stress, and family stress were associated with the risk classes.CONCLUSIONS: A substantial proportion of West African women in our sample developed unfavorable patterns of depressive symptoms during the vulnerable phase of pregnancy and early motherhood. Psychosocial factors, especially antepartum anxiety symptoms, played a decisive role in this process. Perceived economic hardship further exaggerated the mental health burden.

KW - Child

KW - Cote d'Ivoire

KW - Depression, Postpartum

KW - Female

KW - Ghana

KW - Humans

KW - Pregnancy

KW - Surveys and Questionnaires

KW - Journal Article

U2 - 10.1371/journal.pone.0187267

DO - 10.1371/journal.pone.0187267

M3 - SCORING: Journal article

C2 - 29107975

VL - 12

SP - e0187267

JO - PLOS ONE

JF - PLOS ONE

SN - 1932-6203

IS - 11

ER -