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dc.contributor.advisorGrant, Liz
dc.contributor.authorStewart, Robert Charles
dc.date.accessioned2018-01-11T11:17:36Z
dc.date.available2018-01-11T11:17:36Z
dc.date.issued2016-07-02
dc.identifier.urihttp://hdl.handle.net/1842/25898
dc.description.abstractBackground 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.en
dc.language.isoenen
dc.publisherThe University of Edinburghen
dc.relation.hasversionStewart R.C., Umar E., Tomenson B., Creed F. (2013) Validation of screening tools for antenatal depression in Malawi-A comparison of the Edinburgh Postnatal Depression Scale and Self Reporting Questionnaire. Journal of Affective Disorders 150(3):1041-1047en
dc.relation.hasversionStewart R.C., Umar E., Tomenson B., Creed F. (2014) A Cross-Sectional Study of Antenatal Depression and Associated Factors in Malawi. Archives of Women's Mental Health 17 (2):145–154en
dc.relation.hasversionStewart R.C., Umar E., Tomenson B., Creed F. (2014) Validation of the Multi-Dimensional Scale of Perceived Social Support (MSPSS) and the Relationship Between Social Support, Intimate Partner Violence and Antenatal Depression in Malawi. BMC Psychiatry 14 (1):180en
dc.relation.hasversionStewart R.C., Umar E., Gleadow-Ware S., Creed F., Bristow K. (2015) Perinatal distress and depression in Malawi: an exploratory qualitative study of stressors, supports and symptoms. Archives Women’s Mental Health 18 (2), pp. 177– 185en
dc.relation.hasversionStewart R.C., Bunn J., Vokhiwa M., Umar E., Kauye F., Tomenson B., Rahman A., Creed F. (2011) A Prospective Study of Psychological Distress Amongst Mothers of Children Admitted to a Nutritional Rehabilitation Unit in Malawi, and its Impact on Post-discharge Child Weight Gain. Child: Care, Health and Development. 37 (1):55-63en
dc.relation.hasversionColman S., Stewart R.C., MacArthur C., Kennedy N., Tomenson B., Creed F. (2015) Psychological distress in mothers of children admitted to a nutritional rehabilitation unit in Malawi - a comparison with other paediatric wards. Maternal & Child Nutrition. 11, 915–925en
dc.relation.hasversionStewart, R.C. (2007); Maternal depression and infant growth: a review of recent evidence. Maternal Child Nutrition, 3, 94-107en
dc.relation.hasversionStewart R.C., Kauye F., Umar E., Bunn J., Vokhiwa M., Fitzgerald M., Tomenson B., Rahman A., Creed F. (2008); Validation of a Chichewa version of the Self-Reporting Questionnaire (SRQ) as a brief measure of Maternal Depressive Disorder in Malawi, Africa. Journal of Affective Disorders, 112, 126-34en
dc.relation.hasversionStewart R.C., Umar E., Kauye F., Bunn .J, Vokhiwa M., Fitzgerald M., Tomenson B., Rahman A., Creed F. (2008); Maternal Common Mental Disorder and Infant Growth – A Cross-Sectional Study from Malawi. Maternal Child Nutrition, 4, 209-19en
dc.relation.hasversionStewart R.C., Bunn J., Vokhiwa M., Umar E., Kauye F., Fitzgerald M., Tomenson B., Rahman A., Creed F. (2010); Common Mental Disorder and Associated Factors Amongst Women With Young Infants in Rural Malawi. Social Psychiatry and Psychiatric Epidemiology, 45(5):551-9en
dc.subjectmental healthen
dc.subjectdepressionen
dc.subjectpregnancyen
dc.subjectMalawien
dc.subjectlow-income countryen
dc.titleMaternal common mental disorder in Malawi, Africaen
dc.typeThesis or Dissertationen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD(P) Doctor of Philosophy by Research Publicationsen
dc.rights.embargodate2100-12-31en
dcterms.accessRightsRestricted Accessen


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