Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: A cross-sectional study

Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: A cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: A cross-sectional study Musa Kasujja, Samuel Omara, Nasifu Senkungu, Shamim Ndibuuza, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3921521/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Mar, 2024 Read the published version in BMC Women's Health → Version 1 posted 9 You are reading this latest preprint version Abstract Introduction: This study investigated the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it can lead to adverse outcomes, including preterm birth, abortion, low birth weight, and impaired maternal–infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care. Methods A cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants’ psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression. Results Antenatal depression burden was notably high, affecting 37.68% of the participants. The majority of patients with antenatal depression had mild symptoms (72.68%). The significantly associated factors at multivariate analysis included younger age (≤ 20), older age (≥ 35), history of domestic violence, alcohol use, gestational age, abortion history, history of preeclampsia and unplanned pregnancies. Conclusion This study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the need for timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, past preeclampsia, and unplanned pregnancy. Depression during pregnancy antenatal prenatal depression Figures Figure 1 Figure 2 Background Antenatal depression is an episode of a nonpsychotic depressed mood disorder characterized by two weeks or more of feeling low accompanied by loss of interest in previously pleasurable daily activities, low self-esteem, a feeling of guilt, low energy and death wish, which occurs during pregnancy ( 1 ). There is evidence that a number of stressors during pregnancy, including having an unintended pregnancy ( 2 , 3 ), present or past pregnancy complications ( 4 ), chronic disease ( 5 ), previous mental illness ( 6 ), fear of giving birth ( 7 ), gestational age ( 8 ) and maternal age ( 9 ), increase the risk of developing depression. Depression increases maternal noradrenaline and cortisol levels, which reduce uterine blood flow and are linked to adverse obstetric and neonatal outcomes, including spontaneous abortion, hypertensive disorders, APH, IUGR, prematurity, low birth weight, low Apgar scores, babies requiring ICU admission and postnatal depression ( 10 – 12 ). Furthermore, several risky behaviors have been associated with antenatal depression, such as increased substance abuse, e.g., alcoholism and smoking; reduced healthcare service uptake; poor appetite; and suicide, which also worsen fetal and maternal wellbeing ( 6 ). In pregnancy, depression is the most prevalent mental health problem, and it can alter fetal development and cause adverse obstetric and neonatal outcomes when not identified and treated early ( 11 , 13 , 14 ). Despite the high prevalence of antenatal depression in Uganda (35.8%) ( 15 ), maternal and child health programmes in Uganda focus mainly on improving the nutritional and physical status of the mother and ignore her mental status. Current perinatal care guidelines established by the American College of Obstetricians and Gynecologists advocate routine screening for depression for all pregnancies ( 16 ). Several other international standards, such as the WHO ( 17 ), NICE ( 18 ) and RCOG ( 19 ), all advise employing a consistent, validated test to screen for antenatal depression during antenatal care. However, local clinical guidelines in Uganda lack a standard protocol for screening for antenatal depression ( 20 ). The lack of screening for antenatal depression as part of standard antenatal care may increase its prevalence, lead to inadequate detection and treatment, and cause serious consequences for both mothers and babies. Since it is essential to pay attention to maternal mental health, this study aimed to generate evidence about the prevalence, severity and factors associated with antenatal depression among women attending ANC at MRRH. Materials and Methods Study design Cross-sectional. Study site This study was carried out at the antenatal care section of MRRH, a publicly financed hospital located in the Mubende town council, Kyaterekera Parish, Mubende district in Uganda's central region. Sample size calculation : The sample size was estimated using the statistical equation of Kish Leslie (1965): \(n=\frac{{Z}^{2}PQ}{{D}^{2}}\) Where \(n\) = the desired sample size, \(Z\) = the standard normal deviation at the 95% confidence level, \(Z\) =1.96, and \(P\) = the proportion of the target population estimated to have the specific characteristic (female attending ANC who has antenatal depression). The prevalence of antenatal depression in Uganda was found to be 35.8% ( 15 ). \(Q\) = (1- \(P\) ) = proportion of the population without the characteristic. \(D\) = precision of the study (the degree of accuracy desired). In this case, \(D\) = 5% was used. Therefore, substituting \(n =\frac{{1.96}^{2} \text{X}0.358\text{X}0.642}{0.05\text{X}0.05}= 353\) Inclusion and exclusion criteria Inclusion criteria All pregnant and attending ANC at MRRH during the study period. Exclusion criteria Obstetric emergencies or medical illnesses which needed urgent attention like eclampsia, ruptured ectopic, and epilepsy. A severe mental health problem associated with lack of insight and therefore couldn't respond to the interviewer administered questionnaire. E.g schizophrenia and bipolar affective disorder. Women receiving psychiatric treatment and or antidepressants medication. Study procedure At the commencement of each ANC clinic, an educational talk was given by the researcher regarding the study’s objectives, inclusion and exclusion criteria, and benefits. We then employed a consecutive sampling procedure. A list of women attending the ANC clinic who met the inclusion criteria was obtained at the beginning of each clinic day by the research assistants, and every woman was approached to participate in this study. Data collection Patients who agreed to participate were provided with appropriate privacy and confidentiality. The researcher and two research assistants administered a structured questionnaire to each individual participant away from the hearing of other patients. We went through the informed consent form with the participants in the language in which they were knowledgeable, and their written consent was sought before administering the questionnaire. The participants were required to respond to each question they were asked about individually. Study variables The study investigated the influence of independent variables, encompassing psychosocial demographic factors (age, education, marital and employment status, alcohol use, monthly household income, family history of mental illness, and experiences of domestic violence), and obstetric characteristics (gestation age, pregnancy planning, history of spontaneous abortion, eclampsia/preeclampsia, and stillbirth), on the dependent variable, antenatal depression. Data quality control To guarantee that the questionnaires were appropriate, simple English was used, and the use of technical terms was limited. The questionnaires were translated to Luganda and back-translated for precision and accuracy. The translated questionnaires were read to English-naive participants. The researcher monitored the data collection process, and cross-checking of the questionnaires was performed immediately after the participants had finished answering the questions to guarantee accuracy and completeness. Data analysis Objective one The prevalence of antenatal depression was summarized as the frequency and percentage with 95% confidence intervals. The severity of antenatal depression was