Depressive symptoms in mothers after perinatal and early infant loss in rural Bangladesh: a population-based study

PurposeWe examined stillbirth and neonatal death as predictors of depressive symptoms in women experiencing these events during the first 6 months postpartum.MethodsWe 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.ResultsWomen 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).ConclusionsWomen's mental health needs should be prioritized in low-resource settings, where these outcomes are relatively common and few mental health services are available.