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Fisher and colleagues have done a, a systematic review.
To find studies that address this question and
they came up with the following list of risk
factors for perinatal common mental disorder.
And that list includes socioeconomic disadvantage, the fact that
the pregnancy was unintended versus a planned pregnancy, being younger.
Being unmarried and lacking support from your, your intimate partner, lacking
empathy from your intimate partner. Having hostile in-laws experiencing
intimate partner violence, which is is common aspect of life for
many in the world insufficient emotional and practical support in general.
Not just from, from your intimate partner.
Giving birth to a female in in some countries was associated with with higher
levels of perinatal common mental disorder, and
having a personal history of mental health problems.
And as you can see, there was a large variation
in the odds ratio, so the, the strength of this relationship.
Socioeconomic disadvantage odds ratios range from 2
to 13, so having poverty could could increase
your chances for having a perinatal common mental
disorder from between 2 and, and 13 times.
1:41
The systematic review also generated
a list of protective factors, although as you can see
that is that is a less common area of study.
And things that made it less likely that you
suffered a perinatal common mental disorder were having higher levels
of education having a permanent job, being part of the
ethnic majority, and having a kind and trustworthy Intimate partner.
Kind of the corollary of of
the risk factor that we saw in the previous list, where lacking intimate
partner empathy and support was a risk
factor for having perinatal common mental disorders.
Now, poverty is not only a risk factor for
perinatal mental disorder, but also for mental health in general.
Crick Lund in University of Cape Town did a, and colleagues,
conducted a a systematic review of studies that
looked at the relationship between poverty and common mental
disorders, so not just perinatal mental disorders, but common
mental disorders in in low and middle income countries.
And they found 115 studies.
So quite a few studies that have addressed this relationship.
And of those, the far majority did find a,
a relationship between poverty and a common mental disorder.
So, so by far you could conclude that
yes, poverty is associated with mental health issues.
In 15% of these studies there was no association
and then 6% there was a negative in, association.
So poverty was associated with better mental health.
Now poverty is a wide ranging, a wide ranging
concept that includes a lot of different aspects of life.
But, there were more consistent relationships
between mental health when, when poverty was measured as education, food security,
housing, social class, socioeconomic status, and financial stress.
The other risk factor that is commonly studied
in addition to poverty is exposure to violence.
And again, like poverty violence is not only, exposure to
violence is not only a risk factor for perinatal common mental
disorder, but also for mental disorders in,
in populations more broadly. A, a good systematic review on this
topic has been done by by Zachary Steel and colleagues.
It was published in in the Journal of the American Medical Association in 2009.
And that looked at the relationship between violence and
the mental health and conflict affected
populations, those populations exposed to, armed conflict.
And they found that in these populations on average, 17.3%
of people were suffering from depression, and this was in a, a subset of of studies.
There were many more studies that looked at this question, but
26 of these studies had large samples and, and used diagnostic
interviews, which are a methodologically strong way of
looking at if people have depression or not.
Predictors of depression included the number of potentially traumatic events.
So you can see that violence is, is a risk factor for depression.
It can, can raise chances for your developing depression with 1.6 times.
and so did torture,
as well as being a asylum seeker. In other words coming into a country
trying to trying to find the legal way to, to stay in that country as opposed to
refugees who have often already obtained residency status.
And and time since conflict was a a protective factor.
So a longer time had passed since the
the people had been exposed to armed conflict,
the less likely they were to have depression.
In this section we've looked at at what causes common mental disorders.
we've looked at that both for women who are pregnant and who
have just given birth, as well as for the population, more general.
The previous three sections really looked at the problem of depression.
We've looked at
whether depression looks the same across the world.
We've discussed how that kind of depends on what perspective you take.
If you take and emic perspective or an etic perspective.
In the next section, in section B. We looked at if depression is relevant
to the people in the low and middle income countries and we decided yes, because
it shows in the top ten of of factors that contribute to
disability in daily life.
We found for women who are pregnant and have just given birth that they
are highly prevalent and that they're associated
with with impairment in functioning and caused suffering.
William Eaton, PhDProfessor, Mental Health
Wietse A. Tol, PhDAli & Rose Kawi Assistant Professor, Mental Health
Ramin Mojtabai, MDAssociate Professor, Mental Health
