Poverty and postnatal depression: a systematic mapping of the evidence from low and lower middle income countries

There is no systematic assessment of how poverty or socio-economic status and postnatal depression (PND) might be related in low and lower middle income countries (LLMICs). The objective of this paper is to describe the extent of research in LLMICs that deals with the relationships between poverty and PND, including how poverty affects PND and how PND affects poverty.

The paper finds that:

• PND can impact negatively on a wide range of outcomes including maternal deaths due to suicide, the mother-infant relationship, child psychological development and infant nutrition and growth
• high housing density and overcrowding, particularly where housing conditions are poor, is a source of stress, and is associated with common mental disorders, including PND
• how poverty is defined and used in research relating to PND is critical for the relevance of research findings for policy and planning
• longitudinal research that incorporates qualitative research is needed to better understand not only causal mechanisms between PND and poverty, but also the underlying processes that underpin them.

In addition, the authors conclude that if research is to reflect how people live, then an increasing proportion of PND-related research and the management and treatment of PND in LLMICs will need to focus on the urban poor.

Recommendations include:

• greater account needs to be taken of the multi-dimensional nature of poverty
• there is a need for broad “development” agendas and interventions to incorporate common mental disorders in general, and for women, PND in particular
• using low cost interventions focused on mother-infant interaction (e.g. community-based workers support women) has good potential for sustainability in settings with poor health systems.