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Ongeri et al., J Preg Child Health 2016, 3:5
DOI: 10.4172/2376-127X.1000288
ISSN: 2376-127X

Research Article OMICS International

Antepartum Risk Factors for Postpartum Depression: A Follow up Study among

Urban Women Living in Nairobi, Kenya
Linnet Ongeri1*, Phelgona Otieno1, Jane Mbui1, Elizabeth Juma1 and Muthoni Mathai2
1Kenya Medical Research Institute, Kenya
2University of Nairobi, Kenya
*Corresponding author: Linnet Ongeri, Kenya Medical Research Institute, Kenya, Tel: 254722615999; E-mail: linongeri@gmail.com
Received date: October 14, 2016; Accepted date: October 28, 2016; Published date: October 31, 2016
Copyright: © 2016 Ongeri L, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution and reproduction in any medium, provided the original author and source are credited.

Abstract

Introduction: Longitudinal studies that assess antepartum risk factors and outcome in the postpartum period can
help provide a wealth of information in understanding maternal depression. In addition to collecting information on
prevalence and correlates of antepartum depression, such studies reveal postpartum outcomes of depression as
well as its risk factors while avoiding recall bias, a limitation frequently seen in cross sectional postpartum studies.

Methodology: We consecutively recruited 188 adult women residing in an urban, resource poor setting and
attending maternal and child health clinics in 2 major public hospitals in Nairobi, Kenya. A translated Kiswahili EPDS
was used to screen for depressive symptoms at baseline assessment in the 3rd trimester and a follow up
assessment at 6-10 weeks post-partum. A different questionnaire was administered at baseline to collect information
on potential socio demographic and clinical antepartum risk variables.

Study results: At a cut off of 13 or more on the EPDS, our study found a prevalence of 18% for antepartum
depression. Associated correlates of antepartum depression were partner current alcohol use and partner wanting
current pregnancy. Out of the 171 women we followed up at 6-12 weeks postpartum, 21% were found to have
postpartum depression. Antenatal depression and conflict with partner were the strongest independent predictors of
postpartum depression. In the adjusted analysis, the risk of having postpartum depression is increased six-fold in the
presence of antepartum depression and ten times in the presence of conflict with partner.

Conclusion: High rates of perinatal depression among women residing in Africa underscore the need for
addressing this public health burden. Despite the comparably little emphasis on antenatal depression, antenatal
depressive symptoms appear to be as common as postnatal depressive symptoms. Depression screening and
psychosocial support that especially addresses conflict resolution during pregnancy should therefore be targeted for
future interventions.

Keywords: Antepartum depression; Postpartum depression;
Edinburgh postnatal depression scale (EPDS); Urban poor resource
setting
Introduction
A greater focus on perinatal depression is steadily increasing in Sub
Saharan Africa. Previously, it was thought that the existing socio-
cultural structures related to pregnancy and early motherhood would
protect women in the region from developing perinatal depression.
However, it is now evident that not only does perinatal depression exist
in Africa but that the prevalence of affected women in Sub Saharan
Africa surpasses the burden in the West [1]. High rates of civil conflict
and political instability, changing socio-cultural structures and the
scourge of HIV in the region are strong contributors to the higher rates
being seen in the region [2-6].
Maternal depression can present during pregnancy (antepartum
depression) and or after delivery (postpartum depression). Unlike
antepartum depression, postpartum depression has been a focus of
attention and numerous studies have investigated its risk factors,
prevention and care. However, emphasis on antepartum depression is
warranted as it has been shown that significant risk factors for
postpartum depression actually present during the antepartum period
[7,8]. Furthermore, growing evidence points towards a multitude of
detrimental effects related to antepartum depression on the mother,
her partner and infant. Poor compliance with antenatal care as well as
increased risk of developing insomnia, preeclampsia, preterm delivery
and even a greater risk of the catastrophe of suicide are some of the
documented adverse effects seen in mothers with depression during
pregnancy [9-11]. Increased incidence of marital conflict leading to a
general family disharmony is also evidenced in the homes of these
mothers [12]. Outcome studies observing effect on the infant have
shown greater associations with low birth weight, smaller head
circumference, lower Apgar Scores and a higher incidence of
childhood behavioural disorders later in life [13-15].
Prevalence estimates of antepartum depression vary depending on
methodology, period of gestation and with the region the study is
conducted. A recent systematic review estimated a prevalence of 12%
in the 3rd trimester for developed countries [16]. In Sub-Saharan
Africa rates ranging from 8.3% to 39% has been reported [17-20].
Estimates of postpartum depression range between 10-15% in

