Haight Sarah C, Shartle Kaitlin, Kachoria Aparna G, Hagaman Ashley, Gupta Sugandh, Escobar Carias Michelle S, Bibi Amina, Bates Lisa M, Maselko Joanna
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, 135 Dauer Drive, Chapel Hill, NC, 27599, USA; Cecil G. Sheps Center for Health Services Research, University of North Carolina, Rural Health Research and Policy Analysis Center, 725 M.L.K. Jr Blvd, Chapel Hill, NC, 27516, USA.
Sanford School of Public Policy, Duke University, 201 Science Drive, Durham, NC, 27708, USA.
Soc Sci Med. 2025 Feb;367:117704. doi: 10.1016/j.socscimed.2025.117704. Epub 2025 Jan 16.
In Pakistan, a setting with high gender inequality, the relationship between female agency and mental health has not been studied longitudinally or beyond a defined life stage like pregnancy. Using data from the Bachpan cohort of mother-infant dyads in Pakistan, we investigated female agency and depression at two life stages: perinatal (third trimester to 6-months postpartum; n = 1154) and beyond (3- to 4-years postpartum). Modified Poisson models estimated adjusted prevalence ratios (PR) for probable depression (PHQ-9) associated with female agency (freedom of movement and participation in household decision-making) at the two life stages. Among 1154 mothers (average age 26.6 years), female agency was substantially lower during pregnancy than it was at 3-years and depression was more common during postpartum than at 4-years. Low freedom of movement during pregnancy nominally increased the likelihood of postpartum depression (PR: 1.33; 95% CI: 0.98, 1.80). The risk of depression was higher for low- (PR: 1.01; 95% CI: 0.72-1.41) and high- (PR: 1.24; 95% CI: 0.65-2.36) participation in household decision-making compared to moderate, but estimates were imprecise. Results from beyond the perinatal period indicated a stronger relationship between low freedom of movement and subsequent depression (PR: 1.89; 95% CI: 1.12, 3.20; Table 3). Low- (PR: 1.19; 95% CI: 0.67-2.12) and high- (PR: 1.21; 95% CI: 0.67-2.17) decision-making continued to demonstrate a nominal U-shaped relationship with depression, but estimates were imprecise. Overall, restricted freedom of movement beyond the perinatal period, may increase the likelihood of depression. Future research should explore the nuances of participation in decision-making and how it impacts women's mental health.
在性别不平等程度较高的巴基斯坦，女性能动性与心理健康之间的关系尚未得到纵向研究，也未超出孕期等特定生命阶段的范畴。利用巴基斯坦母婴二元组的巴赫潘队列数据，我们在两个生命阶段调查了女性能动性与抑郁情况：围产期（孕晚期至产后6个月；n = 1154）及之后（产后3至4年）。修正泊松模型估计了两个生命阶段与女性能动性（行动自由和参与家庭决策）相关的可能抑郁（PHQ - 9）的调整患病率比（PR）。在1154名母亲（平均年龄26.6岁）中，孕期女性能动性显著低于产后3年，产后抑郁比产后4年更为常见。孕期行动自由受限名义上增加了产后抑郁的可能性（PR：1.33；95%置信区间：0.98，1.80）。与适度参与家庭决策相比，低（PR：1.01；95%置信区间：0.72 - 1.41）和高（PR：1.24；95%置信区间：0.65 - 2.36）参与家庭决策的抑郁风险更高，但估计值并不精确。围产期之后的结果表明，行动自由受限与随后的抑郁之间存在更强的关联（PR：1.89；95%置信区间：1.12，3.20；表3）。低（PR：1.19；95%置信区间：0.67 - 2.12）和高（PR：1.21；95%置信区间：0.67 - 2.17）决策参与度与抑郁之间继续呈现名义上的U型关系，但估计值并不精确。总体而言，围产期之后行动自由受限可能会增加抑郁的可能性。未来的研究应探讨参与决策的细微差别及其如何影响女性心理健康。
