Risk of Depressive Symptoms Associated with Morbidity in Postpartum Women in Rural Bangladesh

Abstract

Objectives Depression following pregnancy is common, but its extent and association with maternal morbidity in the first 6 months postpartum have not been well described in low resource settings such as rural Bangladesh. Methods We used data from a population-based, community trial of approximately 39,000 married rural Bangladeshi women aged 13-44 between 2001 and 2007 to examine the relation between women's reported morbidity symptoms from childbirth to 3 months postpartum, and subsequent depressive symptoms assessed at 6 months postpartum. We calculated crude and adjusted risk ratios for depressive symptoms following women's reports of reproductive, urinary, neurologic, nutrition and other illness measures constructed based on symptomatic reporting. Results In models adjusted for sociodemographic factors and co-morbidities, all postpartum illnesses were associated with an increased relative risk [RR, with 95% confidence intervals (CI) excluding 1] of depressive symptoms by 6 months postpartum. These morbidities included uterine prolapse (RR 1.20, 95% CI 1.04-1.39), urinary tract infection (RR 1.24, 95% CI 1.11-1.38), stress related incontinence (SRI) (RR 1.49, 95% 1.33-1.67), simultaneous SRI and continuously dripping urine (RR 1.60-2.96), headache [RR 1.20 (95% CI 1.12-1.28)], convulsions (RR 1.67, 95%CI 1.36-2.06), night blindness (RR 1.33, 95% CI 1.19-1.49), anemia (RR 1.38, 95% CI 1.31-1.46), pneumonia (RR 1.24, 95% CI 1.12-1.37), gastroenteritis (RR 1.24, 95% CI 1.17-1.31) and hepatobiliary disease (RR 2.10, 96% CI 1.69-2.60). Conclusions for Practice Illnesses during the first three postpartum months were risk factors for depressive symptoms, with the strongest associations noted for convulsions and hepatobiliary disease. Symptoms of depression may be of particular concern among women suffering from physical illnesses.

Clinical trial registration: ClinicalTrials.gov NCT0019882.

Trial registration: ClinicalTrials.gov NCT00198822.

Keywords: Bangladesh; Depressive symptoms; Maternal illness; Maternal morbidity; Mental health.

Conflict of interest statement

Conflict of interest statement: The authors declare that they have no conflict of interest.

Figures

Figure 1. Study Sample

*Other reasons included permanently moved from the study area (2027), sterilized (3148), reported menopause (3914), husband died or divorce (3435), refused to participate (34), died before detecting a pregnancy (493), had a pregnancy outcome after October 12, 2006 (5243), reported a last menstrual period after January 5th, 2006 (1929) or had an unknown date of a last menstrual period (16). ** Reasons for exclusions were: refused consent (594), outcome occurred before consent (60), vital status unknown (51), pregnancy outcome unknown (4), died before consent (5).