Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis
Insan, Nafisa; Weke, Anthony; Forrest, Simon; Rankin, Judith
Professor Simon Forrest firstname.lastname@example.org
Head Of St Hild And St Bede College
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.
Insan, N., Weke, A., Forrest, S., & Rankin, J. (2022). Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis. PLoS ONE, 17(2), Article e0263760. https://doi.org/10.1371/journal.pone.0263760
|Journal Article Type||Article|
|Acceptance Date||Jan 26, 2022|
|Online Publication Date||Feb 9, 2022|
|Deposit Date||Jul 28, 2022|
|Publicly Available Date||Jul 28, 2022|
|Publisher||Public Library of Science|
|Peer Reviewed||Peer Reviewed|
Published Journal Article
Publisher Licence URL
© 2022 Insan et al. This is an open<br /> access article distributed under the terms of the<br /> Creative Commons Attribution License, which<br /> permits unrestricted use, distribution, and<br /> reproduction in any medium, provided the original<br /> author and source are credited.