Prevalence and factors associated with antenatal depressive symptoms among women enrolled in Option B+ antenatal HIV care in Malawi: a cross-sectional analysis

Abstract

Background: Option B+ has increased the number of pregnant women initiating antiretroviral therapy for HIV, yet retention in HIV care is sub-optimal. Retention may be affected by antenatal depression. However, few data exist on antenatal depression in this population.

Aim: Describe the prevalence and factors associated with antenatal depression among Malawian women enrolled in Option B+.

Method: At their first antenatal visit, women with HIV provided demographic and psychosocial information, including depression as measured with the locally validated Edinburgh Postnatal Depression Scale (EPDS). Prevalence ratios (PR) for factors associated with probable depression (EPDS ≥6) were estimated with log binomial regression.

Results: 9.5% (95% CI: 7.5–11.9%) of women screened positive for current depression, and 46% self-reported a history of depression or anxiety. Women were more likely to screen positive for current depression if they reported a history of depression (adjusted PR: 2.42; 95% CI: 1.48–3.95) or had ever experienced intimate partner violence (1.77; 1.11–2.81). Having an unintended current pregnancy (1.78; 0.99–3.21), being unmarried (1.66; 0.97–2.84), or employed (1.56; 1.00–2.44) had potential associations with probable depression.

Conclusions: Probable antenatal depression affected a notable proportion of women living with HIV, comparable to other global regions. Screening for antenatal depression in HIV care should be considered.

Keywords:

• Antenatal depression
• HIV
• Option B+
• sub-Saharan Africa

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Acknowledgements

We are appreciative of our S4 study collaborators (the Malawi Ministry of Health HIV/AIDS Unit, Baobab Health, Lighthouse Trust, Baylor College of Medicine), Bwaila Hospital Family Health Unit, and UNC Project-Malawi. Special thanks to the S4 study participants, and the S4 research team: Allan Jumbe, Trywin Phiri, Mark Maluwa, Clement Mapanje, Gift Sambiri, Linda Chikopa, Ntchindi Gondwe, Agness Gumbo, Jane Kilembe, Alvis Mvula, Juliana Ngwira, Lusubiro Paile, Chimwemwe Baluwa, Limbikani Chimndozi, Madawa Kumwenda, Chalimba Lusewa, Alice Maluwa, Kingsley Msimuko, Shaphil Wallie, Victoria Chilembwe, Tiyamike Itaye, Rob Krysiak, Gerald Tegha, Christopher Mwafulirwa, Kelvin Maziya, Madalitso Maliwichi, Frank Chimbwandira, Portia Kamthunzi, Maganizo Chagomerana, Sam Phiri, Atupele Kapito-Tembo, Nora Rosenberg, Irving Hoffman, Innocent Mofolo, Francis Martinson, Valerie Flax, Saeed Ahmed, Maria Kim, Deborah Demster Kamwendo, Michael Herce, Julie Nelson, Lameck Chinula, Robert Flick, and Austin Wesevich.

Declaration of interest

The authors have no other financial relationships to disclose.

This study was funded by NICHD [grant No. R01HD080485]; the Medical Scientist Training Program [grant No. T32GM008719], the NIMH individual fellowship [grant No. F30MH111370], the Fulbright-Fogarty U.S. Student fellowship, and the NIH Fogarty International Center [grant No. R25TW009340], and the Doris Duke Clinical Research Fellowship.