Psychological distress and its associations with past events in pregnant women affected by armed conflict in Swat, Pakistan: a cross sectional study

Muhammad Naseem Khan, Anna Chiumento, Mukesh Dherani, Katie Bristow, Siham Sikander, Atif Rahman, Muhammad Naseem Khan, Anna Chiumento, Mukesh Dherani, Katie Bristow, Siham Sikander, Atif Rahman

Abstract

Background: The public health significance of maternal mental health is well established. Armed conflicts expose populations to events that could have long-term negative consequences for mental health of pregnant women and their children. This study explores the prevalence and associated risk factors for psychological distress of women during pregnancy, including exposure to past conflict-related potentially traumatic events, in a population exposed to armed conflict in the Swat region of Pakistan.

Methods: A community-based cross-sectional survey of 349 pregnant women in two union councils in Swat was conducted. Psychological distress was measured using the Self-Reporting Questionnaire (SRQ). Conflict-related potentially traumatic events (PTEs) were measured through an adapted version of the Harvard Trauma Questionnaire. Information was also collected on major life events (Life Events Checklist), social support (Multidimensional Scale of Perceived Social Support), and demographic and socio-economic variables.

Results: Prevalence of current psychological distress was 38.1 % (95 % CI: 33.1, 43.3). Psychological distress was significantly associated with three or more potentially traumatic events (PTEs) experienced during the conflict (OR = 2.62, 95 % CI: 1.22, 5.61); three or more major life events in the year following the conflict (OR = 3.25, 95 % CI: 1.82, 5.82) and inversely associated with family support (OR = 0.91, 95 % CI: 0.88, 0.95).

Conclusion: This is one of the first community based cross sectional surveys in Swat valley, Pakistan to assess the prevalence of psychological distress during pregnancy in an area affected by conflict. Over a third of women show evidence of significant psychological distress. Exposure to potentially traumatic events remained independently associated with psychological distress 1 year after conflict ended, suggesting that conflict exposure may have long-term impacts upon maternal mental health. Combining this with findings relating to the cumulative impact of major life-events, and the protective factor of family support highlights the importance of developing culturally appropriate psychological interventions accessible to pregnant women rebuilding their lives following conflict.

Keywords: Conflict; Daily life stressors; Maternal health; Mental health; Pakistan; Pregnancy; Psychological distress; Social support; Traumatic events.