categorized as mild if the total PHQ-9 score was 5 to 9, moderate if it was 10 to 14 or severe if it was 15 or more. The results are presented in the form of pie charts and tables for effective interpretation and discussion. Objective two The factors associated with antenatal depression were assessed using binary logistic regression. A significance level of 5% was used, and a p value less than 0.05 indicated a statistically significant association between the variables. A p value lying outside the limits of confidence indicated no association between the variables. The results are presented in the form of bar graphs and tables for effective interpretation and discussion. Ethical considerations : Ethical approval and clearance for conducting this study were obtained from the Bishop Stuart University Research Ethics Committee (BSU-REC) ( Ref No: BSU-REC-2023-130 ). Administrative permission was obtained from the administration of MRRH and the in-charge ANC clinic. Informed consent was obtained from all study participants before they were interviewed. Results This study was conducted in the ANC unit of the MRRH during the timeframe encompassing August 2023. At the commencement of each ANC clinic, 509 women were given an educational talk by the researcher regarding the study’s objectives, inclusion and exclusion criteria, and benefits. We excluded women who met the exclusion criteria and those who did not consent. The study flow was as shown in Fig. 1below. Figure 1 Study flow chart. Table 1 Descriptive statistics for psychosocial demographic characteristics, N = 353. Psycho-social demographic characteristics Frequency (n) Percentage (%) Age 17 to 20 94 26.63 21 to 34 220 62.32 35 and above 39 11.05 Marital status Married/Cohabiting 328 92.92 Single/Separated 25 7.08 Education Primary 218 61.76 Secondary & Tertiary 135 38.24 Employment Employed 190 53.82 Unemployed 163 46.18 Household Income (UGX) Less than 500,000 195 55.24 More than 500,000 158 44.76 Family history of mental illness No 303 85.84 Yes 50 14.16 History of domestic violence No 329 93.2 Yes 24 6.8 Alcohol use No 322 91.22 Yes 31 8.78 Table 1 above presents the psycho-social demographic characteristics of the participants. Table 2 Descriptive statistics for the obstetric characteristics of the participants (n = 353). Obstetric characteristics Frequency (n) Percentage (%) Gestational Age Less than 13 weeks 46 13.03 13 to 28 weeks 130 36.83 More than 28 weeks 177 s50.14 Previous history of Preeclampsia No 330 93.48 Yes 23 6.52 History of abortion No 299 84.7 Yes 54 15.3 History of a Still birth No 335 94.9 Yes 18 5.1 Pregnancy Planning No (Unplanned) 196 55.52 Yes (Planned) 157 44.48 Table 2 above summarizes the obstetric characteristics of the research population. Table 3 Prevalence of antenatal depression among women attending ANC at MRRH Category Frequency(n) Percentage (%) 95% CI Depression 133 37.68 (32.60–42.96) No depression 220 62.32 (57.04–67.40) Total 353 100.00 Table 3 above shows that of the 353 participants, 133 (37.68%) were classified as having depression, while 220 (62.32%) were identified as not having depression. Figure 2: A pie chart showing the distribution of antenatal depression severity among women with antenatal depression. Figure 2 above shows that out of the 133 participants with antenatal depression, 94 (70.68%) had mild depression, 29 (21.80%) had moderate depression, and 10 (7.52%) had severe depression. Table 4 Multivariate analysis of factors associated with antenatal depression among women receiving antenatal care Characteristic Unadjusted Analysis Adjusted Analysis cOR (95% CI) p aOR (95% CI) p Age 21 to 34 Ref Ref 17 to 20 6.00 (3.55–10.15) < 0.001 7.74 (3.42–17.51) < 0.001 35 and above 4.89 (2.40–9.96) < 0.001 3.16 (1.26–7.92) 0.014 Marital status Married/Cohabiting Ref Ref Single/Separated 5.94 (2.31–15.30) < 0.001 4.23 (0.65–27.66) 0.132 Education Primary Ref Ref Secondary/Tertiary 0.38 (0.24–0.61) < 0.001 0.44 (0.20-1.00) 0.05 Employment Employed Ref Ref Unemployed 2.04 (1.32–3.16) 0.001 1.03 (0.50–2.13) 0.932 Household Income ≥ 500,000 Ref Ref < 500,000 1.77 (1.14–2.75) 0.011 1.38 (0.74–2.57) 0.306 Family mental illness history No Ref Ref Yes 1.49 (0.82–2.73) 0.192 1.71 (0.69–4.25) 0.245 History of violence No Ref Ref Yes 9.56 (3.20-28.64) < 0.001 6.51 (1.81–23.42) 0.004 Alcohol use No Ref Ref Yes 10.45 (3.90-27.97) < 0.001 8.46 (2.76–25.95) < 0.001 Gestational Age 13 to 28 weeks Ref Ref < 13 weeks 7.20 (3.43–15.12) 28 weeks 2.44 (1.47–4.07) 0.001 1.90 (0.94–3.81) 0.075 Previous preeclampsia No Ref Ref Yes 1.88 (0.81–4.40) 0.143 5.46 (1.69–17.63) 0.005 History of abortion No Ref Ref Yes 5.67 (2.98–10.79) < 0.001 4.32 (1.88–9.95) 0.001 Still birth No Ref Ref Yes 2.15 (0.83–5.60) 0.116 1.84 (0.46–7.31) 0.387 Pregnancy Planning Yes (Planned) Ref Ref No (Unplanned) 10.10 (5.78–17.23) < 0.001 12.59 (5.75–27.57) < 0.001 Ref = Reference category, cOR = crude odds ratio, aOR = adjusted odds ratio, CI = confidence interval, p = p value We analyzed the relationship between different participant characteristics and antenatal depression using odds ratios (ORs) along with 95% confidence intervals (CIs). Table 4 presents both the unadjusted (crude) and adjusted OR values for each characteristic. Discussion Objective 1: The prevalence of antenatal depression. It was determined to be 37.68%. This aligns with the worldwide prevalence range of 15 to 65%, as reported by ( 4 ). Additionally, this prevalence surpasses the pooled prevalence of 27.01% for sub-Saharan Africa reported by ( 1 ). This variance might be due to cultural distinctions across various countries and the utilization of alternative assessment tools for antenatal depression other than the PHQ-9 in some studies. The high prevalence observed in this study is consistent with previous research conducted in Kenya, where the prevalence was 36% ( 21 ). However, these findings are higher than those in Tanzania, where the prevalence was 11.5% ( 22 ), and in Rwanda, where it was 26.6% ( 23 ). This discrepancy could be attributed to the fact that Tele et al., (2022), like in our study, utilized the PHQ-9 as an assessment tool, whereas Ngocho et al., (2022) and Umuziga et al., (2022) used the Edinburgh Postnatal Depression Scale (EPDS). Different assessment tools may yield different prevalence rates due to variations in the way antenatal depression is measured. The prevalence depicted aligns with results from northern Uganda, where it was reported as 35.8% ( 15 ). However, this prevalence is notably higher than the 13% reported in a study conducted in Kamuli, Eastern Uganda (Nalwadda et al., 2015). This variation arises because the Kamuli study only considered moderate and severe depression ( 24 ). Study findings also revealed that 70.68% of the participants with depression had mild symptoms, 21.80% had moderate symptoms, and 7.52% had severe symptoms. This underscores the need for timely and targeted interventions to address the psychological needs of pregnant women and prevent the escalation of depression. Objective 2: Factors associated with antenatal depression among women attending ANC at MRRH. Younger women (≤ 20) and older women (≥ 35) were more likely to experience antenatal depression. These findings align with studies conducted in the Netherlands ( 25 ), Vietnam ( 26 ), and Uganda ( 27 ), suggesting that age plays a significant role in antenatal depression risk. Younger women may face challenges in coping with the demands of pregnancy and impending motherhood, while older women may have unique life circumstances and reproductive histories that contribute to depression ( 9 , 21 ). A history of domestic violence was strongly associated with antenatal depression, which is consistent with the findings of studies from South Asia ( 3 ), Bangalore ( 28 ), Zimbabwe ( 29 ), and Kenya ( 21 ). These findings emphasize the detrimental effects of psychological and emotional abuse on maternal mental