Maternal common mental disorder in Malawi, Africa
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Date
02/07/2016Item status
Restricted AccessEmbargo end date
31/12/2100Author
Stewart, Robert Charles
Metadata
Abstract
Background
Maternal common mental disorder (CMD), characterised by depression, anxiety and
somatic symptoms of distress, is known to be an important health problem in low-and-middle-
income countries, but had not been investigated in Malawi, Africa. In
preliminary work, we adapted a CMD screening measure and showed that post-partum
CMD was common and associated with child stunting.
In the research presented here, we expanded the investigation of CMD in Malawi to
include pregnant women and mothers of children with severe acute malnutrition
(SAM). Using validated measures, we aimed to estimate the prevalence of antenatal
CMD/depression and investigate its relationship to social support and intimate partner
violence. Secondly, we sought to explore women’s lived experiences of the perinatal
period. Finally, we investigated CMD amongst mothers of children admitted with
SAM and other life-threatening illness and, in the former, we tested the hypothesis that
maternal CMD would be associated with impaired child recovery.
Method
In an antenatal clinic-based study, we validated and compared Chichewa and Chiyao
versions of the Self Reporting Questionnaire (SRQ) and Edinburgh Postnatal
Depression Scale (EPDS) using major depressive episode (MDE) as the criterion
diagnosis. We adapted and validated the Multi-dimensional Scale of Perceived Social
Support (MSPSS). We measured the prevalence of antenatal MDE and identified
associated factors. We conducted focus group discussions with women and enquired
about perinatal stressors and supports. We administered the SRQ to mothers of
children with SAM during admission to a nutritional rehabilitation unit (NRU) and at
1-month post-discharge, and investigated whether CMD was a risk factor for lower
child weight gain at follow-up. In a subsequent study, we compared levels of CMD
symptoms between mothers of children admitted to a NRU, a high dependency unit
and an oncology ward. Results
We found that the adapted EPDS and SRQ were both valid screening instruments for
antenatal CMD/depression. The weighted prevalence of antenatal MDE was 10.7%
(95% CI 6.9% - 14.5%). The adapted MSPSS showed adequate test characteristics and
differentiated between sources of social support. MDE was associated with lack of
support by a significant other; intimate partner violence moderated this association.
We found that women in rural Malawi recognised depressive and anxious states in the
perinatal period and identified lack of partner support as a key stressor.
During admission with a severely malnourished child to a NRU, mothers had very high
SRQ scores that greatly reduced post-discharge. There was no association between
SRQ score and child weight gain at follow-up. We found no higher level of CMD
symptoms amongst mothers of children admitted for treatment of SAM compared with
those admitted to other wards.
Conclusions
We demonstrated that measures of antenatal CMD and perceived social support can
be adapted for use in Malawi. We found that maternal CMD is common and associated
with lack of social support, intimate partner violence and child illness. We did not find
evidence for a specific association between maternal CMD and child SAM but further
prospective studies are required. Our findings suggest that treatment of CMD in
mothers in Malawi will require attention to social support and partner behaviour.