Pamela J Surkan1, Kwame Sakyi2, Donna M Strobino3, Sucheta Mehra4, Alain Labrique4, Hasmot Ali5, Barkat Ullah5, Lee Wu4, Rolf Klemm4, Mahbubur Rashid4, Keith P West4, Parul Christian4. 1. Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: psurkan@jhu.edu. 2. Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 3. Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 4. Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. 5. The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh.
Abstract
PURPOSE: We examined stillbirth and neonatal death as predictors of depressive symptoms in women experiencing these events during the first 6 months postpartum. METHODS: We performed secondary analyses using data from 41,348 married women aged 13-44 years, originally collected for the JiVitA-1 study (2001-2007) in northwest Bangladesh. Adjusted relative risk ratios were estimated to determine the associations between stillbirth and early infant death and women's risk of reported depressive symptoms (trichotomized 0, 1-2, 3-5) up to 6 months after the death. Adjusted risk ratios, comparing 0-2 versus 3-5 depressive symptoms, were used in stratified analyses. RESULTS: Women having fetal/infant deaths had elevated risk of experiencing 1-2 postpartum depressive symptoms (adj RRRs between 1.2 and 1.7) and of experiencing 3-5 postpartum depressive symptoms (adj RRRs between 1.9 and 3.3), relative to women without a fetal/infant death. Notably, those whose infants died in the early postneonatal period had over a three-fold risk of 3-5 depressive symptoms (adj relative risk ratio [RRR] = 3.3; 95% confidence interval [CI], 2.6-4.3) compared to a two-fold risk for women experiencing a stillbirth (adj RRR = 1.9; 95% CI, 1.7-2.1). After early postneonatal deaths, women with higher levels of education were more likely to suffer 3-5 depressive symptoms (adj relative risk [RR] = 10.6; 95% CI, 5.2-21.7, ≥10 years of education) compared to women with lower levels of education (adj RR = 2.0; 95% CI, 1.6-2.4, no education; adj RR = 2.2; 95% CI, 1.6-2.9, 1-9 years of education). CONCLUSIONS: Women's mental health needs should be prioritized in low-resource settings, where these outcomes are relatively common and few mental health services are available.
PURPOSE: We examined stillbirth and neonatal death as predictors of depressive symptoms in women experiencing these events during the first 6 months postpartum. METHODS: We performed secondary analyses using data from 41,348 married women aged 13-44 years, originally collected for the JiVitA-1 study (2001-2007) in northwest Bangladesh. Adjusted relative risk ratios were estimated to determine the associations between stillbirth and early infantdeath and women's risk of reported depressive symptoms (trichotomized 0, 1-2, 3-5) up to 6 months after the death. Adjusted risk ratios, comparing 0-2 versus 3-5 depressive symptoms, were used in stratified analyses. RESULTS:Women having fetal/infant deaths had elevated risk of experiencing 1-2 postpartum depressive symptoms (adj RRRs between 1.2 and 1.7) and of experiencing 3-5 postpartum depressive symptoms (adj RRRs between 1.9 and 3.3), relative to women without a fetal/infantdeath. Notably, those whose infants died in the early postneonatal period had over a three-fold risk of 3-5 depressive symptoms (adj relative risk ratio [RRR] = 3.3; 95% confidence interval [CI], 2.6-4.3) compared to a two-fold risk for women experiencing a stillbirth (adj RRR = 1.9; 95% CI, 1.7-2.1). After early postneonatal deaths, women with higher levels of education were more likely to suffer 3-5 depressive symptoms (adj relative risk [RR] = 10.6; 95% CI, 5.2-21.7, ≥10 years of education) compared to women with lower levels of education (adj RR = 2.0; 95% CI, 1.6-2.4, no education; adj RR = 2.2; 95% CI, 1.6-2.9, 1-9 years of education). CONCLUSIONS:Women's mental health needs should be prioritized in low-resource settings, where these outcomes are relatively common and few mental health services are available.
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