Perinatal depression in Rural Kenya and the associated risk and protective factors: A prospective cohort study before and during the COVID-19 pandemic

PurposeThis study aimed to estimate the prevalence of perinatal depression in rural Kakamega, Kenya while exploring risk and protective factors in the context of the COVID-19 pandemic. MethodsThe mixed method approach employed i) quantitative data collected in a longitudinal maternal health evaluation conducted from October 2019 to May 2021 and ii) an ethnographic study conducted from March to July 2022, which provided detailed insights on the risk and protective factors of perinatal depression. The quantitative sample of 135 Pregnant and postpartum women was screened monthly for depression (>13) using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression assessed the association between socioeconomic status, clinical and psychosocial variables, and perinatal depression. A sample of 20 women was enrolled in the qualitative component of the study. ResultsThe cumulative prevalence of perinatal depression was 11%. Depression symptoms were seen in 7% of pregnant women and 13% of mothers. During COVID-19, the odds of depression increased with maternal complications (aOR=7.05, 95%CI 1.66-29.94) and financial stress (aOR=1.40, 95%CI 0.66-2.98). Live birth outcomes reduced the odds of depression (aOR 0.03, 95%CI 0.002-0.73). Risk factors included health and healthcare challenges, lack of spousal and social support, intimate partner violence, and financial difficulties. Protective factors included adequate spousal and social support and access to economic resources, including digital platforms for soft loans and income hiding. ConclusionOne in seven women experienced perinatal depressive symptoms. Increase in depression during the COVID-19 pandemic is indicative of the need for i) financial and social safety nets to cushion perinatal women during emergencies, ii) Integration of depression screening into healthcare and establishing confidential pathways for psychosocial support. What is already known about this topic - summarize the state of scientific knowledge on this subject before your study and explain why this study was necessary.Previous studies indicate that the prevalence of perinatal depression is rising in Kenya, with rates of antepartum depression ranging from 33% to 38% and postpartum depression between 19% and 27%. These studies mainly focus on urban and low-income populations. However, there is limited research on the burden of maternal depression in rural areas of Kenya. What this study adds - summarize the new insights gained from this study that were not previously known.This mixed-methods study provides valuable insights into the status of maternal depression in rural Kenya, marking the first household-based screening for depression conducted in such a setting. The findings reveal differences in the prevalence of depression between the periods before and during COVID-19. Additionally, the study details the risk and protective factors related to perinatal depression. How this study might affect research, practice, or policy - summarize the studys implications.Understanding perinatal depression is essential for enhancing the integration of maternal mental health in both primary healthcare and community levels. Analyzing the risk and protective factors before and during the COVID-19 pandemic will provide insight into its impact on perinatal depression. The findings related to these factors will inform the development of targeted maternal health interventions.