health during pregnancy. Addressing intimate partner violence and providing support to affected women are critical steps in preventing and managing antenatal depression. Consistent with the findings of studies conducted in Ethiopia ( 30 ) and Kenya ( 21 ), alcohol use during pregnancy was significantly associated with antenatal depression. This highlights the potential exacerbation of maternal mental health concerns due to alcohol consumption. Health-care providers should prioritize alcohol screening and intervention during antenatal care to safeguard both maternal and fetal well-being. Being in the first trimester of pregnancy was associated with antenatal depression. This aligns with the findings of studies from China and Kenya ( 31 ), indicating that early pregnancy may be characterized by heightened anxiety and mood fluctuations, while a history of abortion can be emotionally distressing. Early identification and support for women in these situations are essential to prevent or manage antenatal depression. A history of abortion was found to be significantly associated with antenatal depression in our study, which is consistent with findings from research conducted in Kenya ( 13 ). This association suggested that previous experiences of abortion can have lasting emotional and psychological impacts on pregnant women. Unplanned pregnancies were consistently associated with higher odds of experiencing antenatal depression, which is consistent with the findings of other studies from the Netherlands ( 25 ), South Asia ( 3 ), Ethiopia ( 6 ), and Kenya ( 13 ). These findings underscore the stress and uncertainty that unplanned pregnancies can cause. Integrating mental health screening and intervention programs tailored to women with unplanned pregnancies may alleviate the burden of antenatal depression. In our study, a previous history of preeclampsia showed a moderate association with antenatal depression, although this association did not initially reach statistical significance in the unadjusted analysis. However, after implementing adjustments, the association became statistically significant, highlighting its relevance. These findings align with research from Canada ( 32 ), which suggested that a history of preeclampsia may increase the risk of experiencing depression. Conclusions A significant prevalence of antenatal depression among pregnant women at MRRH was observed, emphasizing its importance as a public health concern. Most cases of depression were classified as mild, followed by moderate and severe. This highlights the need for appropriate and timely interventions to prevent further escalation of antenatal depression. Antenatal depression was linked to various factors in our multivariate analysis, including younger age (≤ 20), older age (≥ 35), history of domestic violence, alcohol use, first trimester, abortion history, past preeclampsia, and unplanned pregnancies. The identified risk factors highlight the importance of addressing socioeconomic, interpersonal, and pregnancy-related factors to promote better maternal mental health outcomes. Study limitations The study's cross-sectional design limits its ability to establish causal relationships between the identified factors and antenatal depression. A longitudinal approach would have been useful for causal inference. This study focused on a specific hospital in Uganda and may not represent the diversity of antenatal care settings in the country. This limits the generalizability of the findings to the broader population. Further area of study Longitudinal studies that follow pregnant women from early pregnancy to postpartum can provide valuable insights into the trajectory of antenatal depression and its long-term impacts on maternal and child health. Randomized controlled trials evaluating the effectiveness of different interventions for preventing and treating antenatal depression can provide evidence-based guidelines for clinical practice. Studies evaluating the integration of mental health services into routine antenatal care and assessing the feasibility and acceptability of such services are needed. Recommendations We recommend integrating mental health screening and interventions into routine antenatal care to support pregnant women's well-being and maternal-child health. Antenatal care should include screening and intervention for domestic violence and substance abuse. Abbreviations AAP American Academy of Pediatrics ACOG American College of Obstetricians and Gynecologists ANC Antenatal Care APH Antepartum hemorrhage EPDS Edinburgh Postnatal Depression Scale ICU Intensive Care Unit IUGR Intrauterine Growth Restriction KIU Kampala International University MRRH Mubende Regional Referral Hospital. NICE National Institute for Health and Care Excellence. PHQ 2 Patient Health Questionnaire- 2 PHQ 9 Patient Health Questionnaire- 9. RCOG Royal College of Obstetricians and Gynecologists WHO World Health Organization Declarations I, Kasujja Musa, hereby declare that this research titled “Factors Associated with Antenatal Depression among Women Attending Antenatal Care at Mubende Regional Referral Hospital: A cross-sectional Study” is a result of my own original work and has never been submitted to any other institution of higher learning locally or internationally for any award. The work of other people has been included, and it has been duly cited and acknowledged. Consent for publications: Not applicable to this study. Availability of data and material: The datasets used during the current study are available from the corresponding author upon request. Musa Kasujja via email: [email protected] . Conflict of interest: We have no conflicts of interest concerning this study. Funding: The study received no grants. Author contributions: Musa Kasujja was the principal investigator, designed the study, collected and analyzed the data, and wrote a draft of the manuscript. Samuel Omara , Nasifu Senkungu and Ndibuuza Shamim were involved in the discussion and conclusions drawn from the study results. Lyse Barankunda, Joseph Kirabira and Usman Ibe were the supervisors of the study. Acknowledgment: We appreciate all patients who agreed to participate in the study. Guarantor: Musa Kasujja References Dadi AF, Wolde HF, Baraki AG, Akalu TY. 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Cite Share Download PDF Status: Published Journal Publication published 24 Mar, 2024 Read the published version in BMC Women's Health → Version 1 posted Editorial decision: Revision requested 06 Mar, 2024 Reviews received at journal 23 Feb, 2024 Reviewers agreed at journal 16 Feb, 2024 Reviewers agreed at journal 16 Feb, 2024 Reviewers invited by journal 16 Feb, 2024 Editor assigned by journal 08 Feb, 2024 Editor invited by journal 05 Feb, 2024 Submission checks completed at journal 05 Feb, 2024 First submitted to journal 02 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3921521","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":271102070,"identity":"a48c7ce9-29a3-4508-9e9f-d8010f6bc9ca","order_by":0,"name":"Musa Kasujja","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8UlEQVRIiWNgGAWjYJACxgYwcYDxwQcgg42dBC3MhjNAWpiJ1QJSLM0Doghp0Z2R/vDjjJq6xObGww+kbX5tk+djZmD88DEHtxazGznGkhuOHU5sbDhmYJzbd9uwjZmBWXLmNrxaGCQfsB0AajlgkJzbc5sRqIWNmRevlvTHPx/8qwNqOf7hsGXPbXsitCSYSW5sYwZqOWPYzPDjdiJhLWfemFnO7DtsDNRSzNjbcDu5jZmxGb9fjqc/vtnzrU5244zj23/8+HPbdn5788EPH/FogQPDGQeAMdQGYsLiiRCQ5wcp/EOc4lEwCkbBKBhZAAApVl2BA+elqQAAAABJRU5ErkJggg==","orcid":"","institution":"Kampala International University","correspondingAuthor":true,"prefix":"","firstName":"Musa","middleName":"","lastName":"Kasujja","suffix":""},{"id":271102071,"identity":"65b30ff1-6ab1-4518-abb4-b54217a254d1","order_by":1,"name":"Samuel Omara","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Samuel","middleName":"","lastName":"Omara","suffix":""},{"id":271102072,"identity":"7e6634cf-2666-4b2e-a8f9-758d52a77d58","order_by":2,"name":"Nasifu