Characterizing perinatal depression and its impact on infant outcomes and maternal-nurse SMS communication in a cohort of Kenyan women

Abstract

Objective: To examine the prevalence and correlates of perinatal depression, to determine the association between antenatal depression and infant morbidity/mortality, and to compare SMS communication patterns between women with and without perinatal depression.Background: Perinatal depression is broadly defined as depressive symptoms with onset during pregnancy or within the 12 months following delivery, affecting approximately 20-25% of pregnant and postpartum women in low- and middle-income countries. The broad accessibility of mobile phones allows mHealth interventions to be considered as a solution for health providers to identify and treat perinatal depression. Methods: Prospective longitudinal cohort of pregnant women seeking antenatal services at one of two public sector health clinics in Kenya. Pre-programmed SMS messages were sent to participants with content pertaining to their pregnancy status. Sociodemographic and obstetric characteristics, SMS messaging behaviors, infant health status, and depressive symptoms were assessed by a standardized questionnaire administered at enrollment (30-36 weeks gestation) and follow-up (14 weeks postpartum). Generalized estimating equation (GEE) with Poisson link was used to evaluate correlates of perinatal depression, infant outcomes, and frequency of SMS messaging. Results: Of the 572 women with complete follow-up information, 188 (32.9%) had evidence of perinatal depression at some time point in pregnancy or postpartum. Strongest risk factors for perinatal depression included intimate partner violence, fewer years of schooling, and maternal unemployment. Antenatal depression was associated with an increased risk of infant illness or hospitalization (RR = 1.12, 95% CI: 1.11, 1.13). Women with antenatal or persistent perinatal depression sent fewer SMS messages during the study period than their counterparts without depression. Conclusion: Our analysis demonstrated a relatively high prevalence of perinatal depression in this cohort. Differences in messaging frequency suggest two-way SMS messaging systems may have utility in identifying depressive symptoms throughout the perinatal period, making it feasible to incorporate detection and treatment modalities for mothers with depression via mHealth interventions.