Predictors and occurrence of antenatal depression in Galle, Sri Lanka

Abstract

Antenatal depression is a serious mental health issue that can affect both mother and baby. Findings risk factors across a biopsychosocial model for antenatal depression are still inconsistent across context. The purpose of this study is to explore individual and health system factors associated with antenatal depression in Sri Lanka using a cross-sectional mixed methods approach. The quantitative portion included 505 patients from Galle, Sri Lanka, with health record data and responses to psychometric questionnaires. For the qualitative portion, public health midwives working in this district were interviewed about their experiences and typical clinical practices with antenatal depression patients. The estimated prevalence of antenatal depression in this region was 7.5%, with 4.4% reporting self-harm ideation (depression assessed using Edinburgh Postpartum Depression Scale). Prevalence was highest in patients who were over the age of 30 (n = 184, OR = 3.88, 95%CI = 1.71 – 9.97), diabetic (n = 32, OR = 3.99, 95%CI = 1.50 – 9.56), or pre-eclamptic in a previous pregnancy (n = 31, OR = 3.32, 95%CI = 1.17 – 8.21). Lower prevalence was observed in the primiparous (n = 211, OR = 0.29, 95%CI = 0.12 – 0.64) employed (n = 197, OR = 0.33, 95%CI = 0.13 – 0.72), or lower-middle class (n = 172, OR = 0.17, 95%CI = 0.04 – 0.56). Anxiety levels were elevated in depressed patients (OR = 1.13, 95%CI = 1.07 – 1.20), while perceived social support was lower (OR = 0.91, 95%CI = 0.89 – 0.93). Risk factors elucidated by qualitative data were consistent with the quantitative findings. Additionally, interviewed public health midwives described poor inadequate education and no official clinical guidelines for antenatal depression within their practice, leaving diagnosis up to the midwives’ discretion based on subjective measures. The prevalence of antenatal depression is low in this community compared to other communities in Sri Lanka and the global average. Biological, psychological, and social factors are all involved and must be considered to improve antenatal mental healthcare.