title: Risk of psychological distress following severe obstetric complications in Benin: the role of economics, physical health and spousal abuse.
abstract: BACKGROUND
  Little is known about the impact of life-threatening obstetric complications ('near miss') on women's mental health in low- and middle-income countries.
  
  
  OBJECTIVE
  To examine the relationships between near miss and postpartum psychological distress in the Republic of Benin.
  
  
  METHODS
  One-year prospective cohort using epidemiological and ethnographic techniques in a population of women delivering at health facilities.
  
  
  RESULTS
  In total 694 women contributed to the study. Except when associated with perinatal death, near-miss events were not associated with greater risk of psychological distress in the 12 months postpartum compared with uncomplicated childbirth. Much of the direct effect of near miss with perinatal death on increased risk of psychological distress was shown to be mediated through wider consequences of traumatic childbirth.
  
  
  CONCLUSIONS
  A live baby protects near-miss women from increased vulnerability by giving a positive element in their lives that helps them cope and reduces their risk of psychological distress. Near-miss women with perinatal death should be targeted early postpartum to prevent or treat the development of depressive symptoms.
authors.affiliation: London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1 7HT, UK. edward.fottrell@epiph.umu.se
authors.forename: Edward
authors.initials: E
authors.lastname: Fottrell
authors.forename: Lydie
authors.initials: L
authors.lastname: Kanhonou
authors.forename: Sourou
authors.initials: S
authors.lastname: Goufodji
authors.forename: Dominique P
authors.initials: DP
authors.lastname: Béhague
authors.forename: Tom
authors.initials: T
authors.lastname: Marshall
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.forename: Véronique
authors.initials: V
authors.lastname: Filippi
mesh_terms: D000293:Adolescent; D000328:Adult; D001541:Benin / Q000453:epidemiology; D005260:Female; D006801:Humans; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000208:ethnology / Q000523:psychology*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000191:economics / Q000523:psychology*; D011446:Prospective Studies; D012307:Risk Factors; D013179:Spouse Abuse / Q000523:psychology*; D013315:Stress, Psychological / Q000191:economics / Q000523:psychology; D016387:Women's Health; D055815:Young Adult