title: Predictors of psychological distress among postnatal mothers in rural Nepal: a cross-sectional community-based study.
abstract: BACKGROUND
  Perinatal common mental disorders are a major cause of disability among women and have consequences for children's growth and development. We aimed to identify factors associated with psychological distress, a proxy for common mental disorders, among mothers in rural Dhanusha, Nepal.
  
  
  METHODS
  We used data from 9078 mothers who were screened for distress using the 12-item General Health Questionnaire (GHQ-12) around six weeks after delivery. We assessed the association between GHQ-12 score and socioeconomic, gender-based, cultural and reproductive health factors using a hierarchical analytical framework and multilevel linear regression models.
  
  
  RESULTS
  Using a threshold GHQ-12 score of ≥6 to indicate caseness, the prevalence of distress was 9.8% (886/9078). Factors that predicted distress were severe food insecurity (β 2.21 (95% confidence interval 1.43, 3.40)), having a multiple birth (2.28 (1.27, 4.10)), caesarean section (1.70 (0.29, 2.24)), perinatal health problems (1.58 (1.23, 2.02)), no schooling (1.37 (1.08, 1.73)), fewer assets (1.33 (1.10, 1.60)), five or more children (1.33 (1.09, 1.61)), poor or no antenatal care (1.31 (1.15, 1.48) p<0.001), having never had a son (1.31 (1.14, 1.49)), not staying in the parental home in the postnatal period (1.15 (1.02, 1.30)), having a husband with no schooling (1.17 (0.96, 1.43)) and lower maternal age (0.99 (0.97, 1.00)).
  
  
  CONCLUSIONS
  The study was cross-sectional and we were therefore unable to infer causality. Because data were not collected for some established predictors, including infant death, domestic violence and history of mental illness, we could not assess their associations with distress.
  
  
  CONCLUSIONS
  Socioeconomic disadvantage, gender inequality and poor reproductive health predict distress among mothers in Dhanusha. Maternal and child health programmes, as well as poverty-alleviation and educational interventions, may be beneficial for maternal mental health.
authors.affiliation: University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom. Electronic address: k.clarke.09@ucl.ac.uk.
authors.forename: Kelly
authors.initials: K
authors.lastname: Clarke
authors.affiliation: University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: Naomi
authors.initials: N
authors.lastname: Saville
authors.affiliation: Mother and Infant Research Activities (MIRA), P.O. Box 921, Kathmandu, Nepal.
authors.forename: Bhim
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Costello
authors.affiliation: Mental Health Sciences Unit, University College London, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: King
authors.affiliation: Mother and Infant Research Activities (MIRA), P.O. Box 921, Kathmandu, Nepal.
authors.forename: Dharma
authors.initials: D
authors.lastname: Manandhar
authors.affiliation: University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Osrin
authors.affiliation: University College London Institute for Global Health, 30 Guilford Street, London WC1N 1EH, United Kingdom.
authors.forename: Audrey
authors.initials: A
authors.lastname: Prost
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D009035:Mothers / Q000523:psychology*; D009390:Nepal / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D012111:Residence Characteristics; D012424:Rural Population; D013315:Stress, Psychological / Q000453:epidemiology* / Q000209:etiology; D055815:Young Adult
keywords: Common mental disorder; Maternal mental health; Nepal; Postnatal depression; Postnatal psychological distress; Rural health