J Preg Child Health, an open access journal Volume 3 • Issue 5 • 1000288

ISSN:2376-127X
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288
developed countries [21] while higher rates are seen in low and middle
income countries ranging between 15 and 57% [21-23].
Longitudinal studies that assess antepartum risk factors during
pregnancy and outcome in the postpartum period are important in
identifying predictive risk factors during the antenatal period for
postpartum depression.
Antenatal risk factors that have been found to be associated with
postnatal depression include marital discord, current or past
emotional, physical, sexual or verbal abuse by partner, lack of social
support, pregnancy unwanted by mother, stressful life events during
pregnancy, past or present psychiatric disorders in the mother,
antepartum depression, prenatal care not started until the third
trimester and poor relationships of the mother with her parents and
mother in law [24-26].
In addition to providing information on prevalence and risk factors
of antepartum and postpartum depression, longitudinal studies that
follow the same cohort of women during pregnancy right into the
post-partum period have the advantage of reduced chance of recall
bias which is a limitation frequently seen in cross sectional studies of
postpartum mental health.
Predicting the risk of postpartum depression based on the antenatal
depression correlates has scarcely been studied. This is the first Kenyan
study that has measured antepartum risk factors for postnatal
depression in a cohort of pregnant women residing in an urban
resource poor setting in Nairobi, Kenya.
Methods
Study design
This was a longitudinal study with initial assessment of pregnant
women in their third trimester and a follow up of this same cohort at
6-10 weeks postpartum.
Setting
The study was approved by the Kenya Medical Research Institute’s
ethical and review committee and was carried out between March 2014
and December 2014. Participants were recruited from the maternal
and child health clinics of 2 major public hospitals (Mathari Teaching
and Referral Hospital and Mbagathi District Hospital) in Nairobi,
Kenya. The maternal and child health clinics offer both antenatal and
postnatal care including family planning and infant immunization.
Majority of the women served by these two hospitals are from an
urban resource poor catchment area.
Participant’s recruitment and screening
Inclusion criteria: pregnant women aged between 18 and 49 years in
their 3rd trimester. As the study had a follow up time point to assess
postnatal outcome, participating women had to be willing to seek
postnatal care at the same facility. The pregnancy gestation was verified
using the patient attendance card. A total sample size of 188
participants was conveniently recruited from the outpatient waiting
area of the maternal and child health clinic of the two hospitals.
Following registration at the MCH clinic the study nurses would
inform attending women in their 3rd trimester of this on-going study
survey. Voluntary informed consent was sought after a nurse trained
on the protocol gave all explanation about the study. Those that fitted
J Preg Child Health, an open access journal
ISSN:2376-127X
Page 2 of 8
the eligibility criteria were enrolled into the study. Of the women who
met the study inclusion criteria 7 refused to participate. The reasons
given for refusal to participate were time constraints (4) and others (3)
opted to first ask permission from their partners before enrolment.
About 20 women who were over 18 years and in their 3rd trimester
could not participate as they did not plan to continue with follow-up in
the same facility (This being a hospital setting women preferred to
attend antenatal clinic here for ease of delivery in a hospital setting but
be followed up in a smaller clinic closer to their residence for
vaccination and family planning during the post-partum period) - it is
for this same reason that 16 participants (8.5%) were lost to follow-up.
Assessment procedures
Social, demographic and clinical history data were collected using a
face to face interview with structured questionnaires. Depression levels
were then assessed at baseline and again at 6-10 week postpartum
follow up using the EPDS. The structured social, demographic, clinical
history questionnaires and the EPDS screening tool were administered
by trained nurses working at the facility. Nurses were trained to
conduct the interviews as part of a larger study to see the feasibility and
acceptability of integrating the EPDS into the MCH clinics.
EPDS
The Edinburgh Postnatal Depression Scale [27-29] (EPDS or EDS
when used in the antenatal period) is the most widely used scale to
screen for antepartum and postpartum depression symptoms in low
and middle income countries. It is a 10 item questionnaire, scored
from 0-3 with scores ≥ to 10 indicating depression symptoms. The
scale has been validated for detection of depression in both
antepartum and postpartum samples [30] and used in many countries
including Kenya [31]. Prior to data collection the EPDS tool was
translated and back translated through a rigorous process into
Kiswahili language [32]. A cut off of 13 or more for screening for
antepartum depression and a cut off of 10 or more for screening for
postpartum depression was used, as recommended by Murray and Cox
in the assessment for minor antepartum depression and minor
postpartum depression respectively [33,34].
Statistical methods
Data analysis was done using STATA version 13 (Stata Cop LP,
Texas 77845 USA. Continuous data were summarized using means
(SD) or median (IQR) while categorical variables as proportions. Rates
of Antepartum depression was determined by the proportion of
women who screened 13 and more for probable depression on the
EPDS at (P 36+). To determine the risk factors for postpartum
depression, individual socio-demographic and clinical variables were
analysed using logistic regression. All tests were two sided and the level
of statistical significance was set at 5%.
Results
At an EPDS score of 13 and more, the prevalence of antenatal
depressive symptoms was found to be 18% while the postnatal
depression rate a score of 10 or more among the women followed up
was at 21%. Thirty seven per cent of the women with antenatal
depression were found to have postnatal depression at 6-10 weeks
postpartum (Figure 1).
Volume 3 • Issue 5 • 1000288
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288

