UCSF

Background: In low- and lower-middle-income countries (LLMICs), 16% of pregnant and 20% of postpartum women experience common maternal mental health disorders, far surpassing global rates of 10% and 13%, respectively. Maternal depression is associated with poor perinatal outcomes, including maternal, newborn, and early childhood outcomes. The Edinburgh Postnatal Depression Scale (EPDS) was recently validated in Rwanda, yet maternal depression prevalence and associated factors are unknown.

Objectives: The primary objectives of the study are to describe antenatal depression prevalence and its associated factors.

Methods: This is a secondary analysis of the Preterm Birth Initiative-Rwanda randomized controlled trial of group antenatal care (ANC) data obtained between June 2017 – June 2018. Thirty-four health centers in five districts were selected. At each health center, convenience sampling was used to ascertain EPDS scores from the first five women to present for initial ANC each calendar month. A cut-off EPDS score of ≥13 was used to define maternal depression. Multi-level simple and multiple logistic regressions were used to explore associated factors of antenatal depression. The study obtained informed consent and was approved by the Rwanda National Ethics Committee and the University of California, San Francisco institutional review board.

Results: Twenty-percent of women in the antenatal period screened positive for depression. In the adjusted multi-level multiple logistic regression model, family social support, age, ability to communicate with partner, and perceived stress were significantly associated with antenatal depression.

Conclusions: Antenatal and postpartum depression prevalence in Rwanda exceeds LLMIC averages. The authors recommend universal depression screening and treatment for pregnant and postpartum women.