European Journal of Cardiovascular Medicine

Pregnancy is a transformative period in a woman’s life, bringing significant physical, emotional, and psychological changes. While it is often associated with joy and anticipation, it can also be a time of considerable stress and vulnerability, leading to mental health concerns such as depression. ^[] Depression during pregnancy, also known as antenatal or prenatal depression, is a prevalent yet often underdiagnosed condition that can have serious consequences for both the mother and the developing fetus. It is characterized by persistent feelings of sadness, hopelessness, and a lack of interest in daily activities, along with other symptoms such as sleep disturbances, changes in appetite, and difficulty concentrating. The impact of untreated depression during pregnancy extends beyond the mother, affecting fetal development, birth outcomes, and even the long-term emotional and cognitive development of the child. ^[2]

Globally, depression among pregnant women is a growing concern, with prevalence rates varying widely depending on geographical location, socioeconomic status, and access to healthcare services. Studies suggest that between 10% and 25% of pregnant women experience depressive symptoms, with higher rates reported in low- and middle-income countries. ^[3] The stigma surrounding mental health

issues, cultural beliefs, and lack of awareness often prevent many women from seeking help, leading to a worsening of symptoms and increased risk of complications. The consequences of antenatal depression are profound, ranging from premature birth and low birth weight to increased risk of postpartum depression and impaired maternal-infant bonding. Therefore, understanding the risk factors associated with depression during pregnancy is crucial for early identification and intervention. ^[4]

Several biological, psychological, and social factors contribute to the development of depression in pregnant women. Hormonal fluctuations play a significant role in mood regulation, and the drastic hormonal shifts during pregnancy can make some women more susceptible to depressive symptoms. ^[5] Genetic predisposition is another crucial factor, as women with a family history of depression or mental health disorders are at higher risk. Additionally, pre-existing mental health conditions, such as anxiety or previous episodes of depression, significantly increase the likelihood of experiencing antenatal depression. ^[6]

Psychosocial factors, including stress, lack of social support, and financial difficulties, are also strongly linked to depression during pregnancy. Women who experience domestic violence, relationship conflicts, or unplanned pregnancies are at a higher risk of developing depressive symptoms. ^[7] Socioeconomic status also plays a critical role, as financial instability and limited access to healthcare can exacerbate stress levels and hinder the ability to seek appropriate treatment. Furthermore, lifestyle factors such as poor nutrition, lack of physical activity, and substance abuse can contribute to the onset or worsening of depression during pregnancy. ^[8]

Recognizing the importance of early detection and intervention, healthcare providers must integrate mental health screening into routine prenatal care. Timely diagnosis and appropriate management strategies, including counseling, psychotherapy, and, in some cases, pharmacological treatment, can significantly improve maternal and fetal outcomes. ^[9] Public health initiatives aimed at raising awareness, reducing stigma, and improving access to mental health services are essential in addressing this growing concern. ^[10]

This study aimed to assess the prevalence of antenatal depression and identify significant risk factors among pregnant women attending a tertiary care hospital in Hyderabad, Telangana, India

This was a cross-sectional study conducted at the Gandhi Medical College & Hospital, Secunderabad, Telangana, between November 2020 and June 2022.

Study Population

The study included 300 pregnant women who attended the antenatal clinic. Participants provided informed consent prior to enrollment. Women with obstetric emergencies,

severe medical conditions, or multiple stressful life events

were excluded.

 Data Collection Tools

1. Edinburgh Postnatal Depression Scale (EPDS): A 10-item validated tool used to assess depressive symptoms, with a cutoff score of ≥13 for likely depression.
2. HITS Tool: Assessed intimate partner violence; a score >10 indicated domestic violence.
3. Presumptive Stressful Life Events Scale (PSLES): Evaluated exposure to stressful life events relevant to Indian settings.

Statistical Analysis

Data were analyzed using SPSS version 22. Frequencies and percentages were calculated for categorical variables. Chi-square analysis was used to assess associations between depression and risk factors, with a p-value <0.05 considered significant.