Page 3 of 8

Figure 1: Study profile.

J Preg Child Health, an open access journal Volume 3 • Issue 5 • 1000288

ISSN:2376-127X
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288

Page 4 of 8

No significant association was found with age, marital status and stress and those who reported experiencing both physical and verbal
level of education. conflict in their relationships.
The risk of having postpartum depression was increased in women
found to have antepartum depression, women reporting economic

Postpartum depression

Yes No OR (95% CI) p

Age

<21 5 (15.6) 16 (11.5) 1

21-25 years 11 (34.4) 54 (38.8) 0.65 (0.20-2.15) 0.483

26-30 years 13 (40.6) 47 (33.8) 0.89 (0.27-2.87) 0.839

31-35 years 1 (3.1) 17 (12.2) 0.19 (0.02-1.79) 0.146

36+ years 2 (6.3) 5 (3.6) 1.28 (0.19-8.76) 0.801

Marital status

Single 3 (9.4) 12 (8.6) 1

Married 29 (90.6) 121 (87.1) 0.96 (0.25-3.62) 0.95

Separated 0(0.0) 6 (4.3) na na

Formal education

No formal education 0 (0.0) 1 (0.7) 1

Primary 10 (31.3) 35 (25.2) 2.34 (0.73-7.51) 0.152

Secondary 17 (53.1) 62 (44.6) 2.25 (0.77-6.57) 0.139

Tertiary (College/University) 5 (15.6) 41 (29.5) 1.00 (1.00-1.00)

Religion

Catholic 8 (25.0) 44 (31.7) 1

Protestant 17 (53.1) 78 (56.1) 1.20 (0.48-3.00) 0.699

Others 7 (21.9) 17 (12.2) 2.26 (0.71-7.21) 0.167

Monthly Income

KES2500-10 000 18 (56.3) 50 (36.0) 1

KES 10 000-30 000 12 (37.5) 66 (47.5) 0.51 (0.22-1.14) 0.102

KES 30 000-60 000 2 (6.3) 22 (15.8) 0.25 (0.05-1.18) 0.081

>KES 60 000 0 (0.0) 1 (0.7) na na

Table 1: Demographic antenatal risk factors.

