Perinatal depression among mothers in a South African birth cohort study: trajectories from pregnancy to 18 months postpartum
Open accessAbstract
BACKGROUND: Perinatal depression affects 21-50% of women in South Africa and poses significant health risks to mothers and children. Trajectories of depressive symptoms change over time and have not been well characterized during the perinatal period in low and middle-income countries. METHODS: Data from women enrolled in a population-based birth cohort study in Paarl, South Africa with at least 3 depression measures from pregnancy through 18 months postpartum (N = 831) were analyzed. Depressive symptoms were measured continuously using the Edinburgh Postnatal Depression Scale (EPDS). Group-based trajectory models were used to estimate trajectories of depressive symptoms during the perinatal period and multinomial multivariable models to identify predictors of trajectory group membership. RESULTS: Five distinct trajectory patterns of depressive symptoms were identified: moderate levels of depressive symptoms during pregnancy but minimal postpartum (3.5%), minimal levels during pregnancy and increasing postpartum (3.7%), unstable levels peaking at 12 months postpartum (6.6%), mild levels with slight decrease postpartum (82.9%), and severe levels during pregnancy and postpartum (3.1%). Membership in the chronic severe symptom group was associated with stressful life events, sexual intimate partner violence and tobacco use. LIMITATIONS: Modeling limitations prevented determining how changes in psychosocial predictors over time may influence depressive symptom trajectories. CONCLUSIONS: Mild to severe depressive symptoms during pregnancy/postpartum were common among this South African cohort. Interventions to treat women with severe chronic depressive symptoms with co-occurring psychosocial issues are urgently needed.
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The findings highlight the influential role of poverty-related risk factors, including unemployment, deprivation, disempowerment, and food insecurity, in shaping maternal mental health and subjectivities.
“The findings highlight the influential role of poverty-related risk factors, including unemployment, deprivation, disempowerment, and food insecurity, in shaping maternal mental health and subjectivities (22, 65).”
From “Motherhood is a work in progress”: a qualitative longitudinal study of maternal subjectivity and well-being of women in the Bukhali trial in Soweto, South Africa (2026) · cites this paper as [22]
The Introduction (page unavailable) identifies unemployment and food insecurity as social factors that may exacerbate depressive symptoms, supporting part of the claim as background context. But the Discussion (page unavailable) says unemployment was not significantly associated with the depression trajectory tested; the paper does not establish effects of deprivation or disempowerment, or address maternal subjectivities. The claim overstates these factors as findings of this study. (LLM, conf=0.86)
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Self-citation
- Authors
- Pellowski, J. A., Bengtson, A. M., Barnett, W., DiClemente, K., Koen, N., Zar, H. J., & Stein, D. J.
- Affiliations
- Brown University (US)
- South African Medical Research Council (ZA)
- Corresponding author
- Pellowski, Jennifer A.
- ORCID
- Venue
- Journal of Affective Disorders
- Publisher
- Elsevier BV
- Published
- 2019-12
- Volume
- 259
- Pages
- 279-287
- ISSN
- 0165-0327 (ISSN-L)
- PMC
- PMC6851529
- OpenAlex
- W2969427363
- Cited by
- 67
- References
- 51
- Citations by year
- 2026: 9 · 2025: 16 · 2024: 5 · 2023: 10 · 2022: 18 · 2021: 5 · 2020: 4
- FWCI
- 6.22
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Journal of Affective Disorders (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health
- Bill and Melinda Gates Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Keywords
- perinatal depression, depressive symptom trajectories, pregnancy, postpartum period, Edinburgh Postnatal Depression Scale, group-based trajectory modeling, life events, intimate partner violence, tobacco use, South Africa, birth cohort
- MeSH terms
- Adult, Depression, Female, Humans, Longitudinal Studies, Mothers, Pregnancy, Pregnancy Complications, Psychiatric Status Rating Scales, Risk Factors, Severity of Illness Index, South Africa, Disease Progression, Depression, Postpartum, Young Adult
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