A Quarter of Women in Low- and Middle-Income Countries Report Perinatal Depression

A systematic review and meta-analysis published in JAMA Psychiatry found that a quarter of perinatal women living in low- and middle-income countries were affected by depression.

Investigators from The University of Melbourne in Australia searched publication databases from inception through April 2021 for studies of depression among perinatal women on the basis of country income status. The perinatal period was defined as anytime during pregnancy to 12 months postpartum.

A total of 589 studies published between 1992 and 2021 met the inclusion criteria. The study population comprised 616,708 women from 51 countries defined by the World Bank as low, lower-middle, and upper-middle income countries.

Perinatal depression was reported at a prevalence of 24.7% (95% CI, 23.7%-25.6%).

Depression depended on country income level (P <.001), in which the prevalence was highest in lower-middle-income countries (25.5%; 95% CI, 23.8%-27.1%), followed by upper-middle-income countries (24.7%; 95% CI, 23.6%-25.9%) and low-income countries (20.7%; 95% CI, 18.4%-23.0%).

Stratified by geographic region, depression was lowest in East Asia and the Pacific (21.4%; 95% CI, 19.8%-23.1%) and highest in the Middle East (31.5%; 95% CI, 26.9%-36.2%; P <.001).

Stratified by period, the pooled prevalence of antenatal depression was 26.3% (95% CI, 24.9%-27.6%) which was higher than prenatal depression (23.1%; 95% CI, 21.8%-24.5%; P =.001) and antenatal plus postnatal depression (20.9%; 95% CI, 15.1%-26.6%).

Among at-risk groups, the overall rate of depression was 35.0% (95% CI, 32.3%-37.6%). Stratified by risk, depression was highest among women who experienced any intimate partner violence (46.3%; 95% CI, 38.7%-53.9%) and lowest for those living in war or conflict zones (15.1%; 95% CI, 9.1%-21.2%).

As significant study heterogeneity was observed, the investigators performed a sensitivity analysis. After removing 42 studies that reported depression at a prevalence below 5% or greater than 60%, the pooled estimate of depression was 23.4% (95% CI, 22.6%-24.2%).

The major limitation of this analysis was that significant effects were observed for study setting (eg, community setting, teaching hospital) and depression tool use (eg, self-report, Edinburgh Postnatal Depression Scale, Mini International Neuropsychiatric Interview).

Review authors concluded, “[P]erinatal depression in [low- and middle-income countries] was common. One quarter of individuals living in LMICs reported experiencing depression during and within a year following pregnancy.”

This article originally appeared on Psychiatry Advisor