title: Postpartum depression and HIV infection among women in Malawi.
abstract: BACKGROUND
  HIV-infected women face several risk factors related to postpartum depression (PPD). We aimed to describe the prevalence and cumulative incidence of PPD in the low-income setting of Malawi and to determine the association between maternal and infant HIV and PPD.
  
  
  METHODS
  This longitudinal cohort study included 156 HIV-uninfected and 373 HIV-infected Malawian women enrolled 10-14 weeks after delivery who returned at 6, 9, 12, 15, and 18 months for follow-up visits. PPD was assessed at all visits. The prevalence of PPD at all visits was estimated using the Edinburgh Postnatal Depression Scale (EPDS). Association between PPD at 10-14 weeks and maternal and infant HIV status was assessed using log binomial regression. Cumulative incidence of PPD was assessed using Kaplan-Meier curves.
  
  
  RESULTS
  Prevalence of PPD was highest (11%) at 10-14 weeks postpartum and decreased to 2.9% at 18 months. There was no association between maternal HIV status and PPD (prevalence ratio, 1.18; 95% confidence interval: 0.68 to 2.08). Among HIV-infected women, prevalence of PPD was higher among women whose infants had acquired HIV (prevalence ratio, 2.0; 95% confidence interval: 1.1 to 3.6). The cumulative probability of experiencing PPD over the first 12 months postpartum was estimated to be 33.5% for HIV-infected mothers with HIV-infected infants vs. 22.5% for HIV-infected mothers with uninfected infants and 23.2% for HIV-uninfected mothers.
  
  
  CONCLUSIONS
  PPD prevalence did not differ between HIV-infected and -uninfected mothers but increased among women with an HIV-infected infant. Our findings suggest that it may be important to monitor PPD among women with HIV-infected infants.
authors.affiliation: *Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; and †Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.
authors.forename: Anna
authors.initials: A
authors.lastname: Dow
authors.forename: Queen
authors.initials: Q
authors.lastname: Dube
authors.forename: Brian W
authors.initials: BW
authors.lastname: Pence
authors.forename: Annelies
authors.initials: A
authors.lastname: Van Rie
mesh_terms: D000328:Adult; D015331:Cohort Studies; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D055815:Young Adult