Antenatal mental disorders in sub-Saharan African countries poorly understood as compared to high-income countries (1).The term common mental disorder (CMD) was first used by Goldberg and Huxley to describe a distress condition characterized by diffuse somatic symptoms, anxiety, and depressive states (2). Pregnancy and childbirth are gaining recognition as significant risk factors for the development and exacerbation of mental health problems. In LMICs, about one in six pregnant women experiences CMD (3, 4).
Maternal mental illness affects child health and may increase infant mortality as depression may adversely affect bonding between mother and child, and may result in a child’s failure to thrive (5). Perinatal mental illness is a significant complication of pregnancy during the postpartum period and disorders include depression, anxiety disorders, and postpartum psychosis (6). Non-psychotic common perinatal mental disorders (CPMD) are more prevalent in low- and lower-middle-income countries (LMICs) particularly among poorer women with gender-based risks or a psychiatric history (7).
Antenatal mental disorders are among the commonest health problems associated with pregnancy and the postpartum period (8). Specifically, maternal mental illness is likely to have a profound impact in less developed parts of the world (9). A woman experiencing mental distress in a low income settings is at risk of providing sub-optimal care for her offspring which can have grave consequences in an environment where poverty, overcrowding, poor sanitation, malnutrition, tropical diseases and a lack of appropriate medical services may be pronounced (10). In addition, antenatal mental disorders are associated with adverse effects on the fetus including low birth weight, pre-term delivery, perinatal and infant the last associated with subsequent behavioral/emotional problems in the child and adolescent (11).
A review on focusing on CMDs in mothers versus infant and obstetric outcomes in 2012 reported CMD varying from 12 to 43% during pregnancy both in LMICs and in high-income countries though economic conditions increase women’s vulnerability in LMICs (12).
A total of 25 articles published between 1975 and 2010 were reviewed on CMD in mothers versus infant and obstetric outcomes in Brazil and most studies reported a prevalence of 20% for CMD during pregnancy, similar to that found generally in women (13). A review about prevalence and determinants of non-psychotic antenatal CMDs in LMICs found weighted mean prevalence of 15.6% (3)and reported risk factors were: socioeconomic disadvantage (14); unintended pregnancy (15–17); being younger; being unmarried; lacking intimate partner empathy and support (15); experiencing intimate partner violence (18); having insufficient emotional and practical support (18–21), and history of mental health problems (16, 22).
CMD during pregnancy was studied in different settings globally using psychometric instruments including Self-reporting Questionnaires-20 items (SRQ-20), Chinese Health Questionnaire-12 items (CHQ-12), General Health Questionnaire-30 items (GHQ-30), Edinburgh Postnatal Depression Scale (EPDS), Present State Examination Schedule (PSE),Comprehensive Psychopathological Rating Scale (CPRS), or psychiatrist-administered structured clinical interviews. And prevalence of CMD was reported as: 41.4–43.1% in Brazil (23–25); 17.4–37.4% in Viet Nam (26–29); 7% in Nigeria (10); 16.7% in Uganda (30). Estimations of CMD ranged from 9.2%-33% in Ethiopia (16, 29, 31–35).
A measure of CMD (SRQ-20) has been shown to have criterion validity in Ethiopia (35), Nigeria, Malawi, China, and Mongolia, as well as in high-income settings and a cut-off score of ≥ 6 was shown to have convergent validity as an indicator of CMD probable case (15, 36–39).
The rationale for investigating CMD in pregnant women is that, because pregnancy is a period of physiological mal-adjustment, psychological and social factors may impose vulnerability to develop mental distress (12). Little is known about the prevalence and risk factors of CMDS in pregnant women in LMICs including Ethiopia. Even within the available studies, Ethiopia is a country with diverse socio-cultural characteristics and determinants of CMD may vary from culture to culture.
It is therefore anticipated that the study findings will contribute to the development of local knowledge about antenatal CMD and be used to scale up the assessment of risks in pregnant mothers involving a careful exploration of CMD vulnerabilities. The findings of this study might also help in influencing the development of appropriate policies, plans and intervention programs for the screening and treatment of antenatal CMD.