Ethical Considerations

The study was approved by the Institutional Ethics Committee of Gandhi Medical College, and confidentiality was maintained throughout.

Prevalence of Antenatal Depression

The prevalence of antenatal depression was 13.3% (40 out of 300) based on EPDS scores ≥13. The mean EPDS score was 8.24 ± 4.6, with a range of 1-25.

Table 1: Distribution of Age

Most respondents were aged 26-35 years (46.7%).

Table 2: Distribution of Education

Table 3: Distribution of Economic Status

Table 4: Distribution of Residence

Table 5: Distribution of study sample based on trimester

 Sociodemographic Characteristics

• Age: Most respondents were aged 26-35 years (46.7%).
• Education: A majority (43%) had secondary-level education.
• Economic Status: 61% belonged to the lower-income group.
• Residence: 71.3% of participants were from urban areas.
• No significant relationships were observed between antenatal depression and these factors.

Table 6: Distribution of study sample based on parity

 Psychosocial Risk Factors

• Intimate Partner Violence: Women with HITS scores >10 had a significantly higher prevalence of depression (p < 0.001).
• Stressful Life Events: Experiencing more than one stressful life event (PSLES score >1) was significantly associated with depression (p = 0.047).

 Obstetric Factors

• Most participants were in their second trimester (52%) and were multiparous (61%). Neither trimester nor parity showed significant associations with depression.

This study found that the prevalence of antenatal depression in Hyderabad aligns with findings from other hospital-based studies in India, such as those conducted by Bavle et al. (12.3%) and George et al. (16.3%). This consistency suggests that depression during pregnancy is a significant and persistent issue across different regions within the country. ^[11] The comparable prevalence rates emphasize the importance of routine screening and early intervention strategies to prevent adverse maternal and fetal outcomes.

One of the key findings of this study is the significant association between antenatal depression and psychosocial stressors, particularly intimate partner violence (IPV) and stressful life events. This aligns with global research highlighting the impact of domestic abuse and major life stressors on maternal mental health. ^[12] IPV has been widely documented as a crucial risk factor for antenatal depression, as it contributes to chronic stress, fear, and emotional distress, all of which exacerbate depressive symptoms. Furthermore, stressful life events such as financial instability, loss of a loved one, relationship conflicts, or major transitions (e.g., relocation or job loss) can increase psychological vulnerability during pregnancy. ^[13] Given these associations, there is a strong need for healthcare providers to incorporate routine screening for IPV and psychosocial stress in antenatal care settings. Interventions such as counseling, social support programs, and legal aid services should be made accessible to affected women to mitigate these risks. ^[14]

Interestingly, this study did not find significant associations between sociodemographic factors—such as age, education, and socioeconomic status—and antenatal depression. This finding contrasts with several studies conducted in low- and middle-income countries (LMICs), where younger maternal age, lower educational attainment, and poor socioeconomic conditions were identified as strong risk factors. ^[15] The discrepancy may be due to the unique cultural and economic context of the study population in Hyderabad. ^[16] For instance, pregnant women attending hospital-based antenatal care might have better access to medical and social support services, reducing the impact of lower socioeconomic status on mental health outcomes. Additionally, in some cultural settings, strong family support systems, particularly within extended families, may buffer against the effects of lower education or financial difficulties. However, this aspect requires further investigation to determine the specific protective factors that may be at play in this population. ^[17]

The study’s findings also underscore the importance of targeted interventions rather than a one-size-fits-all approach to addressing antenatal depression. Since psychosocial factors such as IPV and life stressors were found to be significant contributors, mental health programs should focus on strengthening emotional support systems, enhancing resilience strategies, and integrating mental health services within antenatal clinics. ^[18] Future research should explore the role of protective factors such as family support, community engagement, and coping mechanisms to gain a more comprehensive understanding of the determinants of antenatal depression in various settings. ^[19]

Although this study provides valuable insights, it is not without limitations. The hospital-based nature of the study may limit the generalizability of the findings to the broader population, as women who seek antenatal care may differ in significant ways from those who do not. Additionally, self-reported measures of depression and psychosocial stressors are subject to bias, and some participants may have underreported their symptoms due to stigma surrounding mental health. Longitudinal studies with larger and more diverse samples are needed to validate these findings and provide deeper insights into the causal mechanisms linking psychosocial stressors with antenatal depression.

