title: Depressive symptoms in mothers after perinatal and early infant loss in rural Bangladesh: a population-based study.
abstract: We examined stillbirth and neonatal death as predictors of depressive symptoms in women experiencing these events during the first 6 months postpartum.
  
  
  
  We performed secondary analyses using data from 41,348 married women aged 13-44 years, originally collected for the JiVitA-1 study (2001-2007) in northwest Bangladesh. Adjusted relative risk ratios were estimated to determine the associations between stillbirth and early infant death and women's risk of reported depressive symptoms (trichotomized 0, 1-2, 3-5) up to 6 months after the death. Adjusted risk ratios, comparing 0-2 versus 3-5 depressive symptoms, were used in stratified analyses.
  
  
  
  Women having fetal/infant deaths had elevated risk of experiencing 1-2 postpartum depressive symptoms (adj RRRs between 1.2 and 1.7) and of experiencing 3-5 postpartum depressive symptoms (adj RRRs between 1.9 and 3.3), relative to women without a fetal/infant death. Notably, those whose infants died in the early postneonatal period had over a three-fold risk of 3-5 depressive symptoms (adj relative risk ratio [RRR] = 3.3; 95% confidence interval [CI], 2.6-4.3) compared to a two-fold risk for women experiencing a stillbirth (adj RRR = 1.9; 95% CI, 1.7-2.1). After early postneonatal deaths, women with higher levels of education were more likely to suffer 3-5 depressive symptoms (adj relative risk [RR] = 10.6; 95% CI, 5.2-21.7, ≥10 years of education) compared to women with lower levels of education (adj RR = 2.0; 95% CI, 1.6-2.4, no education; adj RR = 2.2; 95% CI, 1.6-2.9, 1-9 years of education).
  
  
  
  Women's mental health needs should be prioritized in low-resource settings, where these outcomes are relatively common and few mental health services are available.
authors.affiliation: Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Electronic address: psurkan@jhu.edu.
authors.forename: Pamela J
authors.initials: PJ
authors.lastname: Surkan
authors.affiliation: Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Kwame
authors.initials: K
authors.lastname: Sakyi
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Donna M
authors.initials: DM
authors.lastname: Strobino
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Sucheta
authors.initials: S
authors.lastname: Mehra
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Alain
authors.initials: A
authors.lastname: Labrique
authors.affiliation: The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh.
authors.forename: Hasmot
authors.initials: H
authors.lastname: Ali
authors.affiliation: The JiVitA Project, Johns Hopkins University in Bangladesh, Gaibandha, Bangladesh.
authors.forename: Barkat
authors.initials: B
authors.lastname: Ullah
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Lee
authors.initials: L
authors.lastname: Wu
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Rolf
authors.initials: R
authors.lastname: Klemm
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Mahbubur
authors.initials: M
authors.lastname: Rashid
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
authors.affiliation: Center for Human Nutrition, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Parul
authors.initials: P
authors.lastname: Christian
mesh_terms: D000293:Adolescent; D000328:Adult; D001459:Bangladesh / Q000453:epidemiology; D015331:Cohort Studies; D016208:Databases, Factual; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D003906:Developing Countries; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D000068097:Maternal Health; D009035:Mothers / Q000523:psychology*; D020380:Needs Assessment; D054238:Perinatal Mortality / Q000639:trends; D049590:Postpartum Period; D011247:Pregnancy; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D050497:Stillbirth / Q000208:ethnology*; D055815:Young Adult
keywords: Bangladesh; Depressive symptoms; Mental health; Neonatal death; Stillbirth