An exploratory study of neighborhood-level risk factors of perinatal depression and anxiety among Ethiopian perinatal women

Melesse, Biniyam Berhanu

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https://hdl.handle.net/2142/124665 Copy

Description

Title

An exploratory study of neighborhood-level risk factors of perinatal depression and anxiety among Ethiopian perinatal women

Author(s)

Melesse, Biniyam Berhanu

Issue Date

2024-04-18

Director of Research (if dissertation) or Advisor (if thesis)

Lara-Cinisomo, Sandraluz

Doctoral Committee Chair(s)

Lara-Cinisomo, Sandraluz

Committee Member(s)

• Alamu, Josiah
• Alston, Reginald
• Raj, Minakshi

Department of Study

Kinesiology & Community Health

Discipline

Community Health

Degree Granting Institution

University of Illinois at Urbana-Champaign

Degree Name

Ph.D.

Degree Level

Dissertation

Keyword(s)

• Perinatal Mental Health
• Perinatal Depression
• Perinatal Anxiety
• Sub-Saharan Africa
• Ethiopia
• Neighborhood Study
• Social cohesion
• neighborhood violence
• neighborhood crime
• individual-level factors
• low-and-middle income countries
• mental health issues
• minority women
• black women
• mental health stigma
• health inequity
• minority research
• community health
• public health
• Fulbright fellowship
• research award
• mixed-method studies
• qualitative studies
• quantitative studies

Abstract

Background: Perinatal depression and anxiety are common in high-income countries (HICs), with 10–15% of women suffering from these conditions. In contrast, perinatal depression rates in low- and middle-income countries (LMICs) range from 19% to 48%. Depressive and anxiety symptoms in pregnant women and mothers of children under two years of age have been linked to various individual-level risk factors in the Sub-Saharan African region (SSA). Individual-level risk factors such as stressful life events, intimate partner violence, poor social support, and childhood trauma are associated with depressive and anxiety symptoms in studies conducted in the SSA region and the U.S., but neighborhoods may also play a role in perinatal mental health. Developing a thorough understanding of neighborhood-level factors (e.g., social isolation due to a lack of social cohesion) that contribute to poor maternal mental health outcomes (e.g., depression/anxiety) may aid in reducing SSA women’s high rates of depressive and anxiety symptoms. Neighborhood violence has been shown to increase depressive and anxiety symptoms. Neighborhood social cohesion is also associated with poor mental health outcomes. Purpose: The purpose of this research was to explore the association between perceived neighborhood social cohesion and perceived neighborhood violence and depressive and anxiety symptoms among Ethiopian women who are pregnant or who have children under two. The objective was to survey 111 women and conduct 50 qualitative interviews with women who met the cutoff for depressive or anxiety symptoms. Methods: This was a mixed-methods study with women from low-income neighborhoods in Addis Ababa, Ethiopia. Demographic data was collected using either a self-administered or a nurse-administered instrument. Depressive symptoms were assessed using the Patient Health Questionnaire (PHQ-2) with a score range of 0¬–6. Anxiety was measured using the two-item Generalized Anxiety Disorder scale (GAD-2) with a score range of 0–6. A score of 3 or greater indicated depressive or anxiety symptoms. The perceived neighborhood social cohesion and perceived neighborhood violence questionnaires and the qualitative interviews evaluated women’s neighborhood experiences. Chi-square and Fisher’s Exact tests were used to determine the association between demographic and mental health variables. Linear regressions were used to test whether there was an association between the neighborhood and mental health variables. Thematic analysis was used to analyze qualitative data. Results: Perceived neighborhood violence was significantly associated with depressive symptoms among participants with complete data (n = 60, β = .353, p = .007). However, when adjusted for demographic variables, perceived neighborhood violence was only marginally significantly associated with depressive symptoms (n = 60, β = .225, p = .057). Only marital status was significantly associated with depressive symptoms; single women had significantly higher symptoms than married or cohabitating women in the model that included neighborhood violence. No other significant associations were observed. Five neighborhood violence subthemes emerged from the qualitative data: neighborhood issues, recurring crimes, safety concerns, policing issues, and the effects of low safety. These themes capture participants' complex experiences living in poor neighborhoods in Addis Ababa, Ethiopia. Despite perceived neighborhood violence, participants also reported a sense of community and connection with neighbors as illustrated by the following eight neighborhood social cohesion subthemes: community engagement, community involvement, hard to live, easy to live due to religious tolerance, existential dilemmas, perceptions of neighbors, raising children/pregnancy help, and coping mechanisms. Conclusion: Prior studies indicate that residing in communities characterized by elevated levels of violence not only results in increased depression and anxiety symptoms but also diminishes social cohesion. The results from the quantitative data did not support these propositions. Additionally, the qualitative data does not provide evidence in favor of the argument that social cohesion is absent in violent neighborhoods. While the participants reported witnessing criminal activities, feelings of fear, victimization, and acts of violence, leading to a diminished sense of safety, they also reported feeling connected to their neighbors. The qualitative data also showed that the women felt a sense of neighborhood social cohesion despite having depressive and anxiety symptoms. The quantitative results showed that marital status attenuated the effect of neighborhood violence on depressive symptoms. Single parenthood is an important predictor even when faced with living in a poor neighborhood where violence is observed. Still, the qualitative data also showed that despite living in an unsafe neighborhood, pregnant women and mothers of children under the age of two experiencing depressive and anxiety symptoms can connect with their neighbors. Future studies should explore the potential protective benefits of neighborhood social cohesion in poor neighborhoods in Addis Ababa, Ethiopia because how we conceptualize social cohesion in the West may not be true of Ethiopia.

Graduation Semester

2024-05

Type of Resource

Thesis

Copyright and License Information

Copyright 2024 Biniyam Melesse

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