Senkungu","email":"","orcid":"","institution":"Nile International Hospital","correspondingAuthor":false,"prefix":"","firstName":"Nasifu","middleName":"","lastName":"Senkungu","suffix":""},{"id":271102073,"identity":"cd0f9519-114f-4192-bc49-0a1f19bfdcaf","order_by":3,"name":"Shamim Ndibuuza","email":"","orcid":"","institution":"Arahmah Medical Centre","correspondingAuthor":false,"prefix":"","firstName":"Shamim","middleName":"","lastName":"Ndibuuza","suffix":""},{"id":271102074,"identity":"9273be49-74d5-4949-80f6-85d190e406ca","order_by":4,"name":"Joseph Kirabira","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Joseph","middleName":"","lastName":"Kirabira","suffix":""},{"id":271102075,"identity":"af69cf4a-83ce-485b-a7b0-a59a781314c5","order_by":5,"name":"Usman Ibe","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Usman","middleName":"","lastName":"Ibe","suffix":""},{"id":271102076,"identity":"7be2b4af-3ef2-47de-88f1-c3ea08d4fd2a","order_by":6,"name":"Lyse Barankunda","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"prefix":"","firstName":"Lyse","middleName":"","lastName":"Barankunda","suffix":""}],"badges":[],"createdAt":"2024-02-02 16:14:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-3921521/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3921521/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12905-024-03031-0","type":"published","date":"2024-03-25T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":50815171,"identity":"8a6e31ed-95d5-4449-9080-900a9f18daf6","added_by":"auto","created_at":"2024-02-07 19:41:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":50016,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy flow chart.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure1Studyflowprocess.png","url":"https://assets-eu.researchsquare.com/files/rs-3921521/v1/486ca3678da82e5d5dd94fc6.png"},{"id":50815138,"identity":"3629636d-0262-4278-ba6e-cae61a384333","added_by":"auto","created_at":"2024-02-07 19:41:06","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":116295,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eA pie chart showing the distribution of antenatal depression severity among women with antenatal depression.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Figure2Apiechartshowingthedistributionofantenataldepression.jpg.png","url":"https://assets-eu.researchsquare.com/files/rs-3921521/v1/103ee1cdc729d294365c09db.png"},{"id":53794950,"identity":"a3dd588b-72ed-48b0-a964-a4c44bfb1d22","added_by":"auto","created_at":"2024-03-30 23:52:08","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":788167,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3921521/v1/d74e6a04-7e19-4b02-9ee4-42103ac9f52e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: A cross-sectional study","fulltext":[{"header":"Background","content":"\u003cp\u003eAntenatal depression is an episode of a nonpsychotic depressed mood disorder characterized by two weeks or more of feeling low accompanied by loss of interest in previously pleasurable daily activities, low self-esteem, a feeling of guilt, low energy and death wish, which occurs during pregnancy (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is evidence that a number of stressors during pregnancy, including having an unintended pregnancy (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), present or past pregnancy complications (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e), chronic disease (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), previous mental illness (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), fear of giving birth (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e), gestational age (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e) and maternal age (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), increase the risk of developing depression.\u003c/p\u003e \u003cp\u003eDepression increases maternal noradrenaline and cortisol levels, which reduce uterine blood flow and are linked to adverse obstetric and neonatal outcomes, including spontaneous abortion, hypertensive disorders, APH, IUGR, prematurity, low birth weight, low Apgar scores, babies requiring ICU admission and postnatal depression (\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Furthermore, several risky behaviors have been associated with antenatal depression, such as increased substance abuse, e.g., alcoholism and smoking; reduced healthcare service uptake; poor appetite; and suicide, which also worsen fetal and maternal wellbeing (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn pregnancy, depression is the most prevalent mental health problem, and it can alter fetal development and cause adverse obstetric and neonatal outcomes when not identified and treated early (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Despite the high prevalence of antenatal depression in Uganda (35.8%) (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), maternal and child health programmes in Uganda focus mainly on improving the nutritional and physical status of the mother and ignore her mental status.\u003c/p\u003e \u003cp\u003eCurrent perinatal care guidelines established by the American College of Obstetricians and Gynecologists advocate routine screening for depression for all pregnancies (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Several other international standards, such as the WHO (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), NICE (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e) and RCOG (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), all advise employing a consistent, validated test to screen for antenatal depression during antenatal care. However, local clinical guidelines in Uganda lack a standard protocol for screening for antenatal depression (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe lack of screening for antenatal depression as part of standard antenatal care may increase its prevalence, lead to inadequate detection and treatment, and cause serious consequences for both mothers and babies. Since it is essential to pay attention to maternal mental health, this study aimed to generate evidence about the prevalence, severity and factors associated with antenatal depression among women attending ANC at MRRH.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e \u003cstrong\u003eStudy design\u003c/strong\u003e \u003cp\u003eCross-sectional.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy site\u003c/strong\u003e \u003cp\u003e This study was carried out at the antenatal care section of MRRH, a publicly financed hospital located in the Mubende town council, Kyaterekera Parish, Mubende district in Uganda's central region.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eSample size calculation\u003c/b\u003e: The sample size was estimated using the statistical equation of Kish Leslie (1965):\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(n=\\frac{{Z}^{2}PQ}{{D}^{2}}\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cp\u003eWhere \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(n\\)\u003c/span\u003e\u003c/span\u003e = the desired sample size, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(Z\\)\u003c/span\u003e\u003c/span\u003e= the standard normal deviation at the 95% confidence level, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(Z\\)\u003c/span\u003e\u003c/span\u003e=1.96, and \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(P\\)\u003c/span\u003e\u003c/span\u003e = the proportion of the target population estimated to have the specific characteristic (female attending ANC who has antenatal depression). The prevalence of antenatal depression in Uganda was found to be 35.8% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(Q\\)\u003c/span\u003e\u003c/span\u003e= (1- \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(P\\)\u003c/span\u003e\u003c/span\u003e) = proportion of the population without the characteristic. \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(D\\)\u003c/span\u003e\u003c/span\u003e = precision of the study (the degree of accuracy desired). In this case, \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(D\\)\u003c/span\u003e\u003c/span\u003e = 5% was used.