Postnatally, women reporting birth complications, persistent wound their babies had a reduced risk of developing postpartum depression
pain and those who lost their babies had an increased risk of (Tables 2 and 3).
developing postpartum depression. The participants who breastfed

Postpartum depression

Yes No OR (95% CI) p

Antepartum depression

J Preg Child Health, an open access journal Volume 3 • Issue 5 • 1000288

ISSN:2376-127X
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288

Page 5 of 8

No 21 (65.6) 119 (85.6) 1

Yes 11 (34.4) 20 (14.4) 3.12 (1.31-7.44) 0.01

Relationship with partner’s mother

Good 18 (56.3) 87 (62.6) 1

Not good but can cope 5 (15.6) 13 (9.4) 1.86 (0.59-5.87) 0.29

Bad and cannot cope 2 (6.3) 4 (2.9) 2.42 (0.41-14.21) 0.329

7 (21.9) 35 (25.2) 0.97 (0.37-2.52) 0.945

Marital stress

No 24 (75.0) 103 (74.1) 1

Yes 8 (25.0) 36 (25.9) 0.95 (0.39-2.31) 0.916

Family stress

No 26 (81.3) 110 (79.1) 1

Yes 6 (18.8) 29 (20.9) 0.88 (0.33-2.33) 0.789

Economic stress

No 15 (46.9) 97 (69.8) 1

Yes 17 (53.1) 42 (30.2) 2.62 (1.20-5.73) 0.016

Societal stress and Violence

No 31 (96.9) 137 (98.6) 1

Yes 1 (3.1) 2 (1.4) 2.21 (0.19-25.15) 0.523

Conflict

No conflict 11 (34.4) 100 (71.9) 1

Any Physical conflict 2 (6.3) 1 (0.7) 18.18 (1.52-217.09) 0.022

Verbal conflict 16 (50.0) 20 (14.4) 7.27 (2.94-17.99) 0

Infidelity

Yes 5 (15.6) 9 (6.5) 1

Dont know 13 (40.6) 44 (31.7) 0.53 (0.15-1.87) 0.325

No 11 (34.4) 68 (48.9) 0.29 (0.08-1.03) 0.056

Table 2: Psychosocial antenatal risk factors for postpartum depression.

Postpartum depression

Yes No OR (95% CI) P

Mode of delivery

Normal Vaginal delivery 26 (81.3) 111 (79.9) 1

Assisted Vaginal delivery 1 (3.1) 0 (0.0) na na

Caesarean Section 5 (15.6) 27 (19.4) 0.79 (0.28-2.25) 0.66

Reported Birth complications

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ISSN:2376-127X
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288

