Correlates of maternal depression, anxiety and functioning across an urban-rural gradient in northern Ecuador

Figures & data

Figure 1. Map of the study area in Northern Ecuador with communities highlighted by urban-rural gradient.

Table 1. Spearman correlations between the Hopkins’ and maternal functioning scales.

	HSCL-25	HSCL Depression Subscale	HSCL Anxiety Subscale	Maternal Functioning
HSCL-25	1	0.96 (0.95, 0.97)	0.86 (0.83, 0.89)	0.31 (0.22, 0.38)
HSCL Depression Subscale		1	0.73 (0.68, 0.78)	0.32 (0.24, 0.40)
HSCL Anxiety Subscale			1	0.25 (0.16, 0.33)
Maternal Functioning				1

Table 2. Descriptive statistics by community, n = 508.

	Esmeraldas (N = 128)	Borbón (N = 155)	Road (N = 172)	River (N = 53)	p-value
Timing of HSCL-25 Assessment					0.134
Late Pandemic	90 (70.3%)	99 (63.9%)	129 (75.0%)	40 (75.5%)
Mid Pandemic	38 (29.7%)	56 (36.1%)	43 (25.0%)	13 (24.5%)
Literacy					0.099
Missing	0	0	1	0
Cannot read or write	0 (0.0%)	2 (1.3%)	3 (1.8%)	2 (3.8%)
Can read and write	128 (100.0%)	147 (94.8%)	162 (94.8%)	47 (88.7%)
Can read but cannot write	0 (0.0%)	1 (0.6%)	0 (0.0%)	1 (1.9%)
Can write but cannot read	0 (0.0%)	5 (3.2%)	6 (3.5%)	3 (5.7%)
Work Status					0.436
Missing	0	0	1	0
Does not work	124 (96.9%)	146 (94.2%)	158 (92.4%)	50 (94.3%)
Works	4 (3.1%)	9 (5.8%)	13 (7.6%)	3 (5.7%)
Marital Status					0.422
Missing	0	0	1	0
Divorced/Separated	25 (19.5%)	146 (94.2%)	25 (14.6%)	6 (11.3%)
Married/Living together	103 (80.5%)	9 (5.8%)	146 (85.4%)	47 (88.7%)
Number of Children*					<0.001
Missing	0	0	1	0
0	38 (29.7%)	50 (32.2%)	37 (21.6%)	13 (24.5%)
1	44 (34.4%)	53 (34.2%)	45 (26.3%)	14 (26.4%)
2–3	36 (28.1%)	40 (25.8%)	85 (43.9%)	13 (24.5%)
4+	10 (7.8%)	12 (7.7%)	14 (8.2%)	13 (24.5%)
Ethnicity					<0.001
Missing	0	0	1	0
Afro-Ecuadorian	74 (57.8%)	109 (70.3%)	151 (88.3%)	52 (98.1%)
Mestizo/Other	54 (42.2%)	46 (29.7%)	20 (11.7%)	1 (1.9%)
Food Security					<0.001
Missing	0	3	1	0
Secure	96 (75.0%)	89 (58.6%)	59 (34.5%)	39 (73.6%)
Insecure	32 (25.0%)	63 (41.4%)	112 (65.5%)	14 (26.4%)
Mean (SD)
Age	26.3 (6.0)	25.3 (5.8)	26.5 (5.1)	28.2 (6.8)	0.015
Years of Education	12.2 (3.2)	11.0 (3.0)	10.8 (4.2)	8.5 (3.8)	<0.001
Age of Marriage**	18.1 (2.5)	17.2 (3.0)	17.6 (3.3)	17.3 (2.4)	0.086
Age of First Pregnancy	19.0 (2.8)	18.3 (3.0)	18.6 (3.2)	18.4 (4.2)	0.255
MCA SES Score	0.3 (1.1)	0.0 (1.1)	−0.11 (0.9)	−0.31 (0.7)	<0.001

* Excluding the current pregnancy.

**Among women who report having ever been married.

Figure 2. Bar graph of HSCL scores by community.* Possible range 1–4.

