Mathew S, Lund C, Seward N
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Soc Psychiatry Psychiatr Epidemiol. 2025 Sep 5. doi: 10.1007/s00127-025-02986-1.
Understanding the mechanisms through which poverty influences perinatal depression can provide insight into how to develop interventions to improve maternal mental health. To address this question, we aim to estimate indirect effects of important mediators on the causal relationship between food insecurity and symptoms of postnatal depression.
We used data from the control arm of the Africa Focus on Intervention Research for Mental health - South Africa (AFFIRM-SA) trial that included pregnant women with perinatal depression. Interventional effects (used for models that may have multiple correlated mediators) were used to decompose the total effect of food insecurity captured at baseline on symptoms of perinatal depression reducing by at least 40% (using the 17-item HDRS instrument - yes/no) at three months after delivery of the baby, into the following indirect effects: number of antenatal visits attended; suicidality at eight months gestation; and levels of social support captured at eight months gestation using the Multidimensional Scale of Perceived Social Support.
Food insecurity was associated with a 15% reduced probability of symptoms of depression improving at three months post-delivery (-0·151, bias-corrected 95% CI: - 0.267, -0·032), of which 48% was mediated through reduced levels of social support in women exposed to food insecurity (-0.073: bias-corrected 95% CI: -0.146, -0.029). There was no conclusive evidence to support the mediating effects of attending antenatal visits and suicidality.
Our findings suggest that providing social support can help to reduce symptoms of postnatal depression. Future research should explore developing and evaluating a package of care for pregnant women with perinatal depression that improves food security and levels of social support. This research suggests that policy makers and practitioners have a renewed focus on increasing social support systems for women during the perinatal period, especially in cases of food insecurity.
了解贫困影响围产期抑郁症的机制，有助于深入了解如何制定干预措施以改善孕产妇心理健康。为解决这一问题，我们旨在评估重要中介因素对粮食不安全与产后抑郁症状之间因果关系的间接影响。
我们使用了非洲心理健康干预研究 - 南非（AFFIRM-SA）试验对照组的数据，该试验纳入了患有围产期抑郁症的孕妇。干预效应（用于可能有多个相关中介因素的模型）被用于将基线时测得的粮食不安全对产后三个月时围产期抑郁症状减少至少40%（使用17项汉密尔顿抑郁量表 - 是/否）的总效应，分解为以下间接效应：产前检查次数；妊娠八个月时的自杀倾向；以及使用多维感知社会支持量表在妊娠八个月时测得的社会支持水平。
粮食不安全与产后三个月时抑郁症状改善的概率降低15%相关（-0·151，偏差校正95%置信区间：-0.267，-0·032），其中48%是通过粮食不安全女性社会支持水平降低介导的（-0.073：偏差校正95%置信区间：-0.146，-0.029）。没有确凿证据支持产前检查次数和自杀倾向的中介作用。
我们的研究结果表明，提供社会支持有助于减轻产后抑郁症状。未来的研究应探索为患有围产期抑郁症的孕妇制定和评估一套护理方案，以改善粮食安全和社会支持水平。这项研究表明，政策制定者和从业者应重新关注在围产期增加对女性的社会支持系统，特别是在粮食不安全的情况下。