Page 6 of 8

Yes 11 (34.4) 22 (15.8) 1

No 21 (65.6) 116 (83.5) 0.36 (0.15-0.86) 0.021

Persistent wound pain

Present 0 (0.0) 9 (6.5) 1

Absent 20 (62.5) 109 (78.4) 0.31 (0.13-0.72) 0.007

N/A 12 (37.5) 20 (14.4) na na

Low birth weight baby

No 28 (87.5) 124 (89.2) 1

Yes 4 (12.5) 13 (9.4) 1.36 (0.41-4.49) 0.611

Nursery admission

No 27 (84.4) 126 (90.6) 1

Yes 5 (15.6) 12 (8.6) 1.94 (0.63-5.98) 0.246

Outcome

Alive 27 (84.4) 132 (95.0) 1

Baby died 5 (15.6) 6 (4.3) 4.07 (1.16-14.32) 0.029

History of baby being unwell

No 5 (15.6) 24 (17.3) 1

Yes 27 (84.4) 114 (82.0) 1.14 (0.40-3.25) 0.811

Child sex

Male 12 (37.5) 67 (48.2) 1

Female 20 (62.5) 71 (51.1) 1.57 (0.71-3.46) 0.261

Mother happy with birth

No 2 (6.3) 3 (2.2) 1

Yes 28 (87.5) 130 (93.5) 0.32 (0.05-2.02) 0.228

Partner happy with birth

No 2 (6.3) 5 (3.6) 1

Yes 26 (81.3) 118 (84.9) 0.55 (0.10-3.00) 0.49

Breastfeeding

No 4 (12.5) 5 (3.6) 1

Yes 26 (81.3) 133 (95.7) 0.24 (0.06-0.97) 0.045

Table 3: Postnatal risk factors for postpartum depression.

Discussion Antepartum depression rate of 18% is higher than estimates from

The study findings show that in this setting both antenatal and
postpartum depression rates are comparable. At a cut off of 13 or more
on the EPDS antepartum depression rates of 18% was found while for
postpartum depression at 6 weeks postpartum and at a cut off of 10,a
rate of 21% was found. This is in keeping with studies that have
reported similar rates of depression in antepartum, postpartum and
non-pregnant women [35-37].
developed countries (13%) [38], but falls within the range of rates seen
in Sub Saharan Africa (8.3-39%) 6. Higher rates in Sub Saharan Africa
have been attributed to higher rates of poverty, intimate partner
violence and HIV infection [2,35,39-41].This study recruited women
from an urban poor resource setting. Both urban living and poverty
have been shown to contribute to the risk of developing perinatal
depression. Majority of women from urban settings live in nuclear
families hence may lack strong interpersonal support networks seen in

