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Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis

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  • Nafisa Insan
  • Anthony Weke
  • Simon Forrest
  • Judith Rankin

Abstract

Background: 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. Objective: 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. Methods: 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). Results: 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. Conclusion: 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.

Suggested Citation

  • Nafisa Insan & Anthony Weke & Simon Forrest & Judith Rankin, 2022. "Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis," PLOS ONE, Public Library of Science, vol. 17(2), pages 1-25, February.
    • Handle: RePEc:plo:pone00:0263760
    DOI: 10.1371/journal.pone.0263760
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    1. Sharifa Lalani & Shahirose Sadrudin Premji & Kiran Shaikh & Salima Sulaiman & Ilona S Yim & Ntonghanwah Forcheh & Neelofur Babar & Sidrah Nausheen & Nicole Letourneau & the Maternal-infant Global Heal, 2023. "Individual and collective contribution of antenatal psychosocial distress conditions and preterm birth in Pakistani women," PLOS ONE, Public Library of Science, vol. 18(3), pages 1-21, March.
    2. Kass, Benjamin & Roll, Stephanie & Bolster, Marie & Heinrich-Rohr, Michaela & Kuchinke, Lars & Ludwig-Körner, Christiane & Schlensog-Schuster, Franziska & Fricke, Julia & Berghöfer, Anne & Keil, Thoma, 2024. "Utilization and costs of health care and early support services in Germany and the influence of mental health burden during the postnatal period," Children and Youth Services Review, Elsevier, vol. 157(C).

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