title: Mental health related determinants of parenting stress among urban mothers of young children--results from a birth-cohort study in Ghana and Côte d'Ivoire.
abstract: BACKGROUND
  There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS.
  
  
  METHODS
  A longitudinal birth cohort of 577 women from Ghana and Côte d'Ivoire was followed from the 3rd trimester in pregnancy to 2 years postpartum between 2010 and 2013. Depression and anxiety were assessed by the Patient Health Questionnaire depression module (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) at baseline, 3 month, 12 month and 24 month postpartum. PS was measured using the Parenting Stress Index-Short Form (PSI-SF) at 3, 12 and 24 month. The mean total PS score and the subscale scores were compared among depressed vs. non-depressed and among anxious vs. non-anxious mothers at 3, 12 and 24 month postpartum. The proportions of clinical PS (PSI-SF raw score > 90) in depressed vs. non-depressed and anxious vs. non-anxious mothers were also compared. A generalized estimating equation (GEE) approach was used to estimate population-averaged associations between women's depression/anxiety and PS adjusting for age, child sex, women's anemia, education, occupation, spouse's education, and number of sick child visits.
  
  
  RESULTS
  A total of 577, 531 and 264 women completed the PS assessment at 3 month, 12 month and 24 month postpartum across the two sites and the prevalences of clinical PS at each time point was 33.1%, 24.4% and 14.9% in Ghana and 30.2%, 33.5% and 22.6% in Côte d'Ivoire, respectively. At all three time points, the PS scores were significantly higher among depressed mothers vs. non-depressed mothers. In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.
  
  
  CONCLUSIONS
  Parenting stress is frequent and levels are high compared with previous studies from high-income countries. Antepartum and postpartum depression were both associated with PS, while antepartum and postpartum anxiety were not after adjusting for confounders. More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms. Should our findings be replicated, it appears prudent to design and subsequently evaluate intervention strategies.
authors.forename: Nan
authors.initials: N
authors.lastname: Guo
authors.forename: Carola
authors.initials: C
authors.lastname: Bindt
authors.forename: Marguerite
authors.initials: M
authors.lastname: Te Bonle
authors.forename: John
authors.initials: J
authors.lastname: Appiah-Poku
authors.forename: Cecilia
authors.initials: C
authors.lastname: Tomori
authors.forename: Rebecca
authors.initials: R
authors.lastname: Hinz
authors.forename: Dana
authors.initials: D
authors.lastname: Barthel
authors.forename: Stefanie
authors.initials: S
authors.lastname: Schoppen
authors.forename: Torsten
authors.initials: T
authors.lastname: Feldt
authors.forename: Claus
authors.initials: C
authors.lastname: Barkmann
authors.forename: Mathurin
authors.initials: M
authors.lastname: Koffi
authors.forename: Wibke
authors.initials: W
authors.lastname: Loag
authors.forename: Samuel Blay
authors.initials: SB
authors.lastname: Nguah
authors.forename: Kirsten A
authors.initials: KA
authors.lastname: Eberhardt
authors.forename: Harry
authors.initials: H
authors.lastname: Tagbor
authors.forename: Judith K
authors.initials: JK
authors.lastname: Bass
authors.forename: Eliezer
authors.initials: E
authors.lastname: N'Goran
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA. sehrhard@jhsph.edu.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ehrhardt
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D007560:Cote d'Ivoire / Q000453:epidemiology; D019052:Depression, Postpartum / Q000175:diagnosis / Q000453:epidemiology*; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D008603:Mental Health; D009035:Mothers / Q000523:psychology*; D016487:Parenting / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D015995:Prevalence; D013315:Stress, Psychological / Q000175:diagnosis / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D055815:Young Adult