J Preg Child Health, an open access journal Volume 3 • Issue 5 • 1000288

ISSN:2376-127X
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288
their rural counterparts [42]. A low socioeconomic status has been
shown to increase the risk of depression through increased exposure to
traumatic events and stressors [43-45].
Significant antepartum risk factors for postpartum depression were
a diagnosis of antepartum depression during baseline assessment,
reported economic stress and the presence of conflict with partner. The
risk of having postpartum depression symptoms was increased three
fold in the presence of antepartum depression. Physical and verbal
conflicts increased the risk of postpartum depression 18 fold and 7 fold
respectively.
Findings from a recent meta-analysis report conducted on over
14,000 subjects found depression during pregnancy as one of the
strongest predictor of postpartum depression [46]. Similarly, a follow
up study looking at depression in pregnancy and in the postpartum
period found significant association with both antepartum depression
and history of exposure to violence and conflict [25,47,48]. Gender
based violence both physical and verbal is particularly destructive
during pregnancy as this is the period women are most vulnerable and
dependent. Other significant associations reported in previous similar
studies include stressful life events, unwanted pregnancy and having a
non-supportive husband [6,46] however, these were not statistically
significant in our study.
Significant correlates of postpartum depression during the postnatal
period were birth complications, persistent wound pain (caesarean
section wound or episiotomy wound), loss of baby and breastfeeding.
Among the women who reported birth complications majority (90%)
specified this complication to be postpartum haemorrhage, others
reported eclampsia and vaginal tears. Obstetric and infant related
factors such as intrapartum haemorrhage, prolonged labour and bad
outcome of the baby have been shown to confer a small risk to
developing postpartum depression [24,49-51] however, factors related
to mode of delivery do not seem to carry a similar risk [52,53].
Breastfeeding was found to be protective to getting postpartum
depression (OR: 0.24; 95% CI: 0.06 to 0.97). Equivocal evidence has
been documented when it comes to breastfeeding as a risk factor to
developing postpartum depression. Some studies suggest a
bidirectional relationship between breastfeeding and depression with
prenatal depression predicting less breastfeeding and breastfeeding
predicting low depression [54,55] conversely, other studies have
demonstrated that not breastfeeding does not increase the risk of
postpartum depression. Rates of breastfeeding or attitudes towards
breast feeding differ within cultures; this may impact a mother’s
preference for breastfeeding. In our setting breastfeeding tends to be
the norm and hence raises the question that perhaps our non-
breastfeeding mothers had a medical condition not allowing them to
breastfeed and hence confounding the postpartum depression finding.
Study Limitations
A limitation in our study was the small and non-probability
convenient sampling. The size and convenience of the sample may
limit the generalizability of the study.
As this was part of larger study to confirm feasibility of integrating
EPDS depression screening in maternal and child health clinics, we did
not include a concurrent use of a diagnostic tool to confirm depression
diagnosis.
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ISSN:2376-127X
Page 7 of 8
Conclusion
To our knowledge this is the only follow up study published in
Kenya on antepartum depression with a specific focus on antepartum
risk factors as predictors of postpartum depression in an urban poor
resource setting. The study findings confirm antepartum depression,
financial difficulties and conflict with partner as strong predictors of
postpartum depression. Hence, a greater focus in implementing
preventive and curative measures that address depression during
pregnancy is warranted. Nurses in perinatal settings have an
opportunity to screen and counsel high risk pregnant women and
mothers and refer the ones in need of specialist care.
Acknowledgement
This research was supported by a grant from the Kenya Medical
Research Institute. The authors are grateful to Francis Creed, for his
help in editing the manuscript and the mothers who participated in the
study.
References
