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Meta-Analysis
. 2022 Feb 9;17(2):e0263760.
doi: 10.1371/journal.pone.0263760. eCollection 2022.

Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis

Nafisa Insan  1 , Anthony Weke  1 , Simon Forrest  2 , Judith Rankin  1
Affiliations
Meta-Analysis

Social determinants of antenatal depression and anxiety among women in South Asia: A systematic review & meta-analysis

Nafisa Insan et al. PLoS One. .

Abstract

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.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow diagram of included studies.
Fig 2
Fig 2. Forest plot of association between antenatal depression/anxiety and maternal occupation unadjusted OR.
Fig 3
Fig 3. Forest plot of association between antenatal depression/anxiety and maternal occupation AOR.
Fig 4
Fig 4. Forest plot of association between antenatal depression/anxiety and husband’s occupation unadjusted OR.
Fig 5
Fig 5. Forest plot of association between antenatal depression/anxiety and husband’s occupation AOR.
Fig 6
Fig 6. Forest plot of association between antenatal depression/anxiety and relationship with husband unadjusted OR.
Fig 7
Fig 7. Forest plot of association between antenatal depression/anxiety and relationship with husband AOR.
Fig 8
Fig 8. Forest plot of association between antenatal depression/anxiety and IPV unadjusted OR.
Fig 9
Fig 9. Forest plot of association between antenatal depression/anxiety and IPV AOR.
Fig 10
Fig 10. Forest plot of association between antenatal depression/anxiety and pregnancy intentions unadjusted OR.
Fig 11
Fig 11. Forest plot of association between antenatal depression/anxiety and pregnancy intentions AOR.
Fig 12
Fig 12. Forest plot of association between antenatal depression/anxiety and relationship with in-laws unadjusted OR.
Fig 13
Fig 13. Forest plot of association between antenatal depression/anxiety and relationship with in-laws AOR.
Fig 14
Fig 14. Forest plot of association between antenatal depression/anxiety and social/family support unadjusted OR.
Fig 15
Fig 15. Forest plot of association between antenatal depression/anxiety and social/family support AOR.
Fig 16
Fig 16. Forest plot of association between antenatal depression/anxiety and gender preference unadjusted OR.
Fig 17
Fig 17. Forest plot of association between antenatal depression/anxiety and gender preference AOR.
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Grants and funding

NI is a PhD student funded by the Economic and Social Research Council (reference 150041616, https://www.ninedtp.ac.uk/) through UKRI funding. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.