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Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study

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Abstract

Anxiety is highly prevalent in many populations; however, the burden of anxiety disorders amongst pregnant women in low-resource settings is not well documented. We investigated the prevalence and predictors of antenatal anxiety disorders amongst low-income women living with psychosocial adversity. Pregnant women were recruited from an urban, primary level clinic in Cape Town, South Africa. The Mini-International Neuropsychiatric Interview diagnostic interview assessed prevalence of anxiety disorders. Four self-report questionnaires measured psychosocial characteristics. Logistic regression models explored demographic and socioeconomic characteristics, psychosocial risk factors and psychiatric comorbidity as predictors for anxiety disorders. Amongst 376 participants, the prevalence of any anxiety disorder was 23%. Although 11% of all women had post-traumatic stress disorder, 18% of the total sample was diagnosed with other anxiety disorders. Multivariable analysis revealed several predictors for anxiety including a history of mental health problems (adjusted odds ratio [AOR] 4.11; 95% confidence interval (CI) 2.03–8.32), Major depressive episode (MDE) diagnosis (AOR 3.83; CI 1.99–7.31), multigravidity (AOR 2.87; CI 1.17–7.07), food insecurity (AOR 2.57; CI 1.48–4.46), unplanned and unwanted pregnancy (AOR 2.14; CI 1.11–4.15), pregnancy loss (AOR 2.10; CI 1.19–3.75) and experience of threatening life events (AOR 1.30; CI 1.04–1.57). Increased perceived social support appeared to reduce the risk for antenatal anxiety (AOR 0.95; CI 0.91–0.99). A range of antenatal anxiety disorders are prevalent amongst pregnant women living in low-resource settings. Women who experience psychosocial adversity may be exposed to multiple risk factors, which render them vulnerable to developing antenatal anxiety disorders.

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Notes

  1. In South Africa, the term “coloured” refers to a grouping of people of mixed race ancestry that self-identify as a particular ethnic and cultural grouping.

  2. This was a monthly income of R501 or less, equivalent to approximately US$34 per month. According to Statistics South Africa, people earning this amount or less would probably have to sacrifice some food items to be able to afford to buy essential non-food items. Approximately 37% of the South African population live in this income bracket (Statistics South Africa 2015).

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Acknowledgements

The authors would like to acknowledge the women who agreed to participate in our study as well as Sr. Loretta Abrahams and the staff of Hanover Park MOU and CHC. We would also like to acknowledge Professor Susan Fawcus who acted as the principal investigator on this project; Bronwyn Evans, Liesl Hermanus and Sheily Ndwayana for their assistance with data collection; and the Western Cape Department of Health for granting us permission to conduct the study at their facility. This research study was partially funded by the Medical Research Council of South Africa and Cordaid. The PMHP also allocated funds to this study from several donors who had provided general support funding to the organisation. These include the following: The Douglas G. Murray Trust, the Mary Slack and Daughters Foundation and the Rolf-Stephan Nussbaum Foundation. The Truworths Community Foundation Trust also supported this study. The preparation of the article was funded by the National Research Foundation of South Africa and the Harry Crossley Foundation. MT is a lead investigator with the Centre of Excellence in Human Development, University Witwatersrand, South Africa, and is supported by the National Research Foundation, South Africa. None of the funding sources were involved in the study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the article for publication.

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Authors and Affiliations

  1. Perinatal Mental Health Project, Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa

    Thandi van Heyningen, Simone Honikman, Michael N. Onah & Sally Field

  2. Division of Epidemiology & Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Thandi van Heyningen & Landon Myer

  3. School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Canada

    Michael N. Onah

  4. Alan J. Flisher Centre for Public Mental Health, Department of Psychology, Stellenbosch University, Stellenbosch, South Africa

    Mark Tomlinson

Authors
  1. Thandi van Heyningen
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  2. Simone Honikman
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  3. Landon Myer
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  4. Michael N. Onah
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  5. Sally Field
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  6. Mark Tomlinson
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Contributions

SH, SF and TvH designed the study and wrote the protocol. TvH supervised the study, the data collection and managed the literature searches. TvH, LM and MO undertook the statistical analyses. TvH wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.

Corresponding author

Correspondence to Thandi van Heyningen.

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Ethics approval and consent to participate

Informed consent was obtained from participants following a verbal explanation of the study. Participants were free to withdraw from the study at any time. Women with severe psychopathology or who presented a high suicide risk were referred to emergency psychiatric services. Women who were diagnosed with a CMD were offered counselling with the study’s registered mental health counsellor.

Availability of data and material

The data that support the findings of this study are available from The Perinatal Mental Health Project (www.pmhp.za.org), but restrictions apply to the availability of these data, which were used under licence for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of The Perinatal Mental Health Project.

Competing interests

The authors declare that they have no competing interests.

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van Heyningen, T., Honikman, S., Myer, L. et al. Prevalence and predictors of anxiety disorders amongst low-income pregnant women in urban South Africa: a cross-sectional study. Arch Womens Ment Health 20, 765–775 (2017). https://doi.org/10.1007/s00737-017-0768-z

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  • DOI: https://doi.org/10.1007/s00737-017-0768-z

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