RESUMEN
Depression during pregnancy may negatively influence social functioning, birth outcomes and postnatal mental health. A cross-sectional analysis of the baseline survey of a prospective study was undertaken with an objective of determining the prevalence and socio-demographic factors associated with depressive morbidity during pregnancy in a Tanzanian peri-urban setting. Seven hundred and eighty seven second to third trimester pregnant women were recruited at booking for antenatal care at two primary health care clinics. Prenatal structured interviews assessed socio-economic, quality of partner relationships and selected physical health measures. Depressive symptoms were measured at recruitment and three and eight months postpartum using the Kiswahili version of the Hopkins Symptom Checklist. Completed antenatal measures available for 76.2% participants, showed a 39.5% prevalence of depression. Having a previous depressive episode (OR 4.35, P<0.01), low (OR 2.18, P<0.01) or moderate (OR 1.86, P=0.04) satisfaction with ability to access basic needs, conflicts with the current partner (OR 1.89, P<0.01), or booking earlier for antenatal care (OR 1.87, P=0.02) were independent predictors of antenatal depression in the logistic regression model; together explaining 21% of variance in depression scores. Attenuation of strength of multivariate associations suggests confounding between the independent risk factors and socio-demographic and economic measures. In conclusion, clinically significant depressive symptoms are common in mid and late trimester antenatal clinic attendees. Interventions for early recognition of depression should target women with a history of previous depressive episodes or low satisfaction with ability to access basic needs, conflict in partner relationships and relatively earlier booking for antenatal care. Findings support a recommendation that antenatal services consider integrating screening for depression in routine antenatal care.
Asunto(s)
Depresión Posparto/epidemiología , Depresión/epidemiología , Complicaciones del Embarazo/psicología , Esposos , Adulto , Estudios Transversales , Depresión/psicología , Depresión Posparto/psicología , Femenino , Humanos , Relaciones Interpersonales , Masculino , Morbilidad , Embarazo , Complicaciones del Embarazo/epidemiología , Segundo Trimestre del Embarazo , Tercer Trimestre del Embarazo , Atención Prenatal , Prevalencia , Estudios Prospectivos , Factores de Riesgo , Factores Socioeconómicos , Tanzanía/epidemiología , Adulto JovenRESUMEN
Several studies show depression is common during pregnancy. However, there is limited information in Tanzania on the magnitude of perceived distress during pregnancy and meanings ascribed to such distress. A descriptive survey collected data using unstructured interviews from 12 traditional practitioners and 10 peri-urban women with previous pregnancy related mental health concerns identified using a depression vignette. The objectives were to describe the sources and characteristics of distress during pregnancy, and idioms of distress that could inform cultural adaptation of depression screening tools. Narrative analysis showed an emergent category of "problematic pregnancies" framed women's recollections of prolonged periods of sadness. This experience was qualified using various idioms of distress that were differentially emphasized depending on informant's perceived causes of health concern. The idiom kusononeka was consistently used to describe extreme sadness across causal categories and clustered with at least two typical features of major depression. This suggested existence of a construct with similarities to biomedical criteria for depression. "Thinking too much" emerged as a distinctive expression associated with prolonged sadness. Distinctive expressions of social functioning impairments were identified that can inform depression severity assessments. In conclusion, contextual inquiry into experiences of psychological distress showed distinct local idioms that clustered in patterns similar to symptoms of biomedical depressive episodes. Further studies to assess the utility of local idioms of distress and distress related functional impairment in depression assessment tools are warranted.
