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Post Partum Depresion
Post Partum Depresion
Post Partum Depresion
Obadia Yator, Muthoni Mathai, Ann Vander Stoep, Deepa Rao & Manasi
Kumar
To cite this article: Obadia Yator, Muthoni Mathai, Ann Vander Stoep, Deepa Rao & Manasi
Kumar (2016): Risk factors for postpartum depression in women living with HIV attending
prevention of mother-to-child transmission clinic at Kenyatta National Hospital, Nairobi, AIDS
Care, DOI: 10.1080/09540121.2016.1160026
Article views: 10
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AIDS CARE, 2016
http://dx.doi.org/10.1080/09540121.2016.1160026
Risk factors for postpartum depression in women living with HIV attending
prevention of mother-to-child transmission clinic at Kenyatta National Hospital,
Nairobi
Obadia Yatora, Muthoni Mathaia, Ann Vander Stoepb,c, Deepa Raob,d and Manasi Kumara
a
Department of Psychiatry, University of Nairobi, Nairobi, Kenya; bDepartment of Psychiatry and Behavioral Sciences, University of Washington,
Seattle, WA, USA; cDepartment of Epidemiology, University of Washington, Seattle, WA, USA; dDepartment of Global Health, University of
Washington, Seattle, WA, USA
progression for themselves and their children. Stigma has also become a substantial barrier to Accepted 26 February 2016
accessing HIV/AIDS care and prevention services. The study objective was to determine the
KEYWORDS
prevalence and severity of postpartum depression (PPD) among women living with HIV and to Postpartum; depression; HIV;
further understand the impact of stigma and other psychosocial factors in 123 women living stigma; prevention of
with HIV attending prevention of mother-to-child transmission (PMTCT) clinic at Kenyatta mother-to-child transmission
National Hospital located in Nairobi, Kenya. We used the Edinburgh Postnatal Depression Scale
and HIV/AIDS Stigma Instrument – PLWHA (HASI – P). Forty-eight percent (N = 59) of women
screened positive for elevated depressive symptoms. Eleven (9%) of the participants reported
high levels of stigma. Multivariate analyses showed that lower education (OR = 0.14, 95% CI
[0.04–0.46], p = .001) and lack of family support (OR = 2.49, 95% CI [1.14–5.42], p = .02) were
associated with the presence of elevated depressive symptoms. The presence of stigma implied
more than ninefold risk of development of PPD (OR = 9.44, 95% CI [1.132–78.79], p = .04). Stigma
was positively correlated with an increase in PPD. PMTCT is an ideal context to reach out to
women to address mental health problems especially depression screening and offering
psychosocial treatments bolstering quality of life of the mother–baby dyad.
CONTACT Manasi Kumar manni_3in@hotmail.com Department of Psychiatry, University of Nairobi, Nairobi, Kenya
© 2016 Informa UK Limited, trading as Taylor & Francis Group
2 O. YATOR ET AL.
postnatal women with severe depressive symptoms, Finally, the multivariate regression model was fitted
suicidal ideation, and alcohol abuse disorder were with depression as an outcome and predictors such as
offered psychosocial support by the researcher and education, family support, and levels of HIV/AIDS
thereafter referred to the Department of Mental health stigma that were associated in the bivariate analysis
at KNH. with a p value of .05. All relationships were described
with their odds ratio (OR) with their 95% confidence
intervals (Table 1).
Measurements
We gathered information on participants’ socio-demo-
graphics (age, marital status, educational level, occu-
Results
pation, and socio-economic status), clinical
information, and psychosocial information. Probes Prevalence of PPD
were made on quality of support received from family,
The mean age of women in our study was 31 years (N =
significant others on alcohol use and experience with
123, SD = 5.2). The EPDS mean score was 11.53 (SD =
domestic violence. We also assessed presence of STIs,
5.7) and 59 (48%) of our participants met screening cri-
Downloaded by [University of California, San Diego] at 11:33 09 April 2016
Statistical analysis
We analyzed data using the SPSS version 20. We
employed a descriptive univariate analysis to describe
the socio-demographics, psychosocial risk factors, and
depression prevalence. To test relationships among Figure 1. Predictors of PPD among women living with HIV.
these variables, we performed bivariate analyses using *Association is significant at the .05 level (two-tailed) **Associ-
chi-square/Fisher’s exact and Kendall’s tau-b tests. ation is significant at the .01 level (two-tailed).
AIDS CARE 3
stigma type (x2 (3) = 23.17, p < .0001) where poor self- stigma implied more than ninefold risk of development
efficacy is co-terminus with the experience of stigma. of PPD (OR = 9.44, 95% CI [1.132–78.79], p = .04).
Eleven (9%) of the participants reported high levels of
stigma. Multivariate analyses showed that lower edu-
Discussion
cation (OR = 0.14, 95% CI [0.04–0.46], p = .001) and
lack of family support (OR = 2.49, 95% CI [1.14–5.42], We found a large proportion of postpartum women liv-
p = .02) were associated with the presence of elevated ing with HIV experience elevated depressive symptoms.
depressive symptoms. Furthermore, the presence of Family social support, educational level, and stigma are
4 O. YATOR ET AL.
Table 2. Prevalence of PPD and associated features. & Garura, 2001). Education was positively associated
PPD and associated features Category N % with PPD in that women who report low rates of
Total EPDS score Mean 11.53, SD 5.7 depressive symptoms comparatively have higher
EPDS score (ranges 0–30 for non- Non-elevated 64 52
elevated depressive symptoms and depressive education (Bennetts et al., 1999; Prachakul, Grant,
elevated depressive symptoms) symptoms & Keltner, 2007; Rao et al., 2012).
Elevated depressive 59 48
symptoms
(c) Stigma as a strong determinant of depression in
EPDS suicidal ideation intensity None 87 70.7 women with HIV: Our results reconfirm that stigma
Mild 7 5.7 has a strong association with PPD especially in Ken-
Moderate 23 18.7
Severe 6 4.9 yan cultural context (Dillabaugh et al., 2007). Both
Suicidal ideation Absent 87 70.7 experienced stigma and internalized stigma were
Present 36 29.3
Months since birth of child 0–3 months 22 17.9 strong predictors of PPD among HIV-positive
4–6 months 32 26.0 South African women (Peltzer & Shikwane, 2011).
7–9 months 27 22.0
10–12 months 21 17.1 Other studies in the region too have found that
13–15 months 8 6.5 women who had primary education or less have
16–18 months 8 6.5
19–21 months 4 3.3
greater adjusted odds of substantial stigma (Cuca,
Downloaded by [University of California, San Diego] at 11:33 09 April 2016
Funding Fisher, J., Mello, M. C., Patel, V., Rahman, A., Tran, T., Holton,
S., & Holmes, W. (2012). Prevalence and determinants of
This project was supported by National Institutes of Health/ common perinatal mental disorders in women in low-and
National Institute of Mental Health [grant number R25- lower-middle-income countries: A systematic review.
MH099132]. Bulletin of the World Health Organization, 90(2), 139–149.
doi:10.2471/BLT.11.091850
Gavin, A. R., Tabb, K. M., Melville, J. L., Guo, Y., & Katon, W.
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