Major depression among pregnant women attending a tertiary teaching hospital in Northern Uganda assessed using DSM-V criteria.

BACKGROUND

Major depression (MD) during pregnancy complicates maternal and neonatal outcomes. Despite its significant impact, there is a lack of evidence on the prevalence and associated factors of MD among pregnant women in Uganda. We assessed the magnitude and factors associated with MD among pregnant women attending antenatal care (ANC) at a large teaching hospital in Northern Uganda.

METHODS

Between June and August 2023, we enrolled pregnant women aged 18 years or older attending ANC clinic at Gulu Regional Referral Hospital in Northern Uganda. Data were collected using a validated semi-structured questionnaire. MD was evaluated using DSM-V criteria and was defined as having (1) at least two weeks of either persistent low mood or excessive sadness, (2) plus additional symptoms from the MD diagnostic criterion A, for a total of at least five MD symptoms, and (3) the symptoms caused significant distress or problem and significantly altered behaviour or functionality. Modified Poisson regression analyses with robust standard errors was constructed to evaluate for factors independently associated with major depression. Adjusted prevalence ratio (aPR) whose 95% confidence interval (CI) did not include the null value (0) or p < 0.05 was considered statistically significant.

RESULTS

We enrolled 329 participants, with a mean age of 26.1± 5.5 years. Overall, 29.8% (n = 98) had MD; 37 (11.2%) mild, 49 (14.9%) moderate, and 12 (3.6%) severe MD. Having a co-wife (aPR: 1.64, 95% CI:1.09-2.45, p = 0.016), an arranged marriage (aPR: 1.56, 95% CI: 1.02-2.42, p = 0.042), partner's income in second quartile (aPR: 2.14, 95% CI: 1.29-3.54, p = 0.003), experiencing physical violence (aPR: 1.75, 95% CI: 1.09-3.81, p = 0.019), controlling behaviours from partner (aPR: 3.60, 95% CI: 1.79-7.26, p < 0.001), and planned pregnancy (aPR: 0.53%, 955 CI: 0.35-0.81, p = 0.003) were independently associated with MD.

CONCLUSION

Major Depression affects nearly one-third of pregnant women in Northern Uganda. Major Depression is more prevalent among women with co-wives, in arranged marriages, with unplanned pregnancies, whose partners had low income, who experienced physical violence or controlling behaviours from a partner. These findings highlight the urgent need for targeted interventions, including prevention, screening, and treatment services for Major Depression within Antenatal Care clinics. Implementing such measures is crucial to improving maternal, foetal, and neonatal health outcomes in the region.