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Mental health related determinants of parenting stress among urban mothers of young children--results from a birth-cohort study in Ghana and Côte d'Ivoire.

Guo N, Bindt C, Te Bonle M, Appiah-Poku J, Tomori C, Hinz R, Barthel D, Schoppen S, Feldt T, Barkmann C, Koffi M, Loag W, Nguah SB, Eberhardt KA, Tagbor H, Bass JK, N'Goran E, Ehrhardt S, International CDS Study Gro - BMC Psychiatry (2014)

Bottom Line: In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.Parenting stress is frequent and levels are high compared with previous studies from high-income countries.More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. sehrhard@jhsph.edu.

ABSTRACT

Background: There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS.

Methods: A longitudinal birth cohort of 577 women from Ghana and Côte d'Ivoire was followed from the 3rd trimester in pregnancy to 2 years postpartum between 2010 and 2013. Depression and anxiety were assessed by the Patient Health Questionnaire depression module (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) at baseline, 3 month, 12 month and 24 month postpartum. PS was measured using the Parenting Stress Index-Short Form (PSI-SF) at 3, 12 and 24 month. The mean total PS score and the subscale scores were compared among depressed vs. non-depressed and among anxious vs. non-anxious mothers at 3, 12 and 24 month postpartum. The proportions of clinical PS (PSI-SF raw score > 90) in depressed vs. non-depressed and anxious vs. non-anxious mothers were also compared. A generalized estimating equation (GEE) approach was used to estimate population-averaged associations between women's depression/anxiety and PS adjusting for age, child sex, women's anemia, education, occupation, spouse's education, and number of sick child visits.

Results: A total of 577, 531 and 264 women completed the PS assessment at 3 month, 12 month and 24 month postpartum across the two sites and the prevalences of clinical PS at each time point was 33.1%, 24.4% and 14.9% in Ghana and 30.2%, 33.5% and 22.6% in Côte d'Ivoire, respectively. At all three time points, the PS scores were significantly higher among depressed mothers vs. non-depressed mothers. In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.

Conclusions: Parenting stress is frequent and levels are high compared with previous studies from high-income countries. Antepartum and postpartum depression were both associated with PS, while antepartum and postpartum anxiety were not after adjusting for confounders. More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms. Should our findings be replicated, it appears prudent to design and subsequently evaluate intervention strategies.

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Related in: MedlinePlus

Recruitment flow chart.
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Figure 1: Recruitment flow chart.

Mentions: All women in their third trimester of pregnancy, based on gestational age assessed at the antepartum clinic, residing within a distance of ≤ 5 km from the study hospitals were eligible for participation. Exclusion criteria were: age < 18 years, pregnancy with multiples and severe pregnancy complications, e.g. hypertension, hemorrhage, pre-eclampsia, and diabetes. Pregnant women were interviewed in the third trimester (baseline visit); demographic information was obtained and they were screened for depression and anxiety. The participants were followed at 3 month, 12 month and 24 month postpartum to collect data on maternal depression and anxiety, PS, and mother’s and children’s physical status. To enter this analysis, participants needed to have completed at least one follow up visit (Figure 1). Due to political instability and resumed fighting in Côte d’Ivoire during the study period, 311 mothers did not give birth in the designated hospitals and could therefore not be followed-up. Compared with women in the analysis, the ones who were lost to follow up for all 3 visits were more frequently from Côte d’Ivoire, described themselves as housewives, had high depression and anxiety scores at the baseline visit, were HIV positive, and had 0.5 g/dL lower hemoglobin levels on average (Table 1).


Mental health related determinants of parenting stress among urban mothers of young children--results from a birth-cohort study in Ghana and Côte d'Ivoire.

Guo N, Bindt C, Te Bonle M, Appiah-Poku J, Tomori C, Hinz R, Barthel D, Schoppen S, Feldt T, Barkmann C, Koffi M, Loag W, Nguah SB, Eberhardt KA, Tagbor H, Bass JK, N'Goran E, Ehrhardt S, International CDS Study Gro - BMC Psychiatry (2014)

Recruitment flow chart.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4048600&req=5

Figure 1: Recruitment flow chart.
Mentions: All women in their third trimester of pregnancy, based on gestational age assessed at the antepartum clinic, residing within a distance of ≤ 5 km from the study hospitals were eligible for participation. Exclusion criteria were: age < 18 years, pregnancy with multiples and severe pregnancy complications, e.g. hypertension, hemorrhage, pre-eclampsia, and diabetes. Pregnant women were interviewed in the third trimester (baseline visit); demographic information was obtained and they were screened for depression and anxiety. The participants were followed at 3 month, 12 month and 24 month postpartum to collect data on maternal depression and anxiety, PS, and mother’s and children’s physical status. To enter this analysis, participants needed to have completed at least one follow up visit (Figure 1). Due to political instability and resumed fighting in Côte d’Ivoire during the study period, 311 mothers did not give birth in the designated hospitals and could therefore not be followed-up. Compared with women in the analysis, the ones who were lost to follow up for all 3 visits were more frequently from Côte d’Ivoire, described themselves as housewives, had high depression and anxiety scores at the baseline visit, were HIV positive, and had 0.5 g/dL lower hemoglobin levels on average (Table 1).

Bottom Line: In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.Parenting stress is frequent and levels are high compared with previous studies from high-income countries.More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. sehrhard@jhsph.edu.

ABSTRACT

Background: There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS.

Methods: A longitudinal birth cohort of 577 women from Ghana and Côte d'Ivoire was followed from the 3rd trimester in pregnancy to 2 years postpartum between 2010 and 2013. Depression and anxiety were assessed by the Patient Health Questionnaire depression module (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) at baseline, 3 month, 12 month and 24 month postpartum. PS was measured using the Parenting Stress Index-Short Form (PSI-SF) at 3, 12 and 24 month. The mean total PS score and the subscale scores were compared among depressed vs. non-depressed and among anxious vs. non-anxious mothers at 3, 12 and 24 month postpartum. The proportions of clinical PS (PSI-SF raw score > 90) in depressed vs. non-depressed and anxious vs. non-anxious mothers were also compared. A generalized estimating equation (GEE) approach was used to estimate population-averaged associations between women's depression/anxiety and PS adjusting for age, child sex, women's anemia, education, occupation, spouse's education, and number of sick child visits.

Results: A total of 577, 531 and 264 women completed the PS assessment at 3 month, 12 month and 24 month postpartum across the two sites and the prevalences of clinical PS at each time point was 33.1%, 24.4% and 14.9% in Ghana and 30.2%, 33.5% and 22.6% in Côte d'Ivoire, respectively. At all three time points, the PS scores were significantly higher among depressed mothers vs. non-depressed mothers. In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.

Conclusions: Parenting stress is frequent and levels are high compared with previous studies from high-income countries. Antepartum and postpartum depression were both associated with PS, while antepartum and postpartum anxiety were not after adjusting for confounders. More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms. Should our findings be replicated, it appears prudent to design and subsequently evaluate intervention strategies.

Show MeSH
Related in: MedlinePlus