In this study, 13.1% of pregnant women were found to have antenatal common mental disorders. Moreover, women who were married, lived in rural areas, had unplanned pregnancies, had a family history of common mental disorders, and experienced intimate partner violence were more likely to develop antenatal CMD.
This prevalence of 13% (95% CI: 10.01–15.49) was in line with the study conducted in Butajira town (12%) (42), Arba Minch Zuria district (10.0%) (43), Pakistan (13.5%), (44) and, higher than a meta-analysis conducted in LMICs (4.1%) (45). Our estimate for antenatal common mental disorders is also lower than previous estimates in other regions of Ethiopia and other countries (17, 19, 20, 44–46), This variation could be attributed to differences in the antenatal common mental disorder measurement scale, other methodological differences and cut-off points used, adequacy of the sample size, pregnancy trimester, and the socio-demographic and cultural characteristics of the pregnant women.
The findings of this study indicated that pregnant women who experienced intimate partner violence were 2.43 times more likely to develop a common mental disorder than those who had not encountered such abuse. This finding is consistent with similar research conducted in Haromaya (22), Bale (18), and Butajira (17), as well as in Tanzania (49), Vietnam (50), and India (51). Moreover, a systematic review and meta-analysis of LMICs also support this outcome (52). This might be due to violence being inherently humiliating as a result Women who suffer from intimate partner violence often refrain from disclosing the abuse to others due to fear of being stigmatized, and experiencing partner violence might be a generator of sadness and distress for pregnant women. Additionally, being abused by a person they are emotionally involved with can trigger helplessness, low self-esteem, and mental distress (46, 51, 52).
Participants who had a family history of mental illness were 5.08 times more likely to have antenatal common mental disorders than their counterparts. This finding is supported by previous studies done in Ethiopia and other countries (14, 17, 53–55) Having a family history of mental disorders increases the risk of developing mental illness in the long run of a person's life. This may be the genetic and psychological basis of mental illness, and additionally, studies have suggested that those with a family history of mental illness are more likely to develop CMD (58).
Despite the fact that married pregnant women were more protected against mental distress and other epidemiological studies conducted in Ethiopia and other countries supported this evidence (14, 50, 57–59). The result of our study highlights the complexity of marital relationships, and being married has a positive effect on maternal mental distress, similar to the study of Kaiyo et al. (62). The possible explanation attributed to this might be that partnered pregnant women living in poor-quality relationships with their partners also appear to be at greater risk of antenatal mental health problems. Moreover, a study conducted in Australia indicated that poor partner relationships are the strongest predictor of prenatal psychological distress, and partnered pregnant women who live in violent marital relationships receive less support from their spouses and even cause additional psychological distress, which leads to adverse pregnancy outcomes (61).
With respect to residency, common mental disorders among pregnant women who reside in rural areas within the Dabat HDSS were 2.58 times more likely to develop CMD than those living in urban areas. This result is in line with the study conducted in rural Bangladesh (54) and Brazil (63). One possible explanation is that in developing countries such as Ethiopia, particularly in rural areas, there is a lack of mental health services, and mental health services are rarely used by the community for a variety of reasons. First, due to a lack of awareness about mental illness, there is a preference for traditional treatment for the treatment of mental illness in most of the society in Ethiopia (64). Moreover, pregnant women living in a world of economic scarcity, and stressful conditions have a greater risk of developing mental health problems. Additionally, our study, supports the social determinant of theory which indicates that the odds of developing common mental disorders is highest among the most socially and economically disadvantaged women. And these women may have fewer opportunities for paid employment, fewer social contacts, and less access to health services compared to urban women (65).
In this study, pregnant women who unintentionally became pregnant were 1.6 times more likely to have antenatal common mental disorders than those who planned their pregnancy. This may be attributed to limited access to contraception and prevailing beliefs or traditions in Ethiopia, where only 41% of women reported current contraceptive use based on the 2019 Ethiopia Demographic Survey (66). Furthermore, women having unplanned pregnancy are usually not mentally prepared to go through the changes and the responsibility that they have to deal with. This finding is in line with studies in other LMICs (50, 51, 65), and studies in other regions of Ethiopia (20, 44, 54, 66, 67).