Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women
Abstract Aims About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Sa...
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Cambridge University Press
2025-01-01
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| Series: | Epidemiology and Psychiatric Sciences |
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| Online Access: | https://www.cambridge.org/core/product/identifier/S2045796025100103/type/journal_article |
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| author | C. Gastaldon V. Whitesell Skrivankova G. Schoretsanitis N. Folb K. Taghavi M. A. Davies M. Cornell G. Salanti C. Mesa Vieira M. Tlali G. Maartens M. Egger A. D. Haas |
| author_facet | C. Gastaldon V. Whitesell Skrivankova G. Schoretsanitis N. Folb K. Taghavi M. A. Davies M. Cornell G. Salanti C. Mesa Vieira M. Tlali G. Maartens M. Egger A. D. Haas |
| author_sort | C. Gastaldon |
| collection | DOAJ |
| description | Abstract
Aims
About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Saharan Africa. We aimed to estimate the proportion of women with PPD and investigate socio-demographic, medical and obstetric risk factors for PPD among women receiving private medical care in South Africa (SA).
Methods
In this longitudinal cohort study, we analysed reimbursement claims from beneficiaries of an SA medical insurance scheme who delivered a child between 2011 and 2020. PPD was defined as a new International Classification of Diseases, 10th Revision diagnosis of depression within 365 days postpartum. We estimated the frequency of women with a diagnosis of PPD. We explored several medical and obstetric risk factors for PPD, including pre-existing conditions, such as HIV and polycystic ovary syndrome, and conditions diagnosed during pregnancy and labour, such as gestational diabetes, pre-term delivery and postpartum haemorrhage. Using a multivariable modified Poisson model, we estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for factors associated with PPD.
Results
Of the 47,697 participants, 2,380 (5.0%) were diagnosed with PPD. The cumulative incidence of PPD increased from 0.8% (95% CI 0.7–0.9) at 6 weeks to 5.5% (5.3–5.7) at 12 months postpartum. PPD risk was higher in individuals with history of depression (aRR 3.47, 95% CI [3.14–3.85]), preterm delivery (1.47 [1.30–1.66]), PCOS (1.37 [1.09–1.72]), hyperemesis gravidarum (1.32 [1.11–1.57]), gestational hypertension (1.30 [1.03–1.66]) and postpartum haemorrhage (1.29 [0.91–1.85]). Endometriosis, HIV, gestational diabetes, foetal stress, perineal laceration, elective or emergency C-section and preeclampsia were not associated with a higher risk of PPD.
Conclusions
The PPD diagnosis rate was lower than anticipated, based on the PPD prevalence of previous studies, indicating a potential diagnostic gap in SA’s private sector. Identified risk factors could inform targeted PPD screening strategies.
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| format | Article |
| id | doaj-art-6d89b576ea8148c49f16d1eb83bde846 |
| institution | Kabale University |
| issn | 2045-7960 2045-7979 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Epidemiology and Psychiatric Sciences |
| spelling | doaj-art-6d89b576ea8148c49f16d1eb83bde8462025-08-20T03:58:44ZengCambridge University PressEpidemiology and Psychiatric Sciences2045-79602045-79792025-01-013410.1017/S2045796025100103Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 womenC. Gastaldon0https://orcid.org/0000-0001-7257-2962V. Whitesell Skrivankova1G. Schoretsanitis2https://orcid.org/0000-0002-3851-4117N. Folb3K. Taghavi4M. A. Davies5M. Cornell6G. Salanti7C. Mesa Vieira8M. Tlali9G. Maartens10M. Egger11A. D. Haas12https://orcid.org/0000-0002-4849-181XInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, SwitzerlandInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, SwitzerlandDepartment of Psychiatry, Psychotherapy and Psychosomatics, Hospital of Psychiatry, University of Zurich, Zurich, Switzerland Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA Department of Psychiatry, Zucker School of Medicine at Northwell/Hofstra, Hempstead, NY, USAMedscheme, Cape Town, South AfricaInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, Switzerland International Agency for Research on Cancer, Lyon, FranceSchool of Public Health, Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South AfricaSchool of Public Health, Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South AfricaInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, SwitzerlandInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, SwitzerlandSchool of Public Health, Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South AfricaDivision of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South AfricaInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, Switzerland School of Public Health, Centre for Infectious Disease Epidemiology & Research, University of Cape Town, Cape Town, South Africa Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UKInstitute of Social and Preventive Medicine, Faculty of Medicine, University of Bern, Bern, SwitzerlandAbstract Aims About one-third of South African women have clinically significant symptoms of postpartum depression (PPD). Several socio-demographic risk factors for PPD exist, but data on medical and obstetric risk factors remain scarce for low- and middle-income countries and particularly in sub-Saharan Africa. We aimed to estimate the proportion of women with PPD and investigate socio-demographic, medical and obstetric risk factors for PPD among women receiving private medical care in South Africa (SA). Methods In this longitudinal cohort study, we analysed reimbursement claims from beneficiaries of an SA medical insurance scheme who delivered a child between 2011 and 2020. PPD was defined as a new International Classification of Diseases, 10th Revision diagnosis of depression within 365 days postpartum. We estimated the frequency of women with a diagnosis of PPD. We explored several medical and obstetric risk factors for PPD, including pre-existing conditions, such as HIV and polycystic ovary syndrome, and conditions diagnosed during pregnancy and labour, such as gestational diabetes, pre-term delivery and postpartum haemorrhage. Using a multivariable modified Poisson model, we estimated adjusted risk ratios (aRRs) and 95% confidence intervals (CIs) for factors associated with PPD. Results Of the 47,697 participants, 2,380 (5.0%) were diagnosed with PPD. The cumulative incidence of PPD increased from 0.8% (95% CI 0.7–0.9) at 6 weeks to 5.5% (5.3–5.7) at 12 months postpartum. PPD risk was higher in individuals with history of depression (aRR 3.47, 95% CI [3.14–3.85]), preterm delivery (1.47 [1.30–1.66]), PCOS (1.37 [1.09–1.72]), hyperemesis gravidarum (1.32 [1.11–1.57]), gestational hypertension (1.30 [1.03–1.66]) and postpartum haemorrhage (1.29 [0.91–1.85]). Endometriosis, HIV, gestational diabetes, foetal stress, perineal laceration, elective or emergency C-section and preeclampsia were not associated with a higher risk of PPD. Conclusions The PPD diagnosis rate was lower than anticipated, based on the PPD prevalence of previous studies, indicating a potential diagnostic gap in SA’s private sector. Identified risk factors could inform targeted PPD screening strategies. https://www.cambridge.org/core/product/identifier/S2045796025100103/type/journal_articledepressionepidemiologymood disorders postpartumrisk factorswomen |
| spellingShingle | C. Gastaldon V. Whitesell Skrivankova G. Schoretsanitis N. Folb K. Taghavi M. A. Davies M. Cornell G. Salanti C. Mesa Vieira M. Tlali G. Maartens M. Egger A. D. Haas Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women Epidemiology and Psychiatric Sciences depression epidemiology mood disorders postpartum risk factors women |
| title | Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women |
| title_full | Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women |
| title_fullStr | Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women |
| title_full_unstemmed | Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women |
| title_short | Diagnosis of postpartum depression and associated factors in South Africa: a cohort study of 47,697 women |
| title_sort | diagnosis of postpartum depression and associated factors in south africa a cohort study of 47 697 women |
| topic | depression epidemiology mood disorders postpartum risk factors women |
| url | https://www.cambridge.org/core/product/identifier/S2045796025100103/type/journal_article |
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