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  • Title: Trajectories and predictors of perinatal depressive symptoms among Kenyan women: a prospective cohort study.
    Author: Larsen A, Pintye J, Marwa MM, Watoyi S, Kinuthia J, Abuna F, Richardson BA, Gomez L, Dettinger JC, John-Stewart G.
    Journal: Lancet Psychiatry; 2022 Jul; 9(7):555-564. PubMed ID: 35598606.
    Abstract:
    BACKGROUND: There are gaps in understanding longitudinal patterns and predictors of perinatal depressive symptoms in sub-Saharan Africa. This study aimed to explore trajectories of depressive symptoms and associated factors from pregnancy to 9 months post partum among Kenyan women. METHODS: In this prospective cohort study, we analysed data from the PrEP Implementation for Mothers in Antenatal Care (PrIMA) study in which HIV-negative women were enrolled in pregnancy and followed up to 9 months post partum in 20 public sector maternal-child health clinics in western Kenya. Pregnant women were eligible for enrolment if they were not infected with HIV, aged 15 years or older, and were able to provide consent. Eligible participants were screened and enrolled between Jan 15, 2018, and July 31, 2019, and followed up to 9 months post partum, with the last participant study visit conducted on Jan 15, 2021. Study nurses serially assessed depressive symptoms using the Center for Epidemiologic Studies Depression Scale (CESD-10), intimate partner violence with the Hurt, Insult, Threaten, Scream scale, and social support with the Medical Outcomes Study scale. Generalised estimating equations were used to identify correlates of moderate-to-severe depressive symptoms (CESD-10 score ≥10) and group-based trajectory modelling identified discrete trajectories of perinatal depressive symptoms. FINDINGS: Among 4447 participants in the main PrIMA study, 3555 had complete depressive symptom data in pregnancy and depressive symptom data post partum and were included in the primary analysis. Median age was 24·0 years (IQR 21·0-28·7), 1330 (38%) participants had low social support, and 278 (8%) reported intimate partner violence in pregnancy. All participants (100%) were female and all (100%) were of African Kenyan ethnicity. Prevalence of moderate-to-severe depressive symptoms was higher in pregnancy than post partum (870 [24·5%; 95% CI 23·1-25·9] vs 597 [6·8%; 15·6-18·1]; p<0·0001). Five patterns of depressive symptoms were identified; persistent moderate-to-severe depressive symptoms in pregnancy and post partum (295 [8·3%]), moderate-to-severe depressive symptoms in pregnancy that resolved post partum (139 [3·9%]), moderate-to-severe depressive symptoms that emerged post partum (40 [1·1%]), chronically mild symptoms (2709 [76·2%]), and no depressive symptoms (372 [10·5%]). Emergent moderate-to-severe depressive symptoms were associated with older age. Emergent, persistent, and resolving moderate-to-severe depressive symptoms were associated with intimate partner violence during pregnancy; and persistent and resolving moderate-to-severe depressive symptoms were associated with low social support and high HIV risk (all p<0·05). Moderate-to-severe depressive symptom risk was significantly increased with intimate partner violence (adjusted odds ratio 2·07 [95% CI 1·81-2·31]; p<0·0001), low social support (1·74 [1·56-1·95]; p<0·0001), and partner HIV-positive status (1·48 [1·22-1·78]; p<0·0001). 