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Effect of the 2015 Nepal Earthquakes on symptoms of common mental disorders among women who are pregnant.
J Affect Disord. 2018 03 01; 228:238-247.JA

Abstract

BACKGROUND

Antenatal mental health problems are of concern globally not only because of the burden and limits to participation experienced by women but also because of risks for foetal neurocognitive development and adverse birth outcomes. The aim was to describe the indicative prevalence of and risk and protective factors for clinically-significant symptoms of antenatal common mental disorders (CMDs) among women who experienced the 2015 Nepal earthquakes during pregnancy.

METHODS

A population-based cross-sectional study in Bhaktapur, one of 14 districts highly affected by the 2015 Nepal earthquakes. The primary outcome, clinically significant symptoms of CMDs, was ascertained using the Nepali validation of the Edinburgh Postnatal Depression Scale (EPDS-N). In order to investigate potential trauma reactions, a subset of EPDS items as indicators of trauma symptoms was constructed. Standardised instruments and study-specific questions were used to measure potential risk and protective factors. Data were collected in individual structured interviews by trained health researchers. Hierarchical multiple linear regression models were used to establish risk and protective factors for clinically significant symptoms of CMDs and indicators of post-earthquake trauma reaction.

RESULTS

Overall, 497/498 eligible pregnant women provided complete data. We found that 21.9% (95% CI, 18.4; 25.8) of participants had EPDS-N scores > 12 and another 17.1% (95% CI 13.9; 20.7) scored 10-12 indicating a high prevalence of clinically significant CMD symptoms. In total, 20 factors were included in the final hierarchical multiple linear regression model and together explained 33.3% of the variance in EPDS total scores; seven factors, including earthquake experiences and lifetime experience of intimate partner violence, increased risk and five including having income-generating work and a kind, and encouraging partner were protective. The association between earthquake experiences and the indicators of trauma symptoms was not significant in the hierarchical multiple linear regression analysis.

LIMITATIONS

The EPDS has not yet been formally validated in Nepal for use during pregnancy. Data were collected 6 months post-earthquake, so we were not able to capture the experiences of women who had spontaneous or induced abortions or premature births in the immediate aftermath of the earthquake.

CONCLUSIONS

In addition to the restoration of antenatal and obstetric services, the mental health of women who are pregnant requires specific consideration and interventions after natural disasters. This should take into account the additional adverse impact of violence perpetrated by an intimate partner.

Authors+Show Affiliations

Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia.Health Research and Social Development Forum International, Kathmandu 44600, Nepal.Jean Hailes Research Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia. Electronic address: jane.fisher@monash.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29277063

Citation

Khatri, Goma Kumari, et al. "Effect of the 2015 Nepal Earthquakes On Symptoms of Common Mental Disorders Among Women Who Are Pregnant." Journal of Affective Disorders, vol. 228, 2018, pp. 238-247.
Khatri GK, Tran TD, Baral S, et al. Effect of the 2015 Nepal Earthquakes on symptoms of common mental disorders among women who are pregnant. J Affect Disord. 2018;228:238-247.
Khatri, G. K., Tran, T. D., Baral, S., & Fisher, J. (2018). Effect of the 2015 Nepal Earthquakes on symptoms of common mental disorders among women who are pregnant. Journal of Affective Disorders, 228, 238-247. https://doi.org/10.1016/j.jad.2017.12.016
Khatri GK, et al. Effect of the 2015 Nepal Earthquakes On Symptoms of Common Mental Disorders Among Women Who Are Pregnant. J Affect Disord. 2018 03 1;228:238-247. PubMed PMID: 29277063.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Effect of the 2015 Nepal Earthquakes on symptoms of common mental disorders among women who are pregnant. AU - Khatri,Goma Kumari, AU - Tran,Thach Duc, AU - Baral,Sushil, AU - Fisher,Jane, Y1 - 2017/12/09/ PY - 2017/04/21/received PY - 2017/11/17/revised PY - 2017/12/06/accepted PY - 2017/12/26/pubmed PY - 2018/8/28/medline PY - 2017/12/26/entrez KW - Antenatal KW - Common Mental Disorders KW - Earthquake KW - Intimate Partner Violence SP - 238 EP - 247 JF - Journal of affective disorders JO - J Affect Disord VL - 228 N2 - BACKGROUND: Antenatal mental health problems are of concern globally not only because of the burden and limits to participation experienced by women but also because of risks for foetal neurocognitive development and adverse birth outcomes. The aim was to describe the indicative prevalence of and risk and protective factors for clinically-significant symptoms of antenatal common mental disorders (CMDs) among women who experienced the 2015 Nepal earthquakes during pregnancy. METHODS: A population-based cross-sectional study in Bhaktapur, one of 14 districts highly affected by the 2015 Nepal earthquakes. The primary outcome, clinically significant symptoms of CMDs, was ascertained using the Nepali validation of the Edinburgh Postnatal Depression Scale (EPDS-N). In order to investigate potential trauma reactions, a subset of EPDS items as indicators of trauma symptoms was constructed. Standardised instruments and study-specific questions were used to measure potential risk and protective factors. Data were collected in individual structured interviews by trained health researchers. Hierarchical multiple linear regression models were used to establish risk and protective factors for clinically significant symptoms of CMDs and indicators of post-earthquake trauma reaction. RESULTS: Overall, 497/498 eligible pregnant women provided complete data. We found that 21.9% (95% CI, 18.4; 25.8) of participants had EPDS-N scores > 12 and another 17.1% (95% CI 13.9; 20.7) scored 10-12 indicating a high prevalence of clinically significant CMD symptoms. In total, 20 factors were included in the final hierarchical multiple linear regression model and together explained 33.3% of the variance in EPDS total scores; seven factors, including earthquake experiences and lifetime experience of intimate partner violence, increased risk and five including having income-generating work and a kind, and encouraging partner were protective. The association between earthquake experiences and the indicators of trauma symptoms was not significant in the hierarchical multiple linear regression analysis. LIMITATIONS: The EPDS has not yet been formally validated in Nepal for use during pregnancy. Data were collected 6 months post-earthquake, so we were not able to capture the experiences of women who had spontaneous or induced abortions or premature births in the immediate aftermath of the earthquake. CONCLUSIONS: In addition to the restoration of antenatal and obstetric services, the mental health of women who are pregnant requires specific consideration and interventions after natural disasters. This should take into account the additional adverse impact of violence perpetrated by an intimate partner. SN - 1573-2517 UR - https://www.unboundmedicine.com/medline/citation/29277063/Effect_of_the_2015_Nepal_Earthquakes_on_symptoms_of_common_mental_disorders_among_women_who_are_pregnant_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0165-0327(17)30811-X DB - PRIME DP - Unbound Medicine ER -