\u003c/p\u003e \u003cp\u003eTherefore, substituting\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(n =\\frac{{1.96}^{2} \\text{X}0.358\\text{X}0.642}{0.05\\text{X}0.05}= 353\\)\u003c/span\u003e\u003c/span\u003e\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003eAll pregnant and attending ANC at MRRH during the study period.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003eObstetric emergencies or medical illnesses which needed urgent attention like eclampsia, ruptured ectopic, and epilepsy. A severe mental health problem associated with lack of insight and therefore couldn't respond to the interviewer administered questionnaire. E.g schizophrenia and bipolar affective disorder. Women receiving psychiatric treatment and or antidepressants medication.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy procedure\u003c/strong\u003e \u003cp\u003eAt the commencement of each ANC clinic, an educational talk was given by the researcher regarding the study\u0026rsquo;s objectives, inclusion and exclusion criteria, and benefits. We then employed a consecutive sampling procedure. A list of women attending the ANC clinic who met the inclusion criteria was obtained at the beginning of each clinic day by the research assistants, and every woman was approached to participate in this study.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData collection\u003c/strong\u003e \u003cp\u003ePatients who agreed to participate were provided with appropriate privacy and confidentiality. The researcher and two research assistants administered a structured questionnaire to each individual participant away from the hearing of other patients. We went through the informed consent form with the participants in the language in which they were knowledgeable, and their written consent was sought before administering the questionnaire. The participants were required to respond to each question they were asked about individually.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy variables\u003c/strong\u003e \u003cp\u003eThe study investigated the influence of independent variables, encompassing psychosocial demographic factors (age, education, marital and employment status, alcohol use, monthly household income, family history of mental illness, and experiences of domestic violence), and obstetric characteristics (gestation age, pregnancy planning, history of spontaneous abortion, eclampsia/preeclampsia, and stillbirth), on the dependent variable, antenatal depression.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eData quality control\u003c/strong\u003e \u003cp\u003eTo guarantee that the questionnaires were appropriate, simple English was used, and the use of technical terms was limited. The questionnaires were translated to Luganda and back-translated for precision and accuracy. The translated questionnaires were read to English-naive participants. The researcher monitored the data collection process, and cross-checking of the questionnaires was performed immediately after the participants had finished answering the questions to guarantee accuracy and completeness.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eObjective one\u003c/strong\u003e \u003cp\u003eThe prevalence of antenatal depression was summarized as the frequency and percentage with 95% confidence intervals. The severity of antenatal depression was categorized as mild if the total PHQ-9 score was 5 to 9, moderate if it was 10 to 14 or severe if it was 15 or more. The results are presented in the form of pie charts and tables for effective interpretation and discussion.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eObjective two\u003c/strong\u003e \u003cp\u003eThe factors associated with antenatal depression were assessed using binary logistic regression. A significance level of 5% was used, and a p value less than 0.05 indicated a statistically significant association between the variables. A p value lying outside the limits of confidence indicated no association between the variables. The results are presented in the form of bar graphs and tables for effective interpretation and discussion.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e\u003cb\u003eEthical considerations\u003c/b\u003e: Ethical approval and clearance for conducting this study were obtained from the Bishop Stuart University Research Ethics Committee (BSU-REC) (\u003cb\u003eRef No: BSU-REC-2023-130\u003c/b\u003e). Administrative permission was obtained from the administration of MRRH and the in-charge ANC clinic. Informed consent was obtained from all study participants before they were interviewed.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThis study was conducted in the ANC unit of the MRRH during the timeframe encompassing August 2023. At the commencement of each ANC clinic, 509 women were given an educational talk by the researcher regarding the study\u0026rsquo;s objectives, inclusion and exclusion criteria, and benefits. We excluded women who met the exclusion criteria and those who did not consent. The study flow was as shown in Fig.\u0026nbsp;1below.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 1 Study flow chart.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics for psychosocial demographic characteristics, N\u0026thinsp;=\u0026thinsp;353.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePsycho-social demographic characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 to 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 to 34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried/Cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e92.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.08\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e218\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary \u0026amp; Tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e135\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e190\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHousehold Income (UGX)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.24\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.76\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily history of mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e85.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.16\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of domestic violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e329\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.78\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above presents the psycho-social demographic characteristics of the participants.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDescriptive statistics for the obstetric characteristics of the participants (n\u0026thinsp;=\u0026thinsp;353).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eObstetric characteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGestational Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLess than 13 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13.03\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 to 28 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e130\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMore than 28 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003es50.14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious history of Preeclampsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e330\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e84.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of a Still birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e335\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e94.