J w Providence scale lady

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Try out PMC Labs and tell us what you think. Learn More. To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders CPMDs in World Bank categorized low- and lower-middle-income countries. Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study des were included. Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth.

Weighted mean prevalence was Risk factors were: socioeconomic disadvantage odds ratio [OR] range: 2. Protective factors were: having more education relative risk: 0. CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

The nature, prevalence and determinants of mental health problems in women during pregnancy and in the year after giving birth have been thoroughly investigated in high-income countries. The perinatal mental health of women living in low- and lower-middle-income countries has only recently become the subject of research, 1 in part because greater priority has been ased to preventing pregnancy-related deaths.

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In addition, some have argued that in resource-constrained countries women are protected from experiencing perinatal mental problems through the influence of social and traditional cultural practices during pregnancy and in the postpartum period.

This systematic review was performed with the objective of summarizing the evidence surrounding the nature, prevalence and determinants of non-psychotic common perinatal mental disorders CPMDs among women living in low- and lower-middle-income countries.

A senior librarian in the World Health Organization WHO headquarters in Geneva, Switzerland, conducted a systematic search of the literature to identify sources dealing with the prevalence of CPMDs and the factors that make women more vulnerable to, or that protect them from, these disorders.

Several databases were searched for studies published up to November Box 1. Reference lists of the papers meeting inclusion criteria were hand searched to identify further studies. The search was confined to studies published in English or with sufficiently detailed English abstracts to enable comparison of the methods and main findings. Only investigations of the nature, prevalence and determinants of non-psychotic CPMDs in women in low- and lower-middle-income countries, as defined by World Bank country incomewere included. Data about these countries were obtained from published inter-country comparisons that included at least one low- or lower-middle-income country.

Although China is classified as a lower-middle-income country, economic conditions and health infrastructure in Hong Kong Special Administrative Region Hong Kong SAR and in Taiwan are very different from those in mainland China and in the resource-constrained settings that are the focus of this review. From studies whose findings were stratified by maternal age, we extracted data only for adults, not adolescents people aged up to 19 years. We included all studies from which outcome data on CPMDs could be extracted, regardless of study de. Information was extracted systematically using a standardized data extraction form.

The methodological quality of each study was assessed by two authors independently using the Mirza and Jenkins checklist of eight items, 67 with an additional item pertaining to whether appropriate informed consent to participate in the study had been obtained. Differences were discussed and consensus J w Providence scale lady. The checklist included the following quality criteria: i explicit study aims; ii adequate sample size or justification; iii sample representative, with justification; iv clear inclusion and exclusion criteria; v measures of mental health reliable and valid, with justification; vi response rate reported and losses explained; vii adequate description of data; and viii appropriate statistical analyses.

Varied endpoints were reported: scores above thresholds on symptom screening measures, diagnoses by mental health practitioners or structured clinical interviews by research workers, and a combination of these.

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Self-reported symptom measures, including the Edinburgh Postnatal Depression Scale EPDSdetect but do not distinguish between symptoms of anxiety and depression. Therefore they yielded diverse data about the prevalence, severity and duration of non-specific and specific symptoms, including those that met the diagnostic criteria.

Meta-analysis was undertaken to assess antenatal and postnatal prevalence, and heterogeneity was quantified with the I 2 statistic.

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Aggregate means, weighted by participant s, were calculated for comparisons between studies from different health sectors. Publication bias was assessed with the Egger test and represented graphically by a funnel plot. The steps involved in identifying studies meeting the inclusion criteria are summarized in Fig. Study selection process for systematic review of studies on common perinatal mental disorders in women in low- and lower-middle-income countries.

There were 21 prospective studies with at least two assessment waves, but none reported incidence.

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Patel et al. None of these studies reported on the prevalence of common mental disorders during pregnancy. In general, recruitment strategies were not described in detail and few studies considered potential selection biases. Where antenatal care coverage is high, consecutive cohorts yield reasonably representative samples of pregnant women. However, in many low- and lower-middle-income countries high proportions of women lack access to antenatal care or make fewer than the recommended visits.

These studies thus over-represent relatively advantaged women. Three studies generated population-based samples in low- and lower-middle-income countries with low antenatal care coverage. In Pakistan, Rahman et al. Gausia et al. Meta-analysis of individual study and overall prevalence of common perinatal mental disorders in women in low- and lower-middle-income countries. Average prevalence Meta-analysis revealed ificant differences between prevalence estimates based on self-reported symptom measures The papers reported 14 cohort and 20 cross-sectional studies, most of which were at least of reasonable quality.

