The effect of male involvement and a prevention of mother-to-child transmission (PMTCT) intervention on depressive symptoms in perinatal HIV-infected rural South African women

Karl Peltzer, John M. Abbamonte, Lissa N. Mandell, Violeta J. Rodriguez, Tae Kyoung Lee, Stephen M Weiss, Deborah Jones

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Abstract

This study investigated perinatal depressive symptoms among HIV-infected women enrolled in a cluster-randomized, controlled trial in South Africa. Women (n = 1370) attending 12 community health centers were consecutively enrolled in a two-phase (phase 1 = without a male partner, phase 2 = with a male partner) and two-condition (experimental or control) prevention of mother-to-child transmission (PMTCT) intervention. Women were enrolled at 8–24 weeks pregnant and followed postpartum at 6 weeks and 6 and 12 months (retention rate = 69.8%). Antenatally, 45.4% of women were above the 12-point Edinburgh Postnatal Depression Scale (EPDS) cutoff, 30.2% were above the cutoff at 6 weeks, and 34.2% and 36.9% at 6 months and 12 months postpartum, respectively. In multilevel regression analyses, depressive symptoms decreased over time among women in phase 2 participating in the intervention condition, but neither condition nor phase alone was associated with a decrease in depression. Greater HIV stigma, increased psychological intimate partner violence, less male involvement, lower education, and non-adherence during pregnancy were associated with increased depressive symptoms over the perinatal period. Results indicated that women participating had high levels of depressive symptoms (> 40% prenatally and > 30% postnatally), and the combination of the multi-session PMTCT intervention plus male partner participation contributed to a reduction in depressive symptoms. Results suggest that interventions targeting the reduction of depressive symptoms in perinatal HIV-positive women by increasing male involvement and decreasing HIV stigma and intimate partner violence are needed to reduce depression in this vulnerable population.

Original languageEnglish (US)
JournalArchives of Women's Mental Health
DOIs
StatePublished - Jan 1 2019

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Mothers
HIV
Depression
Postpartum Period
Community Health Centers
Multilevel Analysis
Postpartum Depression
Vulnerable Populations
South Africa
Randomized Controlled Trials
Regression Analysis
Psychology
Education
Pregnancy

Keywords

  • Depression symptoms
  • Male participation
  • Perinatal HIV-positive women
  • PMTCT intervention trial
  • South Africa

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Psychiatry and Mental health

Cite this

The effect of male involvement and a prevention of mother-to-child transmission (PMTCT) intervention on depressive symptoms in perinatal HIV-infected rural South African women. / Peltzer, Karl; Abbamonte, John M.; Mandell, Lissa N.; Rodriguez, Violeta J.; Lee, Tae Kyoung; Weiss, Stephen M; Jones, Deborah.

In: Archives of Women's Mental Health, 01.01.2019.

Research output: Contribution to journalArticle

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abstract = "This study investigated perinatal depressive symptoms among HIV-infected women enrolled in a cluster-randomized, controlled trial in South Africa. Women (n = 1370) attending 12 community health centers were consecutively enrolled in a two-phase (phase 1 = without a male partner, phase 2 = with a male partner) and two-condition (experimental or control) prevention of mother-to-child transmission (PMTCT) intervention. Women were enrolled at 8–24 weeks pregnant and followed postpartum at 6 weeks and 6 and 12 months (retention rate = 69.8{\%}). Antenatally, 45.4{\%} of women were above the 12-point Edinburgh Postnatal Depression Scale (EPDS) cutoff, 30.2{\%} were above the cutoff at 6 weeks, and 34.2{\%} and 36.9{\%} at 6 months and 12 months postpartum, respectively. In multilevel regression analyses, depressive symptoms decreased over time among women in phase 2 participating in the intervention condition, but neither condition nor phase alone was associated with a decrease in depression. Greater HIV stigma, increased psychological intimate partner violence, less male involvement, lower education, and non-adherence during pregnancy were associated with increased depressive symptoms over the perinatal period. Results indicated that women participating had high levels of depressive symptoms (> 40{\%} prenatally and > 30{\%} postnatally), and the combination of the multi-session PMTCT intervention plus male partner participation contributed to a reduction in depressive symptoms. Results suggest that interventions targeting the reduction of depressive symptoms in perinatal HIV-positive women by increasing male involvement and decreasing HIV stigma and intimate partner violence are needed to reduce depression in this vulnerable population.",
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