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePregnancy Planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (Unplanned)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (Planned)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e above summarizes the obstetric characteristics of the research population.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePrevalence of antenatal depression among women attending ANC at MRRH\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency(n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e37.68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e(32.60\u0026ndash;42.96)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo depression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e(57.04\u0026ndash;67.40)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e353\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e above shows that of the 353 participants, 133 (37.68%) were classified as having depression, while 220 (62.32%) were identified as not having depression.\u003c/p\u003e \u003cp\u003e \u003cb\u003eFigure 2: A pie chart showing the distribution of antenatal depression severity among women with antenatal depression.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003eFigure 2\u003c/em\u003e above shows that out of the 133 participants with antenatal depression, 94 (70.68%) had mild depression, 29 (21.80%) had moderate depression, and 10 (7.52%) had severe depression.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis of factors associated with antenatal depression among women receiving antenatal care\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eUnadjusted Analysis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003eAdjusted Analysis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ecOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eaOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 to 34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17 to 20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6.00 (3.55\u0026ndash;10.15)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e7.74 (3.42\u0026ndash;17.51)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35 and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e4.89 (2.40\u0026ndash;9.96)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e3.16 (1.26\u0026ndash;7.92)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.014\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried/Cohabiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5.94 (2.31\u0026ndash;15.30)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.23 (0.65\u0026ndash;27.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary/Tertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.38 (0.24\u0026ndash;0.61)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.44 (0.20-1.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmployment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.04 (1.32\u0026ndash;3.16)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.03 (0.50\u0026ndash;2.13)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.932\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHousehold Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;500,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e1.77 (1.14\u0026ndash;2.75)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.38 (0.74\u0026ndash;2.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.306\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eFamily mental illness history\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.49 (0.82\u0026ndash;2.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.71 (0.69\u0026ndash;4.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of violence\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e9.56 (3.20-28.64)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e6.51 (1.81\u0026ndash;23.42)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e10.45 (3.90-27.97)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e8.46 (2.76\u0026ndash;25.95)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eGestational Age\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 to 28 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;13 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e7.20 (3.43\u0026ndash;15.12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.49 (1.53\u0026ndash;13.19)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.006\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;28 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e2.44 (1.47\u0026ndash;4.07)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.90 (0.94\u0026ndash;3.81)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePrevious preeclampsia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.88 (0.81\u0026ndash;4.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e5.46 (1.69\u0026ndash;17.63)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eHistory of abortion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e5.67 (2.98\u0026ndash;10.79)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e4.32 (1.88\u0026ndash;9.95)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eStill birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.15 (0.83\u0026ndash;5.60)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.84 (0.46\u0026ndash;7.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePregnancy Planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes (Planned)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003eRef\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo (Unplanned)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e10.10 (5.78\u0026ndash;17.23)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e12.59 (5.75\u0026ndash;27.57)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eRef\u0026thinsp;=\u0026thinsp;Reference category, cOR\u0026thinsp;=\u0026thinsp;crude odds ratio, aOR\u0026thinsp;=\u0026thinsp;adjusted odds ratio, CI\u0026thinsp;=\u0026thinsp;confidence interval, p\u0026thinsp;=\u0026thinsp;p value\u003c/h2\u003e \u003cp\u003eWe analyzed the relationship between different participant characteristics and antenatal depression using odds ratios (ORs) along with 95% confidence intervals (CIs). Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents both the unadjusted (crude) and adjusted OR values for each characteristic.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003e \u003cb\u003eObjective 1: The prevalence of antenatal depression.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIt was determined to be 37.68%. This aligns with the worldwide prevalence range of 15 to 65%, as reported by (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). Additionally, this prevalence surpasses the pooled prevalence of 27.01% for sub-Saharan Africa reported by (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This variance might be due to cultural distinctions across various countries and the utilization of alternative assessment tools for antenatal depression other than the PHQ-9 in some studies.\u003c/p\u003e \u003cp\u003eThe high prevalence observed in this study is consistent with previous research conducted in Kenya, where the prevalence was 36% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, these findings are higher than those in Tanzania, where the prevalence was 11.5% (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e), and in Rwanda, where it was 26.6% (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). This discrepancy could be attributed to the fact that Tele et al., (2022), like in our study, utilized the PHQ-9 as an assessment tool, whereas Ngocho et al., (2022) and Umuziga et al., (2022) used the Edinburgh Postnatal Depression Scale (EPDS). Different assessment tools may yield different prevalence rates due to variations in the way antenatal depression is measured.