title: Association between probable postnatal depression and increased infant mortality and morbidity: findings from the DON population-based cohort study in rural Ghana.
abstract: OBJECTIVE
  To assess the impact of probable depression in the immediate postnatal period on subsequent infant mortality and morbidity.
  
  
  METHODS
  Cohort study nested within 4 weekly surveillance of all women of reproductive age to identify pregnancies and collect data on births and deaths.
  
  
  METHODS
  Rural/periurban communities within the Kintampo Health Research Centre study area of the Brong-Ahafo Region of Ghana.
  
  
  METHODS
  16,560 mothers who had a live singleton birth reported between 24 March 2008 and 11 July 2009, who were screened for probable postnatal depression (pPND) between 4 and 12 weeks post partum (some of whom had also had depression assessed at pregnancy), and whose infants survived to this point.
  
  
  METHODS
  All-cause early infant mortality expressed per 1000 infant-months of follow-up from the time of postnatal assessment to 6 months of age. The secondary outcomes were (1) all-cause infant mortality from the time of postnatal assessment to 12 months of age and (2) reported infant morbidity from the time of the postnatal assessment to 12 months of age.
  
  
  RESULTS
  130 infant deaths were recorded and singletons were followed for 67,457.4 infant-months from the time of their mothers' postnatal depression assessment. pPND was associated with an almost threefold increased risk of mortality up to 6 months (adjusted rate ratio (RR), 2.86 (1.58 to 5.19); p=0.001). The RR up to 12 months was 1.88 (1.09 to 3.24; p=0.023). pPND was also associated with increased risk of infant morbidity.
  
  
  CONCLUSIONS
  There is new evidence for the association between maternal pPND and infant mortality in low-income and middle-income countries. Implementation of the WHO's Mental Health Gap Action Programme (mhGAP) to scale up packages of care integrated with maternal health is encouraged as an important adjunct to child survival efforts.
authors: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Benedict
authors: B
authors: Weobong
authors: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Augustinus H A
authors: AH
authors: ten Asbroek
authors: Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Seyi
authors: S
authors: Soremekun
authors: Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Lu
authors: L
authors: Gram
authors: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
authors: Seeba
authors: S
authors: Amenga-Etego
authors: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana.
authors: Samuel
authors: S
authors: Danso
authors: Kintampo Health Research Centre, Ghana Health Service, Kintampo, Ghana Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors: Seth
authors: S
authors: Owusu-Agyei
authors: Health Services and Population Research Department, Institute of Psychiatry, King's College London, London, UK.
authors: Martin
authors: M
authors: Prince
authors: Department of Public Health, Academic Medical Centre, Amsterdam, The Netherlands.
authors: Betty R
authors: BR
authors: Kirkwood
mesh_terms: D000328:Adult; D003863:Depression / Q000150:complications; D019052:Depression, Postpartum / Q000150:complications; D003906:Developing Countries; D005260:Female; D005500:Follow-Up Studies; D005869:Ghana / Q000453:epidemiology; D006801:Humans; D007182:Income; D007223:Infant; D066088:Infant Death; D000068104:Infant Health; D007226:Infant Mortality; D007231:Infant, Newborn; D000068097:Maternal Health; D009017:Morbidity; D011247:Pregnancy; D011248:Pregnancy Complications / Q000523:psychology; D011446:Prospective Studies; D012424:Rural Population
keywords: PUBLIC HEALTH