Depression is a leading cause of disease-related disability among women globally[1]. Characterized by the Massachusetts General Hospital Comprehensive Clinical Psychiatry as the presence of depressed mood or loss of interest, most of the day, more days than not, depression presents numerous symptoms including changes in appetite and sleep patterns, feelings of guilt, poor self-esteem, poor concentration, psychomotor agitation, fatigue, and even suicide. The prevalence of depression is deeply concerning with an estimated 280 million people living with the disease globally[1]. Among women with a history of pregnancy and/or childbirth, depression in the period before childbirth was common with a prevalence rate as high as 25% [2]. In low-and-middle-income countries (LMICs), the prevalence rate of antepartum depression is estimated to range between 15% and 57% [3] and it is slightly higher than postpartum depression ranging between 14% and 50% [4]. Evidence shows that when not treated, antepartum depression can continue to the postpartum period [5].
Traditionally, pregnancy was perceived to protect women from depression since it was thought to be a period of wellness and happiness but recent evidence suggests otherwise as the incidence of depression diagnoses during childbirth has been on the rise, with a sevenfold increase in 2015 compared to the year 2000[6]. According to a recent CDC study, Depression during pregnancy is not easily noticeable though its prevalence is high [2]. Evidence suggests it is difficult to diagnose depression during the first trimester because there is usually an overlap between symptoms of pregnancy and symptoms of depression[7]; nonetheless, in a systematic review, [8] documented a 7.4% prevalence of depression during the first trimester in their study. This figure rose to 12.8% during the second trimester and remained at 12% during the last trimester. Another longitudinal study in Sweden by Josefsson et al., [9] found a 17% rate of antepartum depression. These patients were then followed into the postpartum period and depression rates were found to have decreased by 4–13% by the 8th week after delivery and maintained at 6 months postpartum. Two studies [10] [11] have revealed the risk factors connected with depression during pregnancy; personal and family history of depression, childhood abuse, domestic or partner violence, smoking/substance abuse, single motherhood, inadequate social support, lower educational levels, lack of employment and adolescent pregnancies.
Adolescent pregnancy is widely seen as a public health problem due to its health and social implications. Studies show that 11% of all deliveries worldwide and about 14% of all maternal deaths globally are among adolescents aged between 15 and 19 years old with over 90% of such adolescent births occurring in LMICs [1], [12]. In adolescents younger than 15 years, a study revealed that approximately 10 million births occur among young girls between 10 and 15 years every year in LMICs including Ghana. Ghana’s adolescent pregnancy situation is no different from other LMICs. Ghana continues to record high cases of adolescent pregnancies. Research reveals that about one in ten females between 15 and 19 years of age had begun childbearing in cities whereas the situation in rural settings is twice as high as those in urban settings [13]. The 2014 Ghana Demography and Health Survey (GDHS) report revealed that 14% of adolescents aged 15–19 years had begun childbearing with 11% having had a live birth and 3% pregnant with their first child [14]. Adolescent pregnancies are associated with health, psychosocial and economic consequences that make adolescent pregnancy a disturbing public health concern [8], [15]. Some studies suggest that adolescent pregnancy has a higher incidence of health-related complications such as serious maternal and neonatal outcomes [15], [16]. These include preterm birth, low birth weight, anemia, Sexually Transmitted Infections (STIs), postpartum hemorrhage, and mental disorders such as depression.
Studies have documented several factors that may contribute to adolescent pregnancy. Some societies put pressure on girls to marry and bear children, especially because there is more value on motherhood and marriage. Girls may also choose to become pregnant when there are limited educational and job opportunities [1], [17]. These may be because of lack of access to contraceptives, knowledge gaps, financial constraints, sexual violence, and lack of autonomy among many other constraints [18].
Women living in developing countries such as Ghana are particularly vulnerable to multiple exposures to depression. Studies in Africa show that rates of depression during pregnancy are generally significantly higher and may have longer durations than those in developed countries [4], [19]. Ghana has over 2.3 million people living with various mental health conditions, yet mental health care remains a challenge, with a 98% treatment gap [20], [21]. Another study in Ghana, which looked at the prevalence and risk factors of postpartum depression among 153 mothers of sick and hospitalized infants in a tertiary hospital, found 32.4% mild, 27.4% moderate, and 9.8% severe depression [4]. Another study by Okronipa et al. [22] looked at postpartum depression among HIV-positive women in Ghana and established that 10% of the respondents had symptoms of depression at the time of birth and a further 9% six[23] months after birth. Yet another study compared three [24] screening instruments for postpartum depression. It was found that 11% of the 160 respondents had scores that represent clinically major depression [14], [25] and these are all studies among adult women who are not adolescents. Although some studies have shown that depression is common in adolescent pregnancies and has between 28% and 67% among adolescent mothers [24], [26], there currently exists no literature on depression among adolescent pregnant women in Ghana. Thus, this study aimed to contribute to the evidence base on antepartum depression among adolescent women in Ghana by placing it in a larger context of prevalence and factors associated with it.