High rates of perinatal anxiety in women from low- and middle-income countries

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A recent comprehensive study reveals that 1 in 5 women in low- and middle-income countries grapple with perinatal anxiety disorders, shedding light on a critical yet often overlooked mental health challenge affecting maternal and infant outcomes in these regions.

High rates of perinatal anxiety in women from low- and middle-income countries | Image Credit: © tadamichi - © tadamichi - stock.adobe.com.

High rates of perinatal anxiety in women from low- and middle-income countries | Image Credit: © tadamichi - © tadamichi - stock.adobe.com.

One in 5 women living in low- and middle-income countries (LMICs) experience perinatal anxiety disorders, according to a recent study published in JAMA Network Open.

Takeaways

  1. The study reveals that one in five women in low- and middle-income countries (LMICs) experiences perinatal anxiety disorders, shedding light on the significant prevalence of this mental health issue in these regions.
  2. Perinatal anxiety disorders are associated with adverse maternal outcomes, including substance use disorders, recurrent mental illness, and suicide. Additionally, infants born to mothers with perinatal anxiety disorders face risks such as preterm birth, poor neurocognitive development, and increased susceptibility to cardiovascular disease and mental illness in adulthood.
  3. Poverty, gender inequity, and intimate partner violence are identified as factors associated with perinatal anxiety disorders, and these issues are more common in LMICs.
  4. Despite the prevalence of perinatal anxiety disorders, there is a lack of sufficient data on the subject in LMICs. The study emphasizes the need for more research and data collection to better understand the extent of the issue in these regions.
  5. The analysis reveals variations in the prevalence of generalized anxiety disorder among different income groups in LMICs, with higher rates in lower-middle-income countries compared to low-income and upper-middle-income countries.

Anxiety disorders are among the most prevalent mental disorders in high-income countries, with increased incidence observed during the perinatal period. Perinatal anxiety disorders are associated with increased risks of adverse maternal outcomes, including substance use disorders, recurrent mental illness, and suicide.

Adverse infant outcomes associated with perinatal anxiety disorders include preterm birth, poor neurocognitive development, and increased risks of cardiovascular disease and mental illness in adulthood. 

Factors associated with perinatal anxiety disorders include poverty, gender inequity, and intimate partner violence, which are more common in LMICs. However, there is little data on the prevalence of perinatal anxiety disorders in LMICs.

To evaluate perinatal anxiety disorders in LMICs, investigators conducted a systematic review and meta-analysis. Databases evaluated include MEDLINE, PsycINFO, Embase, Cochrane Library, CINAHL, and Web of Science, with articles from database inception to September 7, 2023, eligible for inclusion.

Terms related to mental health disorders, prevalence, and the perinatal period were used to find studies. Eligibility criteria included measuring the prevalence of a mental health disorder in the perinatal period using a diagnostic interview or tested and validated screening tool.Disorders were identified using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Mental disorders included generalized anxiety disorder, social anxiety disorder, obsessive-compulsive disorder, panic disorder, posttraumatic stress disorder, and adjustment disorder. Titles and abstracts were evaluated independently by 2 reviewers, with a third consulted for disagreements.

Data extracted included year of publication, author, country of study, country income status, number of participants, types of disorder, number of participants with disorder, setting, study design, method of assessment, timing of assessment, and assessment tool. Maternal characteristics included intimate partner violence, adolescence, current war or conflict experience, the COVID-19 pandemic, and HIV positivity.

There were 203 studies included in the final analysis, evaluating 212,318 perinatal women across 33 LMICs. Generalized anxiety disorder was the most common mental disorder reported in 22.2% of women, followed by post-traumatic stress disorder in 8.3%, obsessive-compulsive disorder in 6.9%, social anxiety disorder in 3.7%, and adjustment disorder in 2.9%.

Higher generalized anxiety disorder prevalence was observed among lower-middle–income countries vs low-income countries, at 27.6% and 24% respectively. The lowest prevalence was observed among upper-middle-income countries at 19.1%.

These results indicated high rates of anxiety among perinatal women in LMICs. Investigators concluded perinatal mental health is vital for improving outcomes among women and infants in LMICs.

Reference

Roddy Mitchell A, Gordon H, Atkinson J, et al. Prevalence of perinatal anxiety and related disorders in low- and middle-income countries: A systematic review and meta-analysis. JAMA Netw Open. 2023;6(11):e2343711. doi:10.1001/jamanetworkopen.2023.43711

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