Culturally determined risk factors for postnatal depression in Sub-Saharan Africa: a mixed method systematic review.

BACKGROUND: Research suggests that African women experience postnatal depression (PND) at a similar rate to that reported in developed countries. If PND is to be better understood in African populations, its risk factors need to be reliably identified. Studies in the developing world have found that risk factors are often culturally determined. This review aimed at improving our understanding of the culturally determined risk factors of PND within Sub-Saharan Africa by integrating evidence from quantitative and qualitative studies. METHODS: A mixed-method systematic review was employed. Nine quantitative and three qualitative studies were quality assessed, synthesised, and integrated. RESULTS: Quantitative studies indicated that stressful life events, cultural values and the African extended family system have an influential role in women's experience of PND. Qualitative studies described the impact of negative cultural perceptions of others and adhering to cultural traditions and values as contributing to the development and maintenance of PND. LIMITATIONS: The small number of studies is a limitation within the available body of research. Search strategies only included English language articles. CONCLUSIONS: Although some risk factors for postnatal depression were similar to those identified in studies in developed countries, important differences exist; most notably the influence of traditional African value systems, customs and antenatal exposure to extreme societal stress. The findings of this review are especially important for the development of a predictive model for PND within Sub-Saharan Africa and when working with migrant Sub-Saharan African mothers.

The experience of postnatal depression in West African mothers living in the United Kingdom: a qualitative study.

OBJECTIVE: to explore the lived experience of postnatal depression (PND) in West African mothers living in the United Kingdom (UK). DESIGN: using a qualitative design, semi-structured interviews were undertaken. Interpretative Phenomenological Analysis (IPA) was used to explore and analyse the data. SETTING: community health services within inner-city suburbs in Manchester, England. PARTICIPANTS: six West African mothers (Nigeria=3; Ghana=3), who were experiencing low mood in the postnatal period. FINDINGS: five overarching themes emerged: (1) conceptualising PND, (2) isolation, (3) loss of identity, (4) issues of trust and (5) relationships as a protective factor. Women exhibited symptoms of PND but did not regard it as an illness. In their view, postnatal depression and distress resulted from social stress. Participants stated that their cultural background made it difficult to disclose feelings of depression thus adversely influencing their help-seeking behaviour. KEY CONCLUSIONS: this is the first study to investigate the experiences of West African mothers with PND who live in the UK, and how they perceive and make sense of their experiences. The themes generated add to the body of existing research on PND in Black and ethnic minority populations and offer insight into the lived experience of West African women residing in England. Such insights are vital in order to deliver effective, culturally sensitive care. IMPLICATIONS FOR PRACTICE: these findings have implications on how services should be designed to increase their accessibility to African women, by using a community psychology approach alongside systemic and group interventions. Challenges to help seeking and language used to describe experiences are considered.