Derrick Silove1, Susan Rees2, Alvin Kuowei Tay3, Zelia Maria da Costa4, Elisa Soares Savio4, Cesarina Soares4, Wietse Tol5. 1. Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, Liverpool Hospital, Sydney, NSW, Australia. 2. Psychiatry Research and Teaching Unit, School of Psychiatry and Ingham Institute, University of New South Wales, Liverpool Hospital, Sydney, NSW, Australia. Electronic address: s.j.rees@unsw.edu.au. 3. Psychiatry Research and Teaching Unit, Southwest Sydney Local Health District, Liverpool Hospital, Sydney, NSW, Australia. 4. Alola Women's Foundation, Dili, Timor-Leste. 5. Johns Hopkins University, Hampton House, Baltimore, MD, USA.
Abstract
BACKGROUND: The contributions of potentially traumatic events (PTEs) of mass conflict and post-traumatic stress disorder (PTSD) symptoms to perinatal depression in women living in low-income, post-conflict countries are unclear. We tested a model including these factors, intimate partner violence (IPV), and continuing adversity in women in Timor-Leste. METHODS: Our modelling study used cross-sectional data from a sample of women living in two districts in Timor-Leste, identified through service registers, clinic records, village chiefs, and a door-to-door survey between June, 2012, and June, 2013. Eligible women were 3-6 months pregnant or 3-6 months postpartum. We assessed conflict-related PTEs, IPV, continuing adversity (poverty and insecurity), PTSD symptoms (the Harvard Trauma Questionnaire), and maternal depressive symptoms (the Edinburgh Postnatal Depression Scale [EPDS]) to develop a theoretical model to examine pathways leading directly and indirectly to depressive symptoms. FINDINGS: We assessed 427 eligible women, of whom 258 (60%) were pregnant and 169 (40%) were postnatal. 87 (22%) of 387 women who were given the EPDS to complete were above the threshold used to define depression, and 40 (9%) of 427 were regarded as having PTSD. Our most comprehensive model showed that IPV and conflict-related deprivations led directly to depressive symptoms as well as to continuing adversity. Human rights-related trauma, witnessing murder, and a further path from IPV led to PTSD symptoms. Human rights-related trauma also led to continuing adversity. Paths from continuing adversity led to depressive symptoms, and PTSD symptoms, which was the predominant path. We noted a strong and unidirectional path from PTSD symptoms to depressive symptoms. INTERPRETATION: Protection of women from human rights abuses, prevention of IPV, reduction in insecurity and poverty in the post-conflict period, and identification of and treatment for PTSD symptoms might reduce the risk of perinatal depression in post-conflict, low-income countries. Longitudinal studies are needed to confirm these findings. FUNDING: Australian National Health and Medical Research Council.
BACKGROUND: The contributions of potentially traumatic events (PTEs) of mass conflict and post-traumatic stress disorder (PTSD) symptoms to perinatal depression in women living in low-income, post-conflict countries are unclear. We tested a model including these factors, intimate partner violence (IPV), and continuing adversity in women in Timor-Leste. METHODS: Our modelling study used cross-sectional data from a sample of women living in two districts in Timor-Leste, identified through service registers, clinic records, village chiefs, and a door-to-door survey between June, 2012, and June, 2013. Eligible women were 3-6 months pregnant or 3-6 months postpartum. We assessed conflict-related PTEs, IPV, continuing adversity (poverty and insecurity), PTSD symptoms (the Harvard Trauma Questionnaire), and maternal depressive symptoms (the Edinburgh Postnatal Depression Scale [EPDS]) to develop a theoretical model to examine pathways leading directly and indirectly to depressive symptoms. FINDINGS: We assessed 427 eligible women, of whom 258 (60%) were pregnant and 169 (40%) were postnatal. 87 (22%) of 387 women who were given the EPDS to complete were above the threshold used to define depression, and 40 (9%) of 427 were regarded as having PTSD. Our most comprehensive model showed that IPV and conflict-related deprivations led directly to depressive symptoms as well as to continuing adversity. Human rights-related trauma, witnessing murder, and a further path from IPV led to PTSD symptoms. Human rights-related trauma also led to continuing adversity. Paths from continuing adversity led to depressive symptoms, and PTSD symptoms, which was the predominant path. We noted a strong and unidirectional path from PTSD symptoms to depressive symptoms. INTERPRETATION: Protection of women from human rights abuses, prevention of IPV, reduction in insecurity and poverty in the post-conflict period, and identification of and treatment for PTSD symptoms might reduce the risk of perinatal depression in post-conflict, low-income countries. Longitudinal studies are needed to confirm these findings. FUNDING: Australian National Health and Medical Research Council.
Authors: Kathrin Kahnert; Tanja Lucke; Rudolf M Huber; Jürgen Behr; Frank Biertz; Anja Vogt; Henrik Watz; Peter Alter; Sebastian Fähndrich; Robert Bals; Rolf Holle; Stefan Karrasch; Sandra Söhler; Margarethe Wacker; Joachim H Ficker; Klaus G Parhofer; Claus Vogelmeier; Rudolf A Jörres Journal: PLoS One Date: 2017-05-15 Impact factor: 3.240
Authors: Susan J Rees; Mohammed Mohsin; Louis Klein; Zachary Steel; Wietse Tol; Mark Dadds; Valsamma Eapen; Zelia da Costa; Elisa Savio; Natalino Tam; Derrick Silove Journal: BJPsych Open Date: 2022-02-24
Authors: Derrick Silove; Mohammed Mohsin; Louis Klein; Natalino De Jesus Tam; Mark Dadds; Valsamma Eapen; Wietse A Tol; Zelia da Costa; Elisa Savio; Rina Soares; Zachary Steel; Susan J Rees Journal: BMJ Glob Health Date: 2020-03-30