\u003c/p\u003e \u003cp\u003eThe prevalence depicted aligns with results from northern Uganda, where it was reported as 35.8% (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, this prevalence is notably higher than the 13% reported in a study conducted in Kamuli, Eastern Uganda (Nalwadda et al., 2015). This variation arises because the Kamuli study only considered moderate and severe depression (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudy findings also revealed that 70.68% of the participants with depression had mild symptoms, 21.80% had moderate symptoms, and 7.52% had severe symptoms. This underscores the need for timely and targeted interventions to address the psychological needs of pregnant women and prevent the escalation of depression.\u003c/p\u003e \u003cp\u003e \u003cb\u003eObjective 2: Factors associated with antenatal depression among women attending ANC at MRRH.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eYounger women (\u0026le;\u0026thinsp;20) and older women (\u0026ge;\u0026thinsp;35) were more likely to experience antenatal depression. These findings align with studies conducted in the Netherlands (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), Vietnam (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and Uganda (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e), suggesting that age plays a significant role in antenatal depression risk. Younger women may face challenges in coping with the demands of pregnancy and impending motherhood, while older women may have unique life circumstances and reproductive histories that contribute to depression (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA history of domestic violence was strongly associated with antenatal depression, which is consistent with the findings of studies from South Asia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), Bangalore (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), Zimbabwe (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e), and Kenya (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). These findings emphasize the detrimental effects of psychological and emotional abuse on maternal mental health during pregnancy. Addressing intimate partner violence and providing support to affected women are critical steps in preventing and managing antenatal depression.\u003c/p\u003e \u003cp\u003eConsistent with the findings of studies conducted in Ethiopia (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) and Kenya (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e), alcohol use during pregnancy was significantly associated with antenatal depression. This highlights the potential exacerbation of maternal mental health concerns due to alcohol consumption. Health-care providers should prioritize alcohol screening and intervention during antenatal care to safeguard both maternal and fetal well-being.\u003c/p\u003e \u003cp\u003eBeing in the first trimester of pregnancy was associated with antenatal depression. This aligns with the findings of studies from China and Kenya (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), indicating that early pregnancy may be characterized by heightened anxiety and mood fluctuations, while a history of abortion can be emotionally distressing. Early identification and support for women in these situations are essential to prevent or manage antenatal depression.\u003c/p\u003e \u003cp\u003eA history of abortion was found to be significantly associated with antenatal depression in our study, which is consistent with findings from research conducted in Kenya (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). This association suggested that previous experiences of abortion can have lasting emotional and psychological impacts on pregnant women.\u003c/p\u003e \u003cp\u003eUnplanned pregnancies were consistently associated with higher odds of experiencing antenatal depression, which is consistent with the findings of other studies from the Netherlands (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e), South Asia (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e), Ethiopia (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e), and Kenya (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These findings underscore the stress and uncertainty that unplanned pregnancies can cause. Integrating mental health screening and intervention programs tailored to women with unplanned pregnancies may alleviate the burden of antenatal depression.\u003c/p\u003e \u003cp\u003eIn our study, a previous history of preeclampsia showed a moderate association with antenatal depression, although this association did not initially reach statistical significance in the unadjusted analysis. However, after implementing adjustments, the association became statistically significant, highlighting its relevance. These findings align with research from Canada (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e), which suggested that a history of preeclampsia may increase the risk of experiencing depression.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eA significant prevalence of antenatal depression among pregnant women at MRRH was observed, emphasizing its importance as a public health concern.\u003c/p\u003e \u003cp\u003eMost cases of depression were classified as mild, followed by moderate and severe. This highlights the need for appropriate and timely interventions to prevent further escalation of antenatal depression.\u003c/p\u003e \u003cp\u003eAntenatal depression was linked to various factors in our multivariate analysis, including younger age (\u0026le;\u0026thinsp;20), older age (\u0026ge;\u0026thinsp;35), history of domestic violence, alcohol use, first trimester, abortion history, past preeclampsia, and unplanned pregnancies. The identified risk factors highlight the importance of addressing socioeconomic, interpersonal, and pregnancy-related factors to promote better maternal mental health outcomes.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eStudy limitations\u003c/strong\u003e \u003cp\u003eThe study's cross-sectional design limits its ability to establish causal relationships between the identified factors and antenatal depression. A longitudinal approach would have been useful for causal inference. This study focused on a specific hospital in Uganda and may not represent the diversity of antenatal care settings in the country. This limits the generalizability of the findings to the broader population.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eFurther area of study\u003c/strong\u003e \u003cp\u003eLongitudinal studies that follow pregnant women from early pregnancy to postpartum can provide valuable insights into the trajectory of antenatal depression and its long-term impacts on maternal and child health. Randomized controlled trials evaluating the effectiveness of different interventions for preventing and treating antenatal depression can provide evidence-based guidelines for clinical practice. Studies evaluating the integration of mental health services into routine antenatal care and assessing the feasibility and acceptability of such services are needed.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eRecommendations\u003c/strong\u003e \u003cp\u003eWe recommend integrating mental health screening and interventions into routine antenatal care to support pregnant women's well-being and maternal-child health. Antenatal care should include screening and intervention for domestic violence and substance abuse.