Prevalence of psychological distress among pregnant women.
One in five pregnant women receiving antenatal services at Kawempe national referral hospital has psychological distress (PD). This magnitude is similar to findings from studies done in low and middle income countries, including Nigeria, Pakistan, Ethiopia, where the prevalence ranged from 18% to 38.5%(6–11) . However in high income countries, the prevalence of PD, among pregnant women is much lower than what we found. In the USA, the prevalence of PD among pregnant women was 6.4% in the first trimester and 3.9% in the third trimester (18). This may be because ACOG recommends screening for psychological stressors among pregnant women and thus a low prevalence(15,18). In France the prevalence of PD was found at 12.7% (19). This high magnitude in our setting justifies the need to introduce screening for PD among pregnant women.
Factors associated with psychological distress among pregnant women in Kawempe hospital.
In this study the factors that were independently associated with PD, were having a fair/bad relationship with spouse, low monthly income and having less than two meals a day.
These results were similar to a study by Karmaliani et al, carried out among 1368 participants which found that PD was associated with low household wealth(6). Also a study by Busari, et al found that low household wealth and verbal/physical abuse were strongly associated with PD this may be because, different contributing factors, as the pregnant woman may not be able to access the basic needs, or the essential needs, or even this may affect their health seeking behavior, due to inability to reach the health centers(3). Some of these factors are also interdependent as low household wealth is likely to result in food insecurity, especially in city suburbs among which this study was conducted. It has also been noted from several studies that families with low household wealth are likely to have increased levels of gender based violence(20). Among the 664 pregnant women who reported to antenatal care in 11 midwife centers and obstetric units in South Africa, Cape Town 38.6% had psychological distress. This study too had low social economic status as one of the major factors that were significantly associated with PD(21).
In a study by Jebena et al, looking at household food security and its relationship with psychological distress, it was found that pregnant women living in households experiencing food insecurity were 4.15 times more likely to develop psychological distress than their counter parts. The way these women developed PD, involved the worry to access food, which caused them to sacrifice the of quality diets for what is available(9).In our study, the women who had less than two meals a day were 3.31 times more likely to develop PD as compared to those who had three meals a day.
Strengths of the study:
This was a cross sectional study, and therefore we were able to assess, many variables and their strength of association with psychological distress. Data from our study can be used in other types of research methods, for example, these mothers could be followed up in a cohort study, to know the likely impact of psychological distress, on their pregnancies, or can be used as a case control study to ascertain the strength of association with different factors. This study had also not been conducted before in Uganda and as such, the prevalence of psychological distress among pregnant women had not been known.
Limitations:
The results of this study may have the following limitations. Psychological distress was measured at one point in time, and thus may not give a full picture of the strength of association, with the different variables. This was however minimized by doing both bivariate and multivariate logistics regression on the data, to determine the strength of association.