Postpartum depression prevalent in under-developed countries, could impact baby health and mortality

(Press-News.org) ANN ARBOR, Mich. — Postpartum depression not only affects mothers but it could mean higher health risks for the baby – especially in low-income countries like Ghana where the condition isn't well-recognized, University of Michigan Health System research shows.

Efforts to reduce child mortality and improve infant growth, health, and nutritional status in less-developed countries must address the mental health of new moms, the study suggests.

Two-thirds of participating mothers of sick, hospitalized babies in Ghana showed high risk for symptoms of clinical depression – which puts their babies and young children at significant health risks – according to the new research that appears in the International Journal of Gynecology & Obstetrics.

Postpartum depression in Africa appears to be at least as common and perhaps even more common than in high-income countries, yet very little research has looked at maternal mental health in developing nations.

Katherine J. Gold, University of Michigan "Our research provides a mental health snapshot for this population of high-risk moms. We know that if a mother has postpartum depression, both she and her baby face substantial health risks," says lead author Katherine J. Gold, M.D., M.S.W., M.S., assistant professor of family medicine and of obstetrics and gynecology at the University of Michigan Medical School.

"Addressing these health concerns may be particularly important for mothers of sick infants who have additional medical problems impacting their health."

In low- and middle-income nations, maternal depression has been linked to poor infant nutritional status, diarrhea, and respiratory illness – critical factors of child survival. Children with mothers who are depressed are also nearly twice as likely to be underweight and experience growth stunting.

Growing evidence indicates that children of depressed women have higher health risks, ranging from low birth weight, spontaneous abortion, stillbirth, and preterm delivery to reductions in breastfeeding, infant sleep, behavior disorders, and attachment problems.

Lack of perceived social support, poor self-rated health, history of interpersonal violence with a current partner, and home delivery are important risk factors for postpartum depression among mothers of sick infants in Ghana, the study says. These risks are very similar to risk for postpartum depression in the United States.

In places like Ghana, however, there are significant challenges to providing adequate mental health care for new moms, including a lack of trained staff, funding barriers, lack of affordable medications, and social stigma.

"Postpartum depression is well known in the United States, and we recognize that pregnancy and the postpartum period are vulnerable times for maternal mental health," says Gold. "But in low income nations, many people view symptoms of depression as spiritual or personal issues rather than a psychiatric condition which could be treated."

### Additional Authors: Kathryn Spangenberg, Family Medicine, Polyclinic Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Priscilla Wobil, Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana; Thomas L. Schwenk, M.D., former chair of U-M's Department of Family Medicine, now dean of the University of Nevada School of Medicine and vice president of the University of Nevada, Reno, Division of Health Sciences.

Funding: University of Michigan GlobalREACH, National Institutes of Mental Health (Grant NIH K-23)

Conflict of Interest: None

Reference: "Depression and risk factors for depression among mothers of sick infants in Kumasi, Ghana;" http://dx.doi.org/10.1016/j.ijgo.2012.09.016.