1. Parsons CE, Young KS, Rochat TJ, Kringelbach ML, Stein A (2012)
Postnatal depression and its effects on child development: A review of
evidence from low- and middle-income countries. Br Med Bull 101:
57-79.
2. Stein A (2005) Babies of a pandemic. Arch Dis Child 90: 116-118.
3. Dhanda A, Narayan T (2007) Mental health and human rights. Lancet
370: 1197-1198.
4. Manikkam L, Burns JK (2012) Antenatal depression and its risk factors:
An urban prevalence study in KwaZulu-Natal. S Afr Med J 102l: 940-944.
5. Turan B (2014) Linkage to HIV care, postpartum depression and HIV-
related stigma in newly diagnosed pregnant women living with HIV in
Kenya: A longitudinal observational study. BMC Pregnancy Childbirth
14: 400.
6. Cooper PJ (1999) Post-partum depression and the mother-infant
relationship in a South African peri-urban settlement. Br J Psychiatry
175: 554-558.
7. Harvey ST, Pun PKK (2007) Analysis of positive Edinburgh depression
scale referrals to a consultation liaison psychiatry service in a two-year
period. Int J Ment Health Nurs 16: 161-167.
8. Zeng Y, Cui Y, Li J (2015) Prevalence and predictors of antenatal
depressive symptoms among Chinese women in their third trimester: A
cross-sectional survey. BMC Psychiatry 15: 66.
9. Marcus SM, Heringhausen JE (2009) Depression in childbearing women:
When depression complicates pregnancy. Prim Care 36: 151-165.
10. Chung TK, Lau TK, Yip AS, Chiu HF, Lee DT (2006) Antepartum
depressive symptomatology is associated with adverse obstetric and
neonatal outcomes. Psychosom Med 63: 830-834.
11. Yonkers KA (2016) The management of depression during pregnancy: A
report from the American Psychiatric Association and the American
College of Obstetricians and Gynecologists. Gen Hosp Psychiatry 31:
403-413.
12. Bonari L (2004) Perinatal risks of untreated depression during pregnancy.
Can J Psychiatry 49: 726-735.
13. Dunkel-Schetter C, Tanner L (2012) Anxiety, depression and stress in
pregnancy: Implications for mothers, children, research and practice.
Curr Opin Psychiatry 25: 141-148.
14. Davalos DB, Yadon CA, Tregellas HC (2012) Untreated prenatal maternal
depression and the potential risks to offspring: A review. Arch Womens
Ment Health 15: 1-14.
15. Field T (2011) Prenatal depression effects on early development: A review.
Infant Behav Dev 34:1-14.
Volume 3 • Issue 5 • 1000288
Citation: Ongeri L, Otieno P, Mbui J, Juma E, Mathai M (2016) Antepartum Risk Factors for Postpartum Depression: A Follow up Study among
Urban Women Living in Nairobi, Kenya. J Preg Child Health 3: 288. doi:10.4172/2376-127X.1000288
16. Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004)
Prevalence of depression during pregnancy: Systematic review. Obstet
Gynecol 103: 698-709.
17. Cox JL (1979) Psychiatric morbidity and pregnancy: A controlled study of
263 semi-rural Ugandan women. Br J Psychiatry 134: 401-405.
18. Abiodun OA, Adetoro OO, Ogunbode OO (1993) Psychiatric morbidity
in a pregnant population in Nigeria. Gen Hosp Psychiatry 15: 125-128.
19. Hartley M (2011) Depressed mood in pregnancy: Prevalence and
correlates in two Cape Town peri-urban settlements. Reprod Health pp:
8-9.
20. Adewuya AO, Ola BA, Aloba OO, Dada AO, Fasoto OO (2007)
Prevalence and correlates of depression in late pregnancy among
Nigerian women. Depress. Anxiety 24: 15-21.
21. O’hara MW, Swain AM (1996) Rates and risk of postpartum depression-
A meta-analysis. Int Rev Psychiatry 8: 37-54.
22. Sawyer A, Ayers S, Smith H (2010) Pre- and postnatal psychological
wellbeing in Africa: A systematic review. J Affect Disord 123: 17-29.
23. Schmidt R, Wiemann C, Rickert V, Smith E (2006) Moderate to severe
depressive symptoms among adolescent mothers followed four years
postpartum. J Adolesc Heal 38: 12-718.
24. Siu B, Leung WM, Hung SF, O’Hara MW (2012) Antenatal risk factors for
postnatal depression: A prospective study of Chinese women at maternal
and child health centres. BMC Psychiatry 12: 22.
25. Milgrom J (2008) Antenatal risk factors for postnatal depression: a large
prospective study. J. Affect Disord 108: 147-157.
26. Choi SK, Park YG, Park IY, Ko HS, Shin JC (2014) Impact of antenatal
depression on perinatal outcomes and postpartum depression in Korean
women. J Res Med Sci 19: 807-812.
27. Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of
depressed mood during pregnancy and after childbirth. BMJ 323:
257-260.
28. Lau Y, Wong DFK, Chan KS (2010) The utility of screening for perinatal
