Magnitude, trajectory and determinants of antenatal depressive symptoms in Adama Town and East Shewa Zone, Ethiopia: evidence from a prospective longitudinal eCohort survey.

چکیده اصلی

OBJECTIVES: Antenatal depression is a significant yet under-recognised global public health concern that affects a substantial proportion of women in Ethiopia. This study aimed to examine the magnitude, trajectory and determinants of depressive symptoms among pregnant women. DESIGN: A prospective longitudinal study design was conducted between April 2023 and February 2024. SETTING AND PARTICIPANTS: The study was conducted in Adama Town and the East Shewa Zone of the Oromia Region, Ethiopia. A total of 933 pregnant women who visited the health facility for their first ANC visit were recruited and followed throughout their pregnancy. PRIMARY AND SECONDARY OUTCOME MEASURES: Antenatal depressive symptoms were measured using the Patient Health Questionnaire-9 through face-to-face interviews and monthly phone calls. The trajectory and determinants of antenatal depressive symptoms were assessed using group-based trajectory modelling and generalised estimating equations. RESULTS: The study found that overall, 30.5% of participants experienced antenatal depressive symptoms, with a lower prevalence at the first measurement point (24.2%) and higher prevalence at the second measurement point (36.9%). Antenatal depressive symptoms were higher during the first trimester (35.6%) compared with the second (19.8%) and third (13.2%) at baseline, and the pattern was consistent across the monthly follow-up period. Moreover, 11.6% of pregnant women had a trajectory of mild-to-moderate depressive symptoms over time. Factors included being currently married (adjusted OR (aOR) 0.53; 95% CI 0.28 to 0.98), having an unintended pregnancy (aOR 1.29; 95% CI 1.03 to 1.62), experiencing intimate partner violence (aOR 2.43; 95% CI 1.67 to 3.56), experiencing at least one pregnancy danger sign (aOR 2.60; 95% CI 2.22 to 3.04), having a history of at least one pregnancy complication (aOR 1.87; 95% CI 1.53 to 2.29), being in the first trimester (aOR 1.45; 95% CI 1.09 to 1.93), having poorer self-reported health (aOR 1.66; 95% CI 1.40 to 1.97) and moderate to low health-related quality of life (aOR 2.43; 95% CI 1.78 to 3.32) were associated with antenatal depressive symptoms. CONCLUSION: Nearly one-third of pregnant women had antenatal depressive symptoms, and one in 10 demonstrated steadily increased depressive symptoms over time. The high burden of antenatal depressive symptoms and their association with preventable social and pregnancy-related factors underscore the need for comprehensive antenatal care services that incorporate mental health screening, psychosocial support and interventions addressing intimate partner violence and pregnancy-related complications.

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