Overall the methods were more rigorous in the recent studies than in the older ones. The most common limitations were failure to specify inclusion criteria or to describe recruitment strategies. All studies addressed limited literacy by using questionnaires administered by an interviewer in the local language. All but one 34 of these questionnaires had been appropriately validated. Among studies with clearly-described selection criteria, many excluded participants with characteristics relevant to the outcomes.

Thus, the findings from these studies cannot be generalized to the entire population of women who have recently given birth. In our study countries, pooled prevalence of postpartum common mental disorders Meta-analyses revealed ificant differences in mean prevalence estimates derived from self-reported symptom measures Overall meta-analyses revealed no differences in the pooled mean estimated prevalence of CPMDs derived from self-reported symptom measures Potential risk factors for CPMDs in women in low- and middle-income countries reflected diverse conceptual frameworks and differed between studies.

This precluded data pooling. Nineteen studies 91013161820222530 — 32343637394047 — 49 investigated a variety of social, cultural and economic risk factors for CPMDs. Socioeconomic disadvantage was widely associated with increased risk 101618253037394045 Relative rather than absolute disadvantage also appears to be relevant: Wan et al. Rates of CPMD were also higher among women who were young 93749 ; of a religious minority, 34 J w Providence scale lady unmarried.

When other factors were controlled for, higher rates of CPMD were observed among women who experienced difficulties in the intimate partner relationship. Such difficulties included having a partner who rejected paternity, who was unsupportive and uninvolved, or critical and quarrelsome, and who used alcohol to excess.

Only seven 24252830 — 3240 studies investigated an association with intimate partner violence. However, in 6 of them women who had experienced physical abuse during pregnancy or in the year had a higher prevalence of CPMDs than women who had not experienced these problems. Eleven studies 910141825 — 28384548 investigated the risks associated with difficult interpersonal relationships other than with the spouse. While three studies 223845 found higher prevalence of CPMDs among women who had three or more children other studies found no association between family size and mental health.

Reproductive health and general health as risk factors for CPMDs were widely investigated. However, other studies found no ificant association between CPMDs and unwanted pregnancy, 1628 gravidity, 223648 parity 1316202234374757 prior stillbirth, 18203439 coincidental medical problems 48 or caesarean birth.

Five studies 2228303440 identified risks associated with past mental health problems, including during pregnancy. However, other studies found no association between CPMDs and a history of mental illness 37 or with depression during the current pregnancy. In such settings it may not be possible to know whether a woman has a psychiatric history.

In many low- and lower-middle-income countries there is a cultural preference for male children. The potential association between this attitude and the risk of developing a CPMD was examined in various ways. As most of these studies were cross-sectional, the direction of the J w Providence scale lady cannot be ascertained.

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Mothers may feel distressed because their infants are sick or failing to thrive. It is also possible, however, that mothers who have a CPMD are less able to provide sensitive care and that their babies are therefore vulnerable to health problems. Risk was increased among mothers who had experienced difficulty breastfeeding 40 and those whose infants cried for prolonged periods. Even among the poor, relative social and economic advantage appears protective.

Two studies examined the relationship between the observation of traditional postpartum rituals and the risk of developing a CPMD. Rahman et al. Fisher et al. However, practices that involved direct interpersonal care were relevant. Women who were given less than 30 days of rest were at increased risk OR: 1. Of the eight prospective studies initiated in pregnancy, 1021273438404145 five reported both the antenatal and postnatal prevalence of CPMDs and in four this was higher in pregnancy than after childbirth.

The funnel plots Fig. Funnel plot J w Providence scale lady studies on the prevalence of common perinatal mental disorders in women in low- and lower-middle-income countries. There have been recent systematic reviews of studies dealing with perinatal mental disorders in women worldwide 59 and in specific regions, including Asia 6 and Africa, 7 but to our knowledge this is the first review of studies about women in low- and lower-middle-income countries.

This review reveals a serious double disparity. One has to do with the availability of local evidence on which to base practice and policy. Tens of thousands of papers from high-income countries provide high-quality epidemiological, clinical, health service and health system evidence surrounding CPMDs. Furthermore, few countries have more than one study in the English-language literature.

The settings, recruitment strategies, inclusion and exclusion criteria, representative adequacy of the samples and assessment measures used in the studies varied widely. Since all of these factors could have influenced prevalence estimates, only broad comparisons between low- and lower-middle-income countries and high-income countries can be made.

We acknowledge this limitation.

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