Academic journal article Bulletin of the World Health Organization

Prevalence and Determinants of Common Perinatal Mental Disorders in Women in Low- and Lower-Middle-Income Countries: A Systematic Review/ Prevalence et Determinants Des Troubles Mentaux Perinataux Communs Chez Les Femmes Des Pays a Revenu Faible et Moyen: Une Etude Systematique/ Prevalencia Y Determinantes De Los Trastornos Mentales Perinatales Frecuentes En Mujeres En Paises De Ingresos Bajos Y Medios-Bajos: Examen Sistematico

Academic journal article Bulletin of the World Health Organization

Prevalence and Determinants of Common Perinatal Mental Disorders in Women in Low- and Lower-Middle-Income Countries: A Systematic Review/ Prevalence et Determinants Des Troubles Mentaux Perinataux Communs Chez Les Femmes Des Pays a Revenu Faible et Moyen: Une Etude Systematique/ Prevalencia Y Determinantes De Los Trastornos Mentales Perinatales Frecuentes En Mujeres En Paises De Ingresos Bajos Y Medios-Bajos: Examen Sistematico

Article excerpt

Introduction

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. (1) Systematic reviews have shown that in these settings, about 10% of pregnant women and 13% of those who have given birth (2) experience some type of mental disorder, most commonly depression or anxiety. (3) Social, psychological and biological etiological factors interact, but their relative importance is debated.

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 assigned to preventing pregnancy-related deaths. 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. (4,5)

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.

Methods

Search strategy

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 2010 (Box 1. Literature search strategy for systematic review of the evidence on the prevalence and determinants of common perinatal mental disorders). Reference lists of the papers meeting inclusion criteria were hand searched to identify further studies.

Box 1. Literature search strategy for systematic review
of the evidence on the prevalence and determinants
of common perinatal mental disorders

1. "prenatal"OR "antenatal"OR "pregnancy"OR "postnatal"OR "postpartum"

2." mental disorder" OR "adjustment disorder" OR "affective disorder
" OR "dysthymic disorder" OR "psychiat" OR "behaviour control" OR
"psychological phenomena" OR "depression" OR "mental health" OR
"stress disorder "OR" anxiety disorder" OR "maternal welfare" OR
"maternal health" Combined terms: 1 AND 2.

(a) Limited to World Bank defined low- and
lower-middle-income countries.

Note: The following databases were searched for
papers published up to November 2010: CINAHL,
Psychlnfo, Medline, RefMan and Web of Science.

Inclusion and exclusion criteria

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 income categories, were 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. We therefore included in the analysis studies from mainland China but not from Hong Kong SAR or Taiwan. 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 design. Information was extracted systematically using a standardized data extraction form. …

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