Asunto(s)
Depresión/etnología , Trastorno Depresivo/etnología , Complicaciones del Embarazo/psicología , Actitud Frente a la Salud/etnología , Cultura , Depresión/psicología , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Embarazo , Factores Socioeconómicos , TanzaníaRESUMEN
Transactional sex has been associated with risk of HIV infection in a number of studies throughout sub-Saharan Africa. Urban young women are economically vulnerable and at heightened risk of HIV infection in Tanzania; yet there are few studies that have explored relationship dynamics, including transactional sex, in this setting. This paper sheds light on the broader context of sexual relationships among youth at risk for HIV, how transactional sex plays out in these relationships, and how the transactional nature of relationships affects women's risk for HIV. We conducted 60 in depth interviews and 14 focus group discussions with young men and women, 16-24 years old, in Dar es Salaam, Tanzania. These data guided the development of a community based HIV and violence prevention intervention for young men. Youth described the exchange of sex for money or other material goods in all types of sexual relationships. While the exchange was explicit in casual relationships, young women voiced material and monetary expectations from their committed partners as well. Young men described their pursuit of multiple partners as sexually motivated, while women sought multiple partners for economic reasons. Young men were aware of the expectations of material support from partners, and acknowledged that their ability to provide for a partner affected both the longevity and exclusivity of their relationships. Youth described a deep mistrust of the motivations and commitment of their sexual partners. Furthermore, young women's financial dependence on men impacted their ability to negotiate safe sexual behaviors in both casual and committed relationships. Programs designed to reduce HIV risk among Tanzanian youth need to take into account the transactional component of sexual relationships and how such exchanges differ according to partner type.
Asunto(s)
Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Conducta Sexual/psicología , Adolescente , Adulto , Condones/estadística & datos numéricos , Femenino , Grupos Focales/métodos , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Humanos , Masculino , Trabajo Sexual/psicología , Trabajo Sexual/estadística & datos numéricos , Parejas Sexuales/psicología , Tanzanía/epidemiología , Sexo InseguroRESUMEN
OBJECTIVE: To validate the Hopkins Symptom Checklist-25 (HSCL-25) for use as a depression screen amongst human immuno-deficiency virus (HIV) positive pregnant women. METHOD: Amongst 903 (mean age 24.8 years) HIV-positive pregnant women, a two-phased design included measures for health-related quality of life, perceived social support, and the HSCL-25 screen for depressive (HSCL-15 subscale) and anxiety symptoms. The Structured Clinical Interview for DSM-IV (SCID) was independently administered on a stratified random subsample. RESULTS: Internal consistency of the HSCL-25 (alpha 0.93) and HSCL-15 (alpha 0.9) was adequate, with expected findings demonstrated in discriminant validity analysis. A depression-anxiety construct explained nearly 40% of the variance. Eight individual HSCL-25 items demonstrated an area under the curve (AUC) greater than 0.6 for DSM-IV major depression and the HSCL-25 and HSCL-revised had an optimal depression cut-off score of 1.06 and 1.03 for the HSCL-15. CONCLUSION: The HSCL-25 demonstrated utility as a screen for depression; its inability to gauge severity of symptoms in this cultural context is discussed.
Asunto(s)
Depresión/diagnóstico , Infecciones por VIH/psicología , Complicaciones Infecciosas del Embarazo/psicología , Escalas de Valoración Psiquiátrica , Adolescente , Adulto , Ansiedad , Características Culturales , Femenino , Infecciones por VIH/etnología , Humanos , Embarazo , Complicaciones Infecciosas del Embarazo/etnología , Psicometría , Calidad de Vida , Apoyo Social , Tanzanía/etnologíaRESUMEN
PIP: Focusing on increased vulnerability to HIV infection, this article examines some of the contexts within which these risk-taking behaviors occur and illustrates that the risk of contracting the disease is just one of the many risks with which Tanzanian youths are confronted. The sexual and substance use behaviors, and the relationship between such behaviors and economic factors, are discussed. Where evidences exist, attempts are made to compare the prevalence of these behaviors among male and female youths, as well as urban and rural youths. The extent to which males and females engage in risk-taking behaviors is unknown; however, studies show that, depending on age and gender, between 17% and 61% of youths are sexually active. Rates in HIV transmission vary by gender and by whether the youths are rural or urban inhabitants. Factors like adverse socioeconomic conditions, unemployment, lack of parental guidance and supervision, and culture all influence sexual risk-taking behaviors among youths. Meanwhile, increasing use of drugs and alcohol among the young population has been closely linked to increased vulnerability to unprotected sexual intercourse. Again, survival needs play a major role in sustaining risk behaviors. The paper concludes by outlining policy implications of youth risk behaviors, taking into account a multisectoral approach in dealing with the problem.^ieng