Determinants of prenatal depression among women attending the antenatal clinic at a referral facility in Mombasa County, Kenya: a case control study

Abstract

Background: Despite prenatal depression being a public health burden and the major predictor of postnatal depression, it has not received as much attention as postnatal depression in research and policy globally. There is limited evidence on the factors associated with prenatal depression and therefore understanding these factors will inform the design of specific interventions and formulation of guidelines for the effective prevention and control of prenatal depression particularly in high-risk regions. Methods: A hospital-based case control study design was used to identify the determinants of prenatal depression among 170 women attending an antenatal clinic. Prenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). A semi-structured questionnaire was administered to collect data on the socio-demographic, social network and family, lifestyle and obstetric characteristics of the participants. All eligible cases were enrolled into the study while a simple random sample of depression-free women attending the antenatal clinic were enrolled as controls. The relationship between the predictors and prenatal depression was evaluated by logistic regression. Results: In the multivariable analysis, only marital status (adjusted odds ratio (aOR)=17.1; 95% confidence interval (CI):4.0-73.0), occupation (aOR=2.4; 95% CI:1.4-4.2), domestic violence (aOR=18.3; 95% CI: 5.7-58.7) and  social support (aOR=0.2; 95% CI:0.05-0.8) were identified as significant determinants of prenatal depression. Conclusion: Marital status, occupation, domestic violence and lack of social support were  identified as the risk factors for prenatal depression in this setting. To address the burden of prenatal depression in the country, these findings call for inclusion of screening for prenatal depression as an essential component of the routine antenatal care package. We recommend that future studies focus on evaluating specific interventions to address the identified risk factors.