Perinatal mental health in rural Bangladesh : a mixed methods exploration of the social determinants and perspectives of pregnant women and healthcare providers

Abstract

Background: Pregnancy is a time of major psychological changes making pregnant women more susceptible to Perinatal Mental Health (PMH) conditions, especially antenatal depression with comorbid anxiety. Prevalence of antenatal depression in Bangladesh ranges from 18-33% compared to 7-15% in high-income countries like the UK. These disparities stem in part from poor understanding of, and stigma surrounding, PMH, which hinder pregnant women from seeking mental health care. In addition, there is limited research exploring social determinants and perspectives around PMH in rural Sylhet, Bangladesh. Aim: This PhD research aimed to explore the social determinants and perspectives (women and healthcare providers (HCPs)) around antenatal depression in rural Sylhet, Bangladesh, to enable development of better care for underserved women in rural Bangladesh in collaboration with Maternal Aid Association (MAA). Methods: 1) Two systematic reviews of the social determinants and perspectives surrounding PMH in South Asia; 2) Cross-sectional survey of 235 pregnant women in rural Sylhet; 3) Cross-sectional survey of 139 HCPs in Bangladesh; 4) Semi-structured interviews with 14 HCPs, and 5) mixed methods triangulation. Results: The point-prevalence of antenatal depression was 56%. Intimate Partner Violence (adjusted odds ratio (AOR) 10.4 [95% confidence intervals (95%CI) 2.7-39.7]) and perceived husband’s male gender preference (AOR 9.9 [95%CI 1.6-59.6]), were significantly associated with increased odds of antenatal depression among pregnant women. Increased family support was a significant protective factor for antenatal depression (AOR 0.94 [95%CI 0.91-0.97]). HCPs displayed non-stigmatising attitudes towards PMH, but limited knowledge regarding screening and management, and desired further training and education. Conclusion: Antenatal depression commonly occurs in rural Sylhet, Bangladesh, highlighting the need for improved screening and management within this region. The findings recommend the integration of PMH into the MAA antenatal care services. Key activities could involve screening of antenatal depression, psychoeducation for women and families, and training and education for HCPs.