Prevalence of Depression during Pregnancy and Post-Partum Periods in Low-Income Women in Developed Countries

Background and Purpose: CDC research shows that nationally, about one in eight women experience symptoms of postpartum depression (Bauman, Ko, Cox et al., 2020). Depression may have a negative impact on fetal development, birth outcomes, and child functioning (Badovinac, Martin, Guerin-Marion, O'Neill et al., 2018; Gentile, 2017; Jarde, Morais, Kingston Giallo et al., 2016). Additionally, the cost of untreated depression and anxiety in women during pregnancy up until five years post-partum has been estimated at $14 billion for the 2017 birth cohort alone (Luca, Margiotta, Staatz, Garlow, Christensen, & Zivin, 2020). Due to negative consequences on mothers and their children, attention to the experience of depression in low-income women during the pregnancy and post-partum period is necessary. Our aim was to conduct a systematic review of studies reporting prevalence rates of depression in women living in low-income in developed countries during the pregnancy and post-partum periods.

Methods: Published and unpublished literature was searched for studies reporting prevalence of depression in women with low-income in developed countries in two independent processes. The search strategy was formulated by a Ph.D. level academic librarian, who modeled the search strings for each database: PubMed; Psychinfo; Embase; and Dissertation Abstracts. A subsection of studies taking place during pregnancy and post-partum periods was used for this analysis. Data extraction was conducted by two research team members independently with any discrepancies addressed by the research team. Data analysis involved the meta and metafor packages in R with a random effect model to account for estimation.

Results: Sixty-four studies, involving 157,151 participants, were located through the search process. Among low-income women who were pregnant or post-partum, the prevalence of depression was 33.82% according to self-report instruments, and 25% met clinical diagnostic criteria for depression. The degree of heterogeneity for these studies was extremely high, with I2 at 99.24%; this confirms that a random effect model was appropriate. Moderator regression analysis did not reveal any significant observable factor behind the heterogeneity. Other countries than the US had lower depression prevalence, but the difference was only significant at the 10% level and was no longer significant when all moderators were entered together. There were no significant differences in depression prevalence between the pregnancy and the post-partum periods or between different ethnic groups. Higher-income women had a depression prevalence of 15.64% (95% CI: [0.1122; 0.2062]), less than half the prevalence among low-income women in all studies.

Conclusions and Implications: Striking is the high rate of prevalence of depression in women who were pregnant/post-partum and living in low-income circumstances. Over a third of women self-reported depression, and 25% met diagnostic criteria. High rates of depression among women living in low-income is of serious public health concern not only to these women, but also due to generational effects with several possible adverse biological, psychological, and social effects on children. We discuss screening, mental health treatment, as well as the need for addressing women’s social determinants of health.