title: Association of gender disadvantage factors and gender preference with antenatal depression in women: a cross-sectional study from rural Maharashtra.
abstract: Maternal depression is a major public health problem in low- and middle-income countries including India. Very few studies have assessed association of various risk factors with antenatal depression in rural Indian women, especially the effect of marital conflict, gender disadvantage and gender preference on antenatal depression. This paper describes the prevalence of probable antenatal depression in rural Maharashtra, a state in the western part of India and specifically assesses the association of marital and gender disadvantage factors and gender preference for a male child with antenatal depression.
  
  
  
  Primary Health Centre-based cross-sectional survey of antenatal women in rural Maharashtra was carried out. The outcome of interest was a probable diagnosis of depression in antenatal women which was measured using the Edinburgh postnatal depression scale (EPDS). Data were analyzed using simple and multiple logistic regression.
  
  
  
  302 women in their antenatal period were included in this study. The outcome of antenatal depression (EPDS > 12) was found in 51 women (16.9%, 95% CI 12.6-21.1%). Feeling pressurized to deliver a male child was strongly associated with the outcome of antenatal depression (adjusted odds ratio (OR): 3.0; 95% CI 1.4-6.5). Unsatisfactory reaction of in-laws to dowry (adjusted OR 11.2; 95% CI 2.4-52.9) and difficult relationship with in-laws (adjusted OR 5.3; 95% CI 2.4-11.6) were also significantly associated with antenatal depression.
  
  
  
  Our findings demonstrate that antenatal depression in rural women of Western Maharashtra is associated with gender disadvantage factors, especially related to preference for a male child. The agenda to improve maternal mental health should be ultimately linked to address the broader social development goals and gender empowerment.
authors.affiliation: Division of Clinical Sciences, National AIDS Research Institute, Indian Council of Medical Research, Pune, India.
authors.forename: Pallavi
authors.initials: P
authors.lastname: Shidhaye
authors.affiliation: Centre for Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India. rahul.shidhaye@phfi.org.|CAPHRI (Care and Public Health Research Institute), Maastricht University, Maastricht, The Netherlands. rahul.shidhaye@phfi.org.|Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. rahul.shidhaye@phfi.org.
authors.forename: Rahul
authors.identifier: 0000-0001-9365-7164
authors.initials: R
authors.lastname: Shidhaye
authors.affiliation: Public Health Foundation of India, 19, Rishi Nagar, Char Imli, Bhopal, Madhya Pradesh, India.
authors.forename: Vaishali
authors.initials: V
authors.lastname: Phalke
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology / Q000523:psychology*; D019052:Depression, Postpartum / Q000453:epidemiology / Q000523:psychology; D005260:Female; D005783:Gender Identity; D006801:Humans; D007194:India / Q000453:epidemiology; D016015:Logistic Models; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000523:psychology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D035862:Vulnerable Populations / Q000523:psychology*
keywords: Antenatal depression; Gender disadvantage; Gender preference; India