Insan Nafisa, Weke Anthony, Forrest Simon, Rankin Judith
Population Health Sciences Institute, Newcastle University, Newcastle Upon Tyne, United Kingdom.
Department of Sociology, Durham University, Durham, United Kingdom.
PLoS One. 2022 Feb 9;17(2):e0263760. doi: 10.1371/journal.pone.0263760. eCollection 2022.
Pregnancy is a time of major psychological changes making pregnant women more susceptible to depression and anxiety. Prevalence is higher among women living in Bangladesh, India and Pakistan, compared to high-income countries, due to poor understanding and lack of mental health integration within antenatal care. Antenatal depression/anxiety is associated with adverse outcomes including postnatal depression, low birth weight and impaired fetal development. Existing systematic reviews provided only limited information on the social determinants of antenatal depression/anxiety in these South Asian countries.
This review aimed to identify, synthesise and appraise the evidence on the social determinants associated with antenatal depression and anxiety in women living in Bangladesh, India and Pakistan.
We searched five databases (MEDLINE, Embase, PsycINFO, Scopus, Web of Science) and PROSPERO. Observational studies published between 1st January 2000 and 4th January 2021 were included if they were in the English language, used validated tools for measuring depression/anxiety in pregnant women and reported statistical associations or raw numbers. Summary estimates were obtained using random-effects model. Heterogeneity and publication bias was measured using the I2 statistic and Egger's test, respectively. This review was registered on PROSPERO (reference: CRD42020167903).
We included 34 studies (with 27,379 women). Meta-analysis of Adjusted Odds Ratios (AOR) found that Intimate partner violence (AOR 2.48, 95% CI 1.41-4.33), unplanned pregnancy (AOR 1.53, 95% CI 1.28-1.83), male gender preference (AOR 3.06, 95% CI 1.40-6.72) and poor relationship with in-laws (AOR 2.69, 95% CI 1.25-5.80) were significantly associated with antenatal depression/anxiety.
The review identified a complex range of social determinants of antenatal depression and anxiety in Bangladesh, India and Pakistan. Screening tools to identify pregnant women at high risk should be integrated within antenatal care to prevent adverse outcomes. Knowledge of these social determinants will inform the development of such screening tools and interventions.
怀孕是一个心理发生重大变化的时期，这使得孕妇更容易患上抑郁症和焦虑症。与高收入国家相比，孟加拉国、印度和巴基斯坦的女性患病率更高，原因是人们对产前护理中的心理健康了解不足且缺乏心理健康整合。产前抑郁/焦虑与包括产后抑郁、低出生体重和胎儿发育受损在内的不良后果相关。现有的系统评价仅提供了关于这些南亚国家产前抑郁/焦虑的社会决定因素的有限信息。
本综述旨在识别、综合和评估与孟加拉国、印度和巴基斯坦女性产前抑郁和焦虑相关的社会决定因素的证据。
我们检索了五个数据库（医学索引数据库、荷兰医学文摘数据库、心理学文摘数据库、Scopus数据库、科学引文索引数据库）和国际前瞻性系统评价注册库。纳入2000年1月1日至2021年1月4日期间发表的观察性研究，要求其为英文，使用经过验证的工具测量孕妇的抑郁/焦虑，并报告统计关联或原始数据。使用随机效应模型获得汇总估计值。分别使用I²统计量和埃格检验测量异质性和发表偏倚。本综述已在国际前瞻性系统评价注册库注册（参考文献：CRD42020167903）。
我们纳入了34项研究（涉及27379名女性）。对调整后的优势比进行的荟萃分析发现，亲密伴侣暴力（优势比2.48，95%置信区间1.41 - 4.33）、意外怀孕（优势比1.53，95%置信区间1.28 - 1.83）、重男轻女（优势比3.06，95%置信区间1.40 - 6.72）以及与姻亲关系不佳（优势比2.69，95%置信区间1.25 - 5.80）与产前抑郁/焦虑显著相关。
该综述确定了孟加拉国、印度和巴基斯坦产前抑郁和焦虑的一系列复杂的社会决定因素。应将识别高危孕妇的筛查工具纳入产前护理，以预防不良后果。了解这些社会决定因素将为开发此类筛查工具和干预措施提供信息。