Figures

Fig. 1
Fig. 1
Flow diagram of survey sample

References

    1. Rahman A, Surkan PJ, Claudina E, Cayetano CE, Rwagatare P, Dickson KE. Grand challenges: Integrating maternal mental health into maternal and child health programmes. PLoS Med. 2013;10(5):1–7. doi: 10.1371/journal.pmed.1001442.
    1. Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R. Impact of maternal depression on infant nutritional status and illness: A cohort study. Arch Gen Psychiatry. 2004;61(9):946–52. doi: 10.1001/archpsyc.61.9.946.
    1. Grote NK, Bridge JA, Gavin AR, Melville JL, Iyengar S, Katon WJ. A meta-analysis of depression during pregnancy and the risk of preterm birth, low birth weight, and intrauterine growth restriction. Arch Gen Psychiatry. 2010;67(10):1012–24. doi: 10.1001/archgenpsychiatry.2010.111.
    1. Okasha A. Mental health and violence: WPA Cairo declaration--international perspectives for intervention. International Review Of Psychiatry (Abingdon, England) 2007;19(3):193–200. doi: 10.1080/09540260701349449.
    1. Brewin CR, Andrews B, Valentine JD. Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol. 2000;68(5):748–66. doi: 10.1037/0022-006X.68.5.748.
    1. Inter-Agency Standing Committee. IASC guidelines on mental health and psychosocial support in emergency settings. Geneva 2007.
    1. Allden K, Poole C, Chantavanich S, Ohmar K, Aung NN, Mollica RF. Burmese political dissidents in Thailand: Trauma and survival among young adults in exile. Am J Public Health. 1996;86(11):1561–9. doi: 10.2105/AJPH.86.11.1561.
    1. Roberts B, Damundu EY, Lomoro O, Sondorp E. Post-conflict mental health needs: a cross-sectional survey of trauma, depression and associated factors in Juba. Southern Sudan. BMC Psychiatry. 2009;9:7. doi: 10.1186/1471-244X-9-7.
    1. Bile KM, Hafeez A. Crisis in the Swat Valley of Pakistan: need for international action. The Lancet. 2009;374(9683):23. doi: 10.1016/S0140-6736(09)61225-3.
    1. Sultan-i-Rome Crises and reconciliation in Swat. Pakistaniaat : A Journal of Pakistan Studies. 2011;3(1):53–79.
    1. Ud Din I, Mumtaz Z, Ataullahjan A. How the Taliban undermined community healthcare in Swat, Pakistan. Br Med J. 2012;344:e2093-e. doi: 10.1136/bmj.e2093.
    1. PAIMAN. District Health Profile: District Swat. Pakistan Initiative for Mothers and Newborns (PAIMAN). 2009:1–11.
    1. Pakistan Bureau of Statistics. Swat district at a glance. Islamabad. (2014). . Accessed 17th March 2014.
    1. Hafeez A, Mohamud BK, Shiekh MR, Shah SAI, Jooma R. Lady health workers programme in Pakistan: Challenges, achievements and the way forward. J Pak Med Assoc. 2011;61(3):210–5.
    1. Oxford Policy Management. Lady Health Worker Programme External Evaluation of the National Programme for Family Planning and Primary Health Care. Oxford Policy Management. 2009:1–41.
    1. Husain N, Creed F, Tomenson B. Depression and social stress in Pakistan. Psychol Med. 2000;30(2):395–402. doi: 10.1017/S0033291700001707.
    1. Rahman A, Iqbal Z, Waheed W, Hussain N. Translation and cultural adaptation of health questionnaires. Journal of Pakistan Medical Association. 2003;53:142–7.
    1. Rahman A, Iqbal Z, Lovel H, Shah MA. Screening for postnatal depression in the developing world: a comparison of the WHO Self-Reporting Questionnaire (SRQ-20) and the Edinburgh Postnatal Depression Screen (EPDS) Journal of Pakistan Psychiatric Society. 2005;2:69–72.
    1. Halepota AA, Wasif SA. Harvard Trauma Questionnaire Urdu Translation: The only cross-culturally validated screening instrument for the assessment of trauma and torture and their sequelae. J Pak Med Assoc. 2001;51(8):285–90.
    1. Zimet G, Dahlem N, Zimet S, Farley G. The Multidimensional Scale of Perceived Social Support. J Pers Assess. 1988;52(1):30–41. doi: 10.1207/s15327752jpa5201_2.
    1. Akhtar A, Rahman A, Husain M, Chaudhry IB, Duddu V, Husain N. Multidimensional scale of perceived social support: Psychometric properties in a South Asian population. J Obstet Gynaecol Res. 2010;36(4):845–51. doi: 10.1111/j.1447-0756.2010.01204.x.
    1. Rahman A, Iqbal Z, Harrington R. Life events, social support and depression in child birth: perspectives from a rural community in the developing world. Psychol Med. 2003;33(7):1161–7. doi: 10.1017/S0033291703008286.
    1. Dean AG, Sullivan KM, Soe MM. OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2.3.1. . 2011. . Accessed 23rd October 2013.
    1. Chiumento A, Khan MN, Rahman A, Frith L. Managing Ethical Challenges to Mental Health Research in Post‐Conflict Settings. Developing world bioethics. 2015.
    1. National Institute of Population Studies and Macro International Inc. Pakistan Demographic and Health Survey 2006–07. Islamabad, Pakistan 2008.
    1. Kazi A, Fatmi Z, Hatcher J, Kadir MM, Niaz U, Wasserman GA. Social environment and depression among pregnant women in urban areas of Pakistan: Importance of social relations. Soc Sci Med. 2006;63(6):1466–76. doi: 10.1016/j.socscimed.2006.05.019.
    1. Husain N, Chaudhry IB, Afridi MA, Tomenson B, Creed F. Life stress and depression in a tribal area of Pakistan. Br J Psychiatry. 2007;190(JAN.):36–41. doi:10.1192/bjp.bp.106.022913.
    1. Rahman A, Hafeez A. Suicidal feelings run high among mothers in refugee camps: A cross-sectional survey. Acta Psychiatr Scand. 2003;108(5):392–3. doi: 10.1034/j.1600-0447.2003.00220.x.
    1. Omidian P, Miller Ke. Addressing the Psychosocial Needs of Women in Afghanistan. Critical Half. 2006:17–21.
    1. Steel Z, Chey T, Silove D, Marnane C, Bryant RA, van Ommeren M. Association of Torture and Other Potentially Traumatic Events With Mental Health Outcomes Among Populations Exposed to Mass Conflict and Displacement A Systematic Review and Meta-analysis. Journal of American Medical Association. 2009;302(5):537–49. doi: 10.1001/jama.2009.1132.
    1. Bhui K, Warfa N. Trauma, khat and common psychotic symptoms among Somali immigrants: A quantitative study. J Ethnopharmacol. 2010;132(3):549–53. doi: 10.1016/j.jep.2010.07.027.
    1. Karaçam Z, Ançel G. Depression, anxiety and influencing factors in pregnancy: a study in a Turkish population. Midwifery. 2009;25(4):344–56. doi: 10.1016/j.midw.2007.03.006.
    1. Husain N, Cruickshank K, Husain M, Khan S, Tomenson B, Rahman A. Social stress and depression during pregnancy and in the postnatal period in British Pakistani mothers: a cohort study. J Affect Disord. 2012;140(3):268–76. doi: 10.1016/j.jad.2012.02.009.
    1. Husain N, Parveen A, Husain M, Saeed Q, Jafri F, Rahman R, et al. Prevalence and psychosocial correlates of perinatal depression: a cohort study from urban Pakistan. Archives of Women's Mental Health. 2011;14(5):395–403. doi: 10.1007/s00737-011-0233-3.
    1. Mumford DB, Saeed K, Ahmad I, Latif S, Mubbashar MH. Stress and psychiatric disorder in rural Punjab: A community survey. Br J Psychiatry. 1997;170(MAY):473–8. doi: 10.1192/bjp.170.5.473.

Source: PubMed

Sponsorer og samarbeidspartnere

Medisinsk tilstand

Legemiddelintervensjoner

3
Abonnere