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Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling

BACKGROUND: Postnatal depression (PND) is the second most common cause of disability and the most common complication after childbirth. Understanding the potential mechanisms by which the stress process can lead to PND is an important step for planning preventive interventions for PND. This study em...

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Autores principales: Dadi, Abel Fekadu, Mwanri, Lillian, Woodman, Richard J., Azale, Telake, Miller, Emma R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206662/
https://www.ncbi.nlm.nih.gov/pubmed/32381087
http://dx.doi.org/10.1186/s12978-020-00912-z
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author Dadi, Abel Fekadu
Mwanri, Lillian
Woodman, Richard J.
Azale, Telake
Miller, Emma R.
author_facet Dadi, Abel Fekadu
Mwanri, Lillian
Woodman, Richard J.
Azale, Telake
Miller, Emma R.
author_sort Dadi, Abel Fekadu
collection PubMed
description BACKGROUND: Postnatal depression (PND) is the second most common cause of disability and the most common complication after childbirth. Understanding the potential mechanisms by which the stress process can lead to PND is an important step for planning preventive interventions for PND. This study employed a stress process model to explore the possible pathways leading to PND in Gondar Town, Ethiopia. METHODS: A community-based cohort study was conducted in 916 pregnant women, who were assessed for depression in their second or third trimester of pregnancy and re-assessed two to eight weeks after birth. Women with an Edinburgh Postnatal Depression Scale (EPDS) ≥6 were considered to be depressed. Modified Poisson regression was used to identify the independent predictors of PND. A Generalized Structural Equation Modeling (GSEM) was then used to explore the direct and indirect effects of stressors and their mediators on PND. RESULTS: The prevalence and incidence proportion of PND were 9.27% (95%CI: 7.45, 11.36) and 7.77% (95%CI: 6.04, 9.79), respectively and 2.1% of the women demonstrated symptoms of depression within the study period. PND was independently predicted by having limited postnatal care services, Antenatal Depression (AND) and a Common Mental Disorders (CMD) before pregnancy, (IRR = 1.8; 95%CI: 1.0, 3.2), 1.6(95%CI: 1.4, 1.7), and 2.4 (95%CI: 1.4, 4.3) respectively). In SEM, AND (standardized total effect = 0.36) and a CMD before pregnancy (standardized total effect = 0.11) had both a direct and an indirect positive effect on PND scores. Low birth weight (standardized β = 0.32) and self-reported labor complications (standardized β = 0.09) had direct effects only on PND scores. CONCLUSION: The observed incidence and prevalence of PND in Ethiopia were lower than in previous studies. A CMD before pregnancy and low birth weight (LBW) increased PND scores, and these effects were in part mediated via antenatal depression and labor complications. Early detection and treatment of depression before or during pregnancy could either directly or indirectly reduce the risk of labor complications and PND. Interventions that reduce LBW or improve the uptake of postnatal care might reduce PND incidence.
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spelling pubmed-72066622020-05-14 Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling Dadi, Abel Fekadu Mwanri, Lillian Woodman, Richard J. Azale, Telake Miller, Emma R. Reprod Health Research BACKGROUND: Postnatal depression (PND) is the second most common cause of disability and the most common complication after childbirth. Understanding the potential mechanisms by which the stress process can lead to PND is an important step for planning preventive interventions for PND. This study employed a stress process model to explore the possible pathways leading to PND in Gondar Town, Ethiopia. METHODS: A community-based cohort study was conducted in 916 pregnant women, who were assessed for depression in their second or third trimester of pregnancy and re-assessed two to eight weeks after birth. Women with an Edinburgh Postnatal Depression Scale (EPDS) ≥6 were considered to be depressed. Modified Poisson regression was used to identify the independent predictors of PND. A Generalized Structural Equation Modeling (GSEM) was then used to explore the direct and indirect effects of stressors and their mediators on PND. RESULTS: The prevalence and incidence proportion of PND were 9.27% (95%CI: 7.45, 11.36) and 7.77% (95%CI: 6.04, 9.79), respectively and 2.1% of the women demonstrated symptoms of depression within the study period. PND was independently predicted by having limited postnatal care services, Antenatal Depression (AND) and a Common Mental Disorders (CMD) before pregnancy, (IRR = 1.8; 95%CI: 1.0, 3.2), 1.6(95%CI: 1.4, 1.7), and 2.4 (95%CI: 1.4, 4.3) respectively). In SEM, AND (standardized total effect = 0.36) and a CMD before pregnancy (standardized total effect = 0.11) had both a direct and an indirect positive effect on PND scores. Low birth weight (standardized β = 0.32) and self-reported labor complications (standardized β = 0.09) had direct effects only on PND scores. CONCLUSION: The observed incidence and prevalence of PND in Ethiopia were lower than in previous studies. A CMD before pregnancy and low birth weight (LBW) increased PND scores, and these effects were in part mediated via antenatal depression and labor complications. Early detection and treatment of depression before or during pregnancy could either directly or indirectly reduce the risk of labor complications and PND. Interventions that reduce LBW or improve the uptake of postnatal care might reduce PND incidence. BioMed Central 2020-05-07 /pmc/articles/PMC7206662/ /pubmed/32381087 http://dx.doi.org/10.1186/s12978-020-00912-z Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Dadi, Abel Fekadu
Mwanri, Lillian
Woodman, Richard J.
Azale, Telake
Miller, Emma R.
Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling
title Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling
title_full Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling
title_fullStr Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling
title_full_unstemmed Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling
title_short Causal mechanisms of postnatal depression among women in Gondar town, Ethiopia: application of a stress-process model with generalized structural equation modeling
title_sort causal mechanisms of postnatal depression among women in gondar town, ethiopia: application of a stress-process model with generalized structural equation modeling
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7206662/
https://www.ncbi.nlm.nih.gov/pubmed/32381087
http://dx.doi.org/10.1186/s12978-020-00912-z
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