Antenatal depression affects a significant proportion of pregnant women in Hyderabad. The study emphasizes intimate partner violence and stressful life events as significant risk factors. Routine screening for antenatal depression, especially targeting psychosocial stressors, should be integrated into antenatal care programs in India.

1. World Health Organization. Depression and other common mental disorders: global health estimates. Geneva: WHO; 2017.
2. Fisher J, et al. Prevalence and determinants of common perinatal mental disorders in women in LMICs: a systematic review. Bull World Health Organ. 2012;90(2):139–149H.
3. Leigh B, Milgrom J. Risk factors for antenatal depression: a review. BMC Psychiatry. 2008;8:24.
4. Bavle AD, et al. Antenatal depression in a tertiary care hospital. Indian J Psychol Med. 2016;38(1):31-35.
5. George C, et al. Antenatal depression in coastal South India: Prevalence and risk factors. Indian J Community Health. 2018;30(2):143-150.
6. Pereira PK, et al. Violence and depression among women in the perinatal period. J Affect Disord. 2017;210:62-68.
7. Tesfaye Y, et al. Antenatal depression and associated factors in Ethiopia. J Pregnancy. 2021;2021:5047432.
8. Thompson O, Ajayi I. Prevalence of antenatal depression in Nigeria. Depress Res Treat. 2016;2016:4518979.
9. Singh G, et al. Presumptive stressful life events scale. Indian J Psychiatry. 1984;26(2):107-114.
10. Lancaster CA, Gold KJ, Flynn HA, et al. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol. 2010;202(1):5-14.
11. Biaggi A, Conroy S, Pawlby S, Pariante CM. Identifying the women at risk of antenatal anxiety and depression: A systematic review. J Affect Disord. 2016;191:62-77.
12. Faisal-Cury A, Menezes PR. Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Womens Ment Health. 2007;10(1):25-32.
13. Gausia K, Fisher C, Ali M, Oosthuizen J. Antenatal depression and suicidal ideation among rural Bangladeshi women: A community-based study. Arch Womens Ment Health. 2009;12(5):351-8.
14. Goyal D, Gay C, Lee KA. How much does low socioeconomic status increase the risk of prenatal and postpartum depressive symptoms in first-time mothers? Womens Health Issues. 2010;20(2):96-104.
15. Nasreen HE, Kabir ZN, Forsell Y, Edhborg M. Prevalence and associated factors of depressive and anxiety symptoms during pregnancy: A population-based study in rural Bangladesh. BMC Womens Health. 2011;11(1):22.
16. Gelaye B, Rondon MB, Araya R, Williams MA. Epidemiology of maternal depression, risk factors, and child outcomes in low-income and middle-income countries. Lancet Psychiatry. 2016;3(10):973-82.
17. Silverman ME, Reichenberg A, Savitz DA, Cnattingius S, Lichtenstein P, Hultman CM, et al. The risk factors for postpartum depression: A population-based study. Depress Anxiety. 2017;34(2):178-87.
18. Faisal-Cury A, Rossi Menezes P. Prevalence and factors associated with anxiety and depression during pregnancy: A cross-sectional study. J Affect Disord. 2007;102(1-3):137-43.
19. Redinger S, Norris SA, Pearson RM, Richter LM, Rochat TJ. First trimester antenatal depression and anxiety: Prevalence and associated factors in rural South Africa. J Affect Disord. 2018;227:38-47.