Maternal depression and child health: The case for integrating maternal mental health in Maternal and Child Health (MCH) Programmes

While the physical health of women and children is emphasized in international policy guidelines, the mental dimensions of their health are often ignored, especially in developing countries. However, recent and strong evidence suggests that the mental and physical health of mothers and children is inextricably linked, and the one cannot be possible without the other (Prince et al. 2007). This chapter reviews the evidence and suggests directions for policy and research in this area. Depression is the fourth leading cause of disease burden and the largest cause of nonfatal burden, accounting for almost 12% of all total years lived with disability worldwide. Depression around childbirth is common, affecting approximately 10–15% of all mothers in Western societies (O’Hara and Swain 1996). Epidemiological studies from the developing world have reported increasingly high rates of postnatal depression in diverse cultures across the developing world. An early pioneering study by Cox (1979) in a semirural Ugandan tribe found rates of 10% based on the ICD-8 criteria. Two decades later, a community study by Cooper et al. (1999) in a periurban settlement in South Africa, found rates of 34.7%, an increase of over threefold. Hospital-based studies have found rates of 23% in Goa, India (Patel et al. 2002), 22% in eastern Turkey (Inandi 2002) and 15.8% in Dubai, United Arab Emirates (Goubash and Abou-Saleh 1997). A rural-community study in Rawalpindi, Pakistan, reported over 25% women suffering from depression in the antenatal period and 28% in the postnatal period (Rahman et al. 2007). Over half these women were found to be still depressed a year later (Rahman and Creed 2007). A recent meta-analysis shows that the rates in low- and middle-income countries (LAMIC) are higher than high income countries, ranging from 18–25% (Fisher et al. 2012). Risk factors identified include previous psychiatric problems, life events in the previous year, poor marital relationship, lack of social support, and economic deprivation. Female infant gender was found to be an important determinant of postnatal depression in India, but not in South Africa. Importantly, postnatal depression was found to be associated with high degrees of chronicity, disability and disturbances of mother–infant relationship.