depression in the second trimester among Chinese: A three-wave
prospective longitudinal study. Arch Womens Ment Health 13: 153-164.
29. Cox JL, Holden JM, Sagovsky R (1987) Detection of postnatal depression.
Development of the 10-item Edinburgh Postnatal Depression Scale. Br J
Psychiatry 150: 782-786.
30. Murray L, Carothers AD (1990) The validation of the Edinburgh Post-
natal Depression Scale on a community sample. Br J Psychiatry 157:
288-290.
31. Turan B (2014) Linkage to HIV care, postpartum depression and HIV-
related stigma in newly diagnosed pregnant women living with HIV in
Kenya: A longitudinal observational study. BMC Pregnancy Childbirth
14: 400.
32. Kumar M, Ongeri L, Mathai M, Mbwayo A (2015) Translation of EPDS
Questionnaire into Kiswahili: Understanding the cross-cultural and
translation issues in mental health research. J pregnancy child Heal p: 2.
33. Murray D, Cox JL (1990) Screening for depression during pregnancy with
the Edinburgh depression scale (EDDS). J Reprod Infant Psychol 8:
99-107.
34. Harris B, Huckle P, Thomas R, Johns S, Fung H (1989) The use of rating
scales to identify post-natal depression. Br J Psychiatry 154: 813-817.
35. Rochat TJ, Tomlinson M, Newell ML, Stein A (2013) Detection of
antenatal depression in rural HIV-affected populations with short and
J Preg Child Health, an open access journal
ISSN:2376-127X
Page 8 of 8
ultra-short versions of the Edinburgh Postnatal Depression Scale (EPDS).
Arch Womens Ment Health 16: 401-410.
36. Josefsson A, Berg G, Nordin C, Sydsjö G (2001) Prevalence of depressive
symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand
80: 251-255.
37. Vesga-López O (2008) Psychiatric disorders in pregnant and postpartum
women in the United States. Arch Gen Psychiatry 65: 805-815.
38. O’Hara MW, Swain AM (2008) Rates and risk of postpartum depression-
A meta-analysis.
39. Brandt R (2008) Putting mental health on the agenda for HIV+ women: a
review of evidence from sub-Saharan Africa. Women Health 49: 215-228.
40. Dunkle KL (2004) Gender-based violence, relationship power, and risk of
HIV infection in women attending antenatal clinics in South Africa.
Lancet 363: 1415-1421.
41. Jewkes RK, Dunkle K, Nduna M, Shai N (2010) Intimate partner
violence, relationship power inequity, and incidence of HIV infection in
young women in South Africa: A cohort study. Lancet 376: 41-48.
42. Abdollahi F (2014) Bio-psycho-socio-demographic and Obstetric
Predictors of Postpartum Depression in Pregnancy: A prospective Cohort
Study. Iran J psychiatry Behav Sci 8: 11-21.
43. Costello EJ, Compton SN, Keeler G, Angold A (2003) Relationships
between poverty and psychopathology: A natural experiment. JAMA 290:
2023-2029.
44. Lorant V (2003) Socioeconomic inequalities in depression: A meta-
analysis. Am J Epidemiol 157: 98-112.
45. Kathree T, Selohilwe OM, Bhana A, Petersen I (2014) Perceptions of
postnatal depression and health care needs in a South African sample:
The ‘mental’ in maternal health care. BMC Womens Health 14: 140.
46. Robertson E, Grace S, Wallington T, Stewart DE (2014) Antenatal risk
factors for postpartum depression: a synthesis of recent literature. Gen
Hosp Psychiatry 26: 289-295.
47. Kirkan TS (2014) The depression in women in pregnancy and
postpartum period: A follow-up study. Int J Soc Psychiatry.
48. Sawyer A, Ayers S, Smith H (2010) Pre- and postnatal psychological
wellbeing in Africa: A systematic review. J Affect Disord 123: 17-29.
49. Sentilhes L (2011) Long-term psychological impact of severe postpartum
haemorrhage. Acta Obstet. Gynecol Scand 90: 615-620.
50. Mei Z, Huang M (2006) Journal of Southern Medical University 26:
1203-1214.
51. Beck CT (2006) Predictors of postpartum depression: An update Nurs
Res 50: 275-285.
52. Warner R, Appleby L, Whitton A, Faragher B (1999) Demographic and
obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry
168: 607-611.
53. Nielsen-Forman D, Videbech P, Hedegaard M, Dalby-Salvig J, Secher NJ
(2000) Postpartum depression: Identification of women at risk. BJOG
107: 1210-1217.
54. Hahn-Holbrook J, Haselton MG, Dunkel-Schetter C, Glynn LM (2013)
Does breastfeeding offer protection against maternal depressive
symptomatology?: A prospective study from pregnancy to 2 years after
birth. Arch Womens Ment Health 16: 411-422.
55. Hannah P, Adams D, Lee A, Glover V, Sandler M (1992) Links between
early post-partum mood and post-natal depression. Br J Psychiatry 160:
777-780.
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