Figure 3. Bar graph of maternal functioning scores by community. * Possible range 0–4.

Table 3. Bivariate tobit regression models of HSCL subscales, maternal functioning, and risk factors.

	HSCL Depression	p-value	HSCL Anxiety	p-value	Maternal Functioning	p-value
HSCL-25 Assessment late in pandemic (ref. mid-pandemic)	−0.197 (−0.301, −0.95)	<0.001	−0.364 (−0.514, −0.215)	<0.001	−0.014 (−0.173, 0.145)	0.865
Postpartum visit (ref. prepartum)	0.041 (−0.075, 0.158)	0.486	0.221 (0.052, 0.389)	0.010	−0.063 (−0.241, 0.115)	0.487
Age	−0.006 (−0.014, 0.003)	0.188	−0.003 (−0.016, 0.009)	0.620	0.006 (−0.007, 0.018)	0.368
Years of Education	0.010 (−0.003, 0.023)	0.115	0.014 (−0.005, 0.033)	0.139	0.014 (−0.006, 0.033)	0.175
Age of First Pregnancy	−0.010(−0.025, 0.006)	0.213	−0.026 (−0.048, −0.003)	0.027	−0.012 (−0.036, 0.011)	0.305
Number of Children	−0.005 (−0.039, 0.029)	0.767	0.003 (−0.048, 0.054)	0.905	0.021 (−0.030, 0.073)	0.412
Single	0.129 (0.001, 0.258)	0.049	0.200 (0.013, 0.387)	0.036	−0.083 (−0.282, 0.115)	0.410
Food Insecure	0.189 (0.093, 0.286)	<0.001	0.273 (0.131, 0.416)	<0.001	0.168 (0.022, 0.314)	0.024
Resident of Town (Reference = City)	0.126 (0.002, 0.249)	0.046	0.321 (0.137, 0.504)	<0.001	0.509 (0.305, 0.712)	<0.001
Resident of Road Community (Reference = City)	0.058 (−0.063, 0.179)	0.346	0.174 (−0.006, 0.355)	0.058	0.683 (0.483, 0.883)	<0.001
Resident of River Community (Reference = City)	−0.538 (−0.727, −0.348)	<0.001	−0.740 (−1.065, −0.416)	<0.001	0.299 (0.025, 0.574)	0.033
SES Score	−0.002 (−0.050, 0.047)	0.945	0.001 (−0.072, 0.073)	0.993	0.015 (−0.057, 0.088)	0.676

Table 4. Bivariate and multivariate linear regression of overall HSCL-25 scores and risk factors for maternal depression and anxiety.

	Bivariate		Multivariate
	HSCL	p-value	HSCL	p-value
HSCL-25 Assessment late in pandemic (ref. mid-pandemic)	−0.208 (−0.302, −0.115)	<0.001	−0.203 (−0.293, −0.113)	<0.001
Postpartum visit (ref. prepartum)	0.073 (−0.033, 0.179)	0.175	-	-
Age	−0.004 (−0.012, 0.004)	0.318	-	-
Years of Education	0.011 (−0.001, 0.023)	0.067	-	-
Age of First Pregnancy	−0.012 (−0.026, 0.002)	0.083	-	-
Number of Children	−0.001 (−0.032, 0.030)	0.936	-	-
Single (ref. married or partnered)	0.123 (0.005, 0.240)	0.040	-	-
Food Insecure (ref. Food Secure)	0.162 (0.074, 0.250)	<0.001	0.131 (0.043, 0.219)	0.003
Resident of town (ref. urban)	0.156 (0.044, 0.269)	0.006	0.127 (0.016, 0.237)	0.025
Resident of community with road access (ref. urban)	0.073 (−0.038, 0.183)	0.197	0.030 (−0.083, 0.144)	0.599
Resident of riverine community (ref. urban)	−0.475 (−0.648, −0.303)	<0.001	−0.476 (−0.646, −0.306)	<0.001
SES Score	−0.001 (−0.045, 0.044)	0.985	-	-