\u003c/p\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eAAP \u003c/strong\u003e American Academy of Pediatrics\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eACOG\u003c/strong\u003e American College of Obstetricians and Gynecologists\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eANC \u003c/strong\u003e Antenatal Care \u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAPH \u003c/strong\u003e Antepartum hemorrhage\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEPDS\u003c/strong\u003e Edinburgh Postnatal Depression Scale\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICU \u003c/strong\u003eIntensive Care Unit\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eIUGR \u003c/strong\u003eIntrauterine Growth Restriction\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eKIU \u003c/strong\u003e Kampala International University\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMRRH \u003c/strong\u003e Mubende Regional Referral Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNICE\u003c/strong\u003e National Institute for Health and Care Excellence.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePHQ 2 \u003c/strong\u003ePatient Health Questionnaire- 2\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePHQ 9 \u003c/strong\u003ePatient Health Questionnaire- 9.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRCOG \u003c/strong\u003e Royal College of Obstetricians and Gynecologists\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO \u003c/strong\u003e World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eI, Kasujja Musa, hereby declare that this research titled \u003cstrong\u003e\u0026ldquo;Factors Associated with Antenatal Depression among Women Attending Antenatal Care at Mubende Regional Referral Hospital: A cross-sectional Study\u0026rdquo;\u003c/strong\u003e is a result of my own original work and has never been submitted to any other institution of higher learning locally or internationally for any award.\u0026nbsp;The\u0026nbsp;work of other people has been included,\u0026nbsp;and\u0026nbsp;it has been duly cited and acknowledged.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publications:\u0026nbsp;\u003c/strong\u003eNot applicable to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material:\u0026nbsp;\u003c/strong\u003eThe datasets used during the current study are available from the corresponding author upon request.\u003cstrong\u003e\u0026nbsp;Musa Kasujja\u0026nbsp;\u003c/strong\u003evia email:\u0026nbsp;\u003ca href=\"mailto:[email protected]\"\u003e\u003cstrong\[email protected]\u003c/strong\u003e\u003c/a\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest:\u0026nbsp;\u003c/strong\u003eWe have no conflicts of interest concerning this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eThe study received no grants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions: Musa Kasujja\u0026nbsp;\u003c/strong\u003ewas the principal investigator, designed the study, collected and analyzed the data, and wrote a draft of the manuscript.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eSamuel Omara\u003c/strong\u003e,\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eNasifu Senkungu\u003c/strong\u003e and \u003cstrong\u003eNdibuuza Shamim\u003c/strong\u003e were involved in the discussion and conclusions drawn from the study results. \u003cstrong\u003eLyse Barankunda, Joseph Kirabira\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003eUsman Ibe\u0026nbsp;\u003c/strong\u003ewere the supervisors of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment:\u0026nbsp;\u003c/strong\u003eWe appreciate all patients who agreed to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGuarantor: Musa Kasujja\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDadi AF, Wolde HF, Baraki AG, Akalu TY. 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Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://link.springer.com/article/10.1007/s\u003c/span\u003e\u003cspan address=\"https://link.springer.com/article/10.1007/s\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e00127-020-01920-x.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Depression during pregnancy, antenatal, prenatal, depression","lastPublishedDoi":"10.21203/rs.3.rs-3921521/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3921521/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThis study investigated the prevalence, severity, and factors associated with antenatal depression among women receiving antenatal care at Mubende Regional Referral Hospital (MRRH) in Uganda. Antenatal depression is a critical concern for maternal and child well-being, as it can lead to adverse outcomes, including preterm birth, abortion, low birth weight, and impaired maternal\u0026ndash;infant bonding. Despite several international guidelines recommending routine screening for antenatal depression, local Ugandan guidelines often overlook this essential aspect of maternal care.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study involving 353 pregnant women utilized the Patient Health Questionnaire 9 (PHQ-9) to assess antenatal depression. Participants\u0026rsquo; psychosocial demographic and obstetric characteristics were recorded. Logistic regression analysis identified factors linked to antenatal depression.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAntenatal depression burden was notably high, affecting 37.68% of the participants. The majority of patients with antenatal depression had mild symptoms (72.68%). The significantly associated factors at multivariate analysis included younger age (\u0026le;\u0026thinsp;20), older age (\u0026ge;\u0026thinsp;35), history of domestic violence, alcohol use, gestational age, abortion history, history of preeclampsia and unplanned pregnancies.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThis study revealed a significantly high prevalence of antenatal depression, emphasizing its public health importance. Most cases were classified as mild, emphasizing the need for timely interventions to prevent escalation. The identified risk factors included age, history of domestic violence, alcohol use, first-trimester pregnancy, abortion history, past preeclampsia, and unplanned pregnancy.\u003c/p\u003e","manuscriptTitle":"Factors associated with antenatal depression among women attending antenatal care at Mubende Regional Referral Hospital: A cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-02-07 19:41:00","doi":"10.21203/rs.3.rs-3921521/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-03-06T05:13:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-02-23T15:52:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"29641d5b-adf0-4af1-a674-cdaf09c1910f","date":"2024-02-16T20:37:06+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"87125835-219c-489a-beda-2e7d5dde7ee8","date":"2024-02-16T19:47:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-02-16T19:44:29+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-02-08T10:00:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-05T10:36:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-05T10:35:04+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Women's Health","date":"2024-02-02T16:02:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-womens-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bmwh","sideBox":"Learn more about [BMC Women's Health](http://bmcwomenshealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bmwh/default.aspx","title":"BMC Women's Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b12c191a-888f-4b37-a692-e6e177fef426","owner":[],"postedDate":"February 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-30T23:51:59+00:00","versionOfRecord":{"articleIdentity":"rs-3921521","link":"https://doi.org/10.1186/s12905-024-03031-0","journal":{"identity":"bmc-womens-health","isVorOnly":false,"title":"BMC Women's Health"},"publishedOn":"2024-03-25 00:00:00","publishedOnDateReadable":"March 25th, 2024"},"versionCreatedAt":"2024-02-07 19:41:00","video":"","vorDoi":"10.1186/s12905-024-03031-0","vorDoiUrl":"https://doi.org/10.1186/s12905-024-03031-0","workflowStages":[]},"version":"v1","identity":"rs-3921521","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3921521","identity":"rs-3921521","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}