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Longitudinally investigating patterns of maternal psychological distress in a South African birth cohort

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MacGinty, Rae, Hoffman, Nadia, Koen, Nastassja, Zar, Heather J., Stein, Dan J., Pellowski, Jennifer·2025·BMC Public Health
DOI 10.1186/s12889-025-24445-xPMC PMC12505592
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Abstract

Background: Psychological distress, a broad construct that encompasses of a range of emotional difficulties—including depression and anxiety—is prevalent during pregnancy and postnatally with up to 25% of women experiencing psychological distress globally. However, this is mostly described in high income countries (HIC), with little data from low- and middle-income countries (LMICs). The aim of this study was to describe and determine latent trajectory classes of maternal psychological distress from pregnancy through five years postpartum in a LMIC setting. Methods: Data were used from women enrolled in the Drakenstein Child Health Study (DCHS), a birth cohort in South Africa. Women who had completed the Self-Report Questionnaire-20 items (SRQ-20) at two or more timepoints from pregnancy to 5 years postpartum, were included in the analysis. Latent class mixed modelling (LCMM) was used to generate latent trajectory classes of maternal psychological distress. Predictors, including trauma exposure, socio-economic indicators, substance use and pregnancy complications, of the latent classes were investigated using multinomial logistic regression. Results: In 973 women, four trajectory classes of maternal psychological distress were derived from pregnancy through 5 years postpartum, 1) persistent psychological distress symptoms, 2) antenatal symptoms only, 3) late postnatal onset of symptoms (post perinatal stage) and 4) low symptoms of psychological distress. Predictors of the persistent symptom class included early and recent trauma exposure, smoking during pregnancy, and gestational diabetes, whereas partner support was protective. Trauma exposure prior or during pregnancy was a predictor for the antenatal symptom class, while postnatal trauma exposure was associated with the late onset symptom class. Conclusion: Trajectories and predictors of maternal psychological distress were found to be similar to those seen in depression only and in HIC, which suggests there could be a degree of universality with regards to predictors of psychological distress. Trauma experienced by women was found to be a critical risk factor for psychological distress, as was maternal smoking or lack of partner support. There is an urgent need for social transformation surrounding gender-based violence and prevention and smoking cessation programs targeting women of child bearing age.

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Cited by

Sorted by citations

Authors
MacGinty, R., Hoffman, N., Koen, N., Zar, H. J., Stein, D. J., & Pellowski, J.
Affiliations
  • University of Cape Town (ZA)
  • South African Medical Research Council (ZA)
Corresponding author
MacGinty, Rae
ORCID
Venue
BMC Public Health
Publisher
Springer Science and Business Media LLC
Published
2025-10-08
Volume
25
Issue
1
Pages
3409-3409
ISSN
1471-2458 (ISSN-L)
DOI
10.1186/s12889-025-24445-x
PMC
PMC12505592
OpenAlex
W4414968361
Cited by
1
References
7
Citations by year
2026: 1
FWCI
0.91
Type
journal article
Language
en
Open access
Licence
Locations
  • BMC Public Health (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • South African Medical Research Council
  • National Institutes of Health (R01HD108048)
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
  • Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
Keywords
maternal distress, perinatal mental health, pregnancy, postpartum period, trauma exposure, gender-based violence, maternal smoking, partner support, gestational diabetes mellitus, low- and middle-income countries, South Africa, Drakenstein Child Health Study, anxiety and depression
MeSH terms
Psychological Distress, Birth Cohort, Adult, Female, Humans, Longitudinal Studies, Mothers, Pregnancy, Pregnancy Complications, South Africa, Stress, Psychological, Young Adult

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