23·34% (95% CI 18·77-27·65) of cases of perinatal moderate-to-severe depressive symptoms were attributable to low social support. INTERPRETATION: One third of women had perinatal moderate-to-severe depressive symptoms; nearly half of these had higher severity phenotypes of resolving, persistent, and emerging moderate-to-severe depressive symptoms that might require tailored interventions. Perinatal women with comorbid psychosocial stressors such as intimate partner violence and previous pregnancy loss should be prioritised for mental health services that augment social support within routine maternal-child health care. FUNDING: National Institutes of Health. TRANSLATION: For the Kiswahili translation of the abstract see Supplementary Materials section. USULI WA UTAFITI:: Bado kuna mapengo katika kuelewa aina na vibashiri vya muda mrefu vya dalili za sonona kabla na baada ya kujifungua barani Afrika kusini mwa Sahara. Utafiti huu umelenga kuchunguza mielekeo ya dalili za sonona na sababu ambatanishi kutoka kipindi cha ujauzito hadi miezi 9 baada ya kujifungua miongoni mwa wanawake wa Kenya. NJIA:: Katika utafiti huu wa makundi yamuda mrefu, tulichambua data kutoka kwenye Utekelezaji wa utoaji dawa za kujikinga na maambukizi ya virusi vya ukimwi (PrEP) kwa akina Mama katika utafiti wa Utunzaji wa Ujauzito ambapo wanawake wajawazito wasio na maambukizi ya virusi vya ukimwi walifuatiliwa kwa kipindi cha hadi miezi 9 baada ya kujifungua katika kliniki 20 za sekta ya umma ya afya ya watoto Magharibi mwa Kenya. Wauguzi watafiti walitathmini kimfululizo dalili za sonona kwa kutumia Kipimo cha Sonona cha Kituo cha Tafiti za Kiepidemiolojia (CESD-10), ukatili wa mpenzi wa karibu (IPV) chenye kipimo cha Kuumiza, Kutusi, Kutishia, Kulia, na msaada wa kijamii na kipimo cha Utafiti wa Matokeo ya Kimatibabu. Milinganyo ya ujumla ya ukadiriaji ilitumika kutambua mifano ya dalili za wastani hadi kali za sonona (MSD) (Alama ya CESD-10 ≥10) na aina zilizotambulika za uundaji mwelekeo kulingana na kundi (GBTM). MATOKEO:: Kati ya wanawake 3555, umri wa wastani ulikuwa miaka 24 (IQR 21–28.7), 1330 (38%) walikuwa na msaada mdogo wa kijamii, na 278 (8%) ukatili wa mpenzi wa karibu yaani IPV katika ujauzito. Washiriki wote (3555, 100%) walikuwa jinsia ya kike na wote (3555, 100%) walikuwa Waafrika wenye asili ya Kenya. Uwepo wa dalili za wastani hadi kali za sonona yaani MSD ulikuwa mkubwa zaidi katika ujauzito kuliko baada ya kujifungua (870/3555, 24.5% dhidi ya 597/3555, 16.8%, p<0.001). Aina tano za dalili za sonona ziligundulika; dalili za wastani hadi kali za sonona yaani MSD zilizo endelevu katika ujauzito na baada ya kujifungua (295, 8%), dalili za wastani hadi kali za sonona yaani MSD zilizoisha baada ya kujifungua (139, 4%), dalili za wastani hadi kali za sonona yaani MSD zilizotokea baada ya kujifungua (40, 1%), dalili nyepesi za muda mrefu (2,709, 76%), na wasio na dalili za sonona (372, 10%). Dalili za wastani hadi kali za sonona yaani MSD zilizojitokeza zilihusishwa na umri mkubwa zaidi. Dalili za wastani hadi kali za sonona yaani MSD za kujitokeza, endelevu, na zinazoisha zilihusishwa na ukatili wa mwenzi wa karibu yaani IPV katika ujauzito; dalili za wastani hadi kali za sonona yaani MSD zilizo endelevu na zinazoisha zilihusishwa na msaada mdogo wa kijamii na hatari kubwa ya kupata virusi ya ukimwi (p<0.05). Hatari ya dalili za wastani hadi kali za sonona yaani MSD ilikuwa kubwa zaidi kwa mara 1.5 hadi 2.8 kwenye ukatili wa mpenzi wa karibu yaani IPV, msaada mdogo wa kijamii, na hali ya mpenzi kuwa na virusi vya ukimwi. (p<0.05); 23% ya kesi za dalili za wastani hadi kali za sonona yaani MSD wakati wa ujauzito hadi baada ya kujifungua zilichangiwa na msaada mdogo wa kijamii. TAFSIRI:: Theluthi moja ya wanawake walikuwa na dalili za wastani hadi kali za sonona yaani MSD; 13% (474) walikuwa na aina za dalili za wastani hadi kali za sonona yaani MSD za kuisha, endelevu, na zinazojitokeza zenye ukali zaidi ambazo zinaweza kuhitaji hatua stahiki. Wanawake walio kipindi cha ujauzito hadi baada ya kujifungua wenye visababishi vya kisaikolojia na kijamii vya msongo wa mawazo kama vile ukatili wa mwenzi wa karibu yaani IPV na upotezaji ujauzito hapo kabla wanapaswa kupewa kipaumbele kwenye huduma za afya ya akili ambazo zitaongezea msaada wa kijamii ndani ya matunzo ya kawaida ya Afya ya Mama na Mtoto yaani MCH. UFADHILI:: Taasisi za Taifa za Afya
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