Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
Department of Psychiatry, University of Gondar, Gondar, Ethiopia.
PLoS One. 2019 Feb 19;14(2):e0211764. doi: 10.1371/journal.pone.0211764. eCollection 2019.
Maternal depression is the most prevalent psychiatric disorder during pregnancy, can alter fetal development and have a lasting impact on the offspring's neurological and behavioral development. However, no review has been conducted to report the consolidated magnitude of antenatal depression (AND) in Ethiopia. Therefore, this review aimed to systematically summarize the existing evidence on the epidemiology of AND in Ethiopia.
Using PRISMA guideline, we systematically reviewed and meta-analyzed studies that examined the prevalence and associated factors of AND from three electronic databases (PubMed, EMBASE, and SCOPUS). We used predefined inclusion criteria to screen identified studies. A qualitative and quantitative analysis was employed. Heterogeneity across the studies was evaluated using Q and the I² test. Publication bias was assessed by funnel plot and Egger's regression test.
In this review, a total of 193 studies were initially identified and evaluated. Of these, five eligible articles were included in the final analysis. In our meta-analysis, the pooled prevalence of AND in Ethiopia was 21.28% (95% CI; 15.96-27.78). The prevalence of AND was highest in the third trimester of pregnancy at 32.10% and it was 19.13% in the first trimester and 18.86% in the second trimester of pregnancy. The prevalence of AND was 26.48% and 18.28% as measured by Beck depression inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS), respectively. Moreover, the prevalence of AND was 15.50% for the studies conducted in the community setting and it was 25.77% for the studies conducted in the institution-based setting. In our qualitative synthesis, we found that those pregnant women who had a history of stillbirth, complications during pregnancy, previous history of depression, no ANC follow-up, irregular ANC follow-up, not satisfied by ANC follow-up, and monthly income <1500 Ethiopian birr were linked with a greater risk of developing ANC. We also found that those women who experienced partner violence during pregnancy, food insecurity, medium and low social support, and those who were unmarried, age group 20-29, house wives and farmers were associated with a higher risk of developing ANC.
Our meta-analysis found that the pooled prevalence of AND in Ethiopia was 21.28%. The prevalence of AND was high in the third trimester of pregnancy as compared to the first and second trimesters of pregnancy. The prevalence of AND was high in studies conducted using BDI than EPDS. Studies on the magnitude of AND as well as the possible determinants in each trimester of pregnancy with representative sample size are recommended. Screening of depression in a pregnant woman in perinatal setting might be considered backed by integration of family planning and mental health services. The use of validated and a standard instrument to assess AND is warranted.
The protocol for this systematic review and meta-analysis was registered at PROSPERO (record ID=CRD42017076521, 06 December 2017).
孕产妇抑郁症是孕期最常见的精神障碍，可改变胎儿发育，并对后代的神经和行为发育产生持久影响。然而，目前尚无研究报告埃塞俄比亚产前抑郁症（AND）的综合发病情况。因此，本综述旨在系统总结埃塞俄比亚 AND 流行病学的现有证据。
我们采用 PRISMA 指南，系统地检索了来自三个电子数据库（PubMed、EMBASE 和 SCOPUS）的研究，这些研究检查了 AND 的患病率和相关因素。我们使用预设的纳入标准筛选了确定的研究。采用定性和定量分析。使用 Q 检验和 I² 检验评估研究之间的异质性。通过漏斗图和 Egger 回归检验评估发表偏倚。
在本次综述中，最初确定并评估了 193 项研究。其中，有 5 项符合条件的文章纳入最终分析。我们的荟萃分析显示，埃塞俄比亚 AND 的总患病率为 21.28%（95%CI；15.96-27.78）。AND 的患病率在妊娠晚期最高，为 32.10%，在妊娠早期和妊娠中期分别为 19.13%和 18.86%。使用贝克抑郁量表（BDI）和爱丁堡产后抑郁量表（EPDS）测量时，AND 的患病率分别为 26.48%和 18.28%。此外，在社区环境中进行的研究中，AND 的患病率为 15.50%，而在机构环境中进行的研究中，AND 的患病率为 25.77%。在我们的定性综合分析中，我们发现那些有死产史、妊娠并发症、既往抑郁史、未进行 ANC 随访、ANC 随访不规则、对 ANC 随访不满意以及月收入<1500 埃塞俄比亚比尔的孕妇发生 ANC 的风险更高。我们还发现，那些在怀孕期间经历过伴侣暴力、粮食不安全、中低社会支持的女性，以及那些未婚、年龄在 20-29 岁之间、家庭主妇和农民的女性，发生 ANC 的风险更高。
我们的荟萃分析发现，埃塞俄比亚 AND 的总患病率为 21.28%。与妊娠早期和中期相比，妊娠晚期 AND 的患病率更高。使用 BDI 测量时，AND 的患病率高于 EPDS。建议对每个妊娠期间的 AND 严重程度及其可能的决定因素进行研究，样本量应具有代表性。建议在围产期环境中对孕妇进行抑郁筛查，并结合计划生育和精神卫生服务。应使用经过验证和标准的工具来评估 AND。
本系统评价和荟萃分析的方案在 PROSPERO（记录 ID=CRD42017076521，2017 年 12 月 6 日）中注册。
