Data from: Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana

Objectives: To assess the impact of probable depression in the immediate postnatal period upon subsequent infant mortality and morbidity. Design: Cohort study nested within 4-weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths.
Setting: Rural/peri-urban communities within the Kintampo Health Research Centre study area of the Brong Ahafo Region of Ghana. Participants: 16,560 mothers who had a live singleton birth reported between 24th March 2008 and 11th July 2009, who were screened for probable postnatal depression (pPND) between four to 12 weeks postpartum (some of who also had depression assessed at pregnancy), and whose infants survived to this point. Primary/secondary outcome measures: All-cause early infant mortality expressed per 1000 infant-months of follow up from the time of postnatal assessment to six months of age. The secondary outcomes were a) all-cause infant mortality from the time of postnatal assessment to 12 months of age, and b) reported infant morbidity from the time of the postnatal assessment to 12 months of age. Results: 130 infant deaths were recorded and singletons were followed for 67,457.4 infant months from the time of their mothers’ Postnatal Depression assessment. pPND was associated with an almost 3-fold increased risk of mortality up to six months (adjusted rate ratio [RR], 2.86 (1.58-5.19); p=0.001). The RR up to 12 months was 1.88 (1.09-3.24; p=0.023). pPND was also associated with increased risk of infant morbidity. Conclusions: There is new evidence for the association between maternal pPND and infant mortality in low and middle income countries. Implementation of the World Health Organisation’s mhGAP to scale up packages of care integrated with maternal health is encouraged as an important adjunct to child survival efforts.

研究目的：评估产后即刻疑似抑郁症（probable postnatal depression, pPND）对后续婴儿死亡与发病风险的影响。
研究设计：本研究为一项嵌套于全育龄女性每4周1次监测体系的队列研究，该监测体系用于识别妊娠并收集分娩与死亡相关数据。
研究场景：加纳布隆阿哈福地区金坦博健康研究中心所辖研究区域内的农村及城郊社区。
研究对象：2008年3月24日至2009年7月11日期间报告活产单胎的16560名母亲，她们均在产后4至12周接受了疑似产后抑郁症筛查（部分受试者同时在妊娠期完成了抑郁症评估），且其婴儿至筛查时点仍存活。
主要与次要结局指标：主要结局为自产后评估时至婴儿6月龄期间的全因早期婴儿死亡率，以每1000婴儿月数为统计单位。次要结局包括：a）自产后评估时至婴儿12月龄期间的全因婴儿死亡率；b）自产后评估时至婴儿12月龄期间的报告婴儿发病情况。
研究结果：共记录130例婴儿死亡事件，单胎婴儿自其母亲产后抑郁症评估之日起的总随访时长为67457.4婴儿月数。疑似产后抑郁症与婴儿6月龄前死亡风险升高近3倍相关（校正率比[RR]=2.86，95%置信区间1.58~5.19；P=0.001）。婴儿12月龄前的校正率比为1.88（95%置信区间1.09~3.24；P=0.023）。此外，疑似产后抑郁症还与婴儿发病风险升高存在关联。
研究结论：本研究为中低收入国家中母亲产后疑似抑郁症与婴儿死亡之间的关联提供了新的证据支持。建议落实世界卫生组织（World Health Organisation, WHO）的mhGAP方案，推广与孕产妇保健整合的照护包，以此作为儿童生存保障工作的重要辅助手段。