Financial Strain and Prenatal Depression Among Pregnant Women in Ibadan, Nigeria: Mediating Pathways of Intimate Partner Violence, Food Insecurity, and Social Support
DOI:
https://doi.org/10.5708/EJMH.18.2023.0014Keywords:
pregnancy, financial strain, depression, social support, psychosocial stressorsAbstract
Introduction: Although mothers’ mental health is receiving more attention, little remain known about the impact that financial strain may have on the mental health of expectant mothers. This is crucial in low- and middle-income countries because vulnerable populations are disproportionately affected by high rates of poverty, insufficient social safety nets, and unstable economies.
Aims: This study examined the potential role that financial strain may play in prenatal depression while also taking into account the potential mediating roles of food insecurity, intimate relationship violence, and social support.
Methods: To gather the data, a cross-sectional survey of 519 pregnant women in the second and third trimesters were selected methodically from a pool of women awaiting routine antenatal care from one primary health care center in each of the five urban local government areas of Ibadan metropolis. The Edinburgh Postnatal Depression Scale was used to measure prenatal depression. Using parallel and serial mediation models, the relationship between the variables – financial strain, intimate partner violence, food insecurity, social support, and prenatal depression – was examined.
Results: Of the participants in this study, 28.1% reported having symptoms of depression during their pregnancy. The results also show that prenatal depression and financial strain are related, with each of the three mediators operating in a parallel and sequential causal order. The results of the mediation point to a causal chain with moderate effects.
Conclusions: Interventions should evaluate the effects of integrating mental health services and social needs assessments into antenatal and primary health care.
References
Abrahams, Z., Lund, C., Field, S., & Honikman, S. (2018). Factors associated with household food insecurity and depression in pregnant South African women from a low socioeconomic setting: a cross-sectional study. Social Psychiatry and Psychiatric Epidemiology, 53, 363–372.
https://doi.org/10.1007/s00127-018-1497-y
Adam K., Edeh H., Oboh V., Pauw K., & Thurlow, J. (2020). Impacts of COVID-19 on food systems and poverty in Nigeria. Advances in Food Security and Sustainability, 5, 145–173.
https://doi.org/10.1016/bs.af2s.2020.09.002
Adeoye, I. A., Sogbesan, A., & Esan, O. (2022). Prevalence, associated factors and perinatal outcomes of antepartum depression in Ibadan Nigeria. BMC Pregnancy & Childbirth, 22, Article 219.
https://doi.org/10.1186/s12884-022-04549-7
Awungafac, G., Mugamba, S., Nalugoda, F., Sjöland, C. F., Kigozi, G., Rautiainen. S., Malyabe, R. S., Ziegel, L., Nakigozi, G., Nalwoga, G. K., Kyasanku, E. Nkale, J., Watya, S., Ekström, A. M., & Kågesten, A. (2021). Household food insecurity and its association with self-reported male perpetration of intimate partner violence: a survey of two districts in central and western Uganda. BMJ Open, 11(3), e045427.
https://doi.org/10.1136/bmjopen-2020-045427
Barnett, P., Mackay, E., Matthews, H., Gate, R., Greenwood, H., Ariyo, K., Bhui, K., Halvorsrud, K., Pilling, S., & Smith, S. (2019). Ethnic variations in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data. Lancet Psychiatry, 6(4), 305–317.
https://doi.org/10.1016/S2215-0366(19)30027-6
Bedaso, A., Adams, J., Peng, W., & Sibbritt, D. (2021). Prevalence and determinants of low social support during pregnancy among Australian women: a community-based cross-sectional study. Reproductive Health, 18(1), Article 158.
https://doi.org/10.1186/s12978-021-01210-y.
Benebo, F. O., Schumann, B., & Vaezghasemi, M. (2018). Intimate partner violence against women in Nigeria: a multilevel study investigating the effect of women’s status and community norms. BMC Women's Health, 18, Article 136.
https://doi.org/10.1186/s12905-018-0628-7
Breiding, M. J., Smith, S. G., Basile, K. C., Walters, M. L., Chen, J., & Merrick, M. T. (2014). Prevalence and Characteristics of Sexual Violence, Stalking, and Intimate Partner Violence Victimization–National Intimate Partner and Sexual Violence Survey, United States, 2011. MMWR Surveillance Summaries, 63(8), 1–18.
https://www.cdc.gov/mmwr/preview/mmwrhtml/ss6308a1.htm
Coates, J., Swindale, A., & Bilinsky, P. (2007). Household Food Insecurity Access Scale (HFIAS) for Measurement of Food Access: Indicator Guide. Food and Nutrition Technical Assistance Project, Academy for Educational Development.
https://www.fantaproject.org/sites/default/files/resources/HFIAS_ENG_v3_Aug07.pdf
Conger, R. D., & Elder, G. H. (1994). Families in troubled times: The Iowa Youth and Family Project. In R. Conger (Ed.), Families in troubled times: Adapting to Change in Rural America (pp. 3–16). Routledge.
https://doi.org/10.4324/9781003058809
Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782–786.
https://doi.org/10.1192/bjp.150.6.782
Dadi, A. F., Wolde, H. F., Baraki, A. G., & Akalu, T. Y. (2020). Epidemiology of antenatal depression in Africa: a systematic review and meta-analysis. BMC Pregnancy & Childbirth, 20, Article 251.
https://doi.org/10.1186/s12884-020-02929-5
Drewnowski, A. (2022). Food insecurity has economic root causes. Nature Food, 3, 555–556.
https://doi.org/10.1038/s43016-022-00577-w
Folayan, M. O., Ibigbami, O., El Tantawi, M., Brown, B., Aly, N. M., Ezechi, O., Abeldaño, G. F., Ara, E., Ayanore, M. A., Ellakany, P., Gaffar, B., Al-Khanati, N. M., Idigbe, I., Ishabiyi, A. O., Jafer, M., Khan, A. T.-A., Khalid, Z., Lawal, F. B., Lusher, J.…Nguyen, A. L. (2021). Factors Associated with Financial Security, Food Security and Quality of Daily Lives of Residents in Nigeria during the First Wave of the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 18(15), Article 7925.
https://doi.org/10.3390/ijerph18157925
French, D., & Vigne, S. (2018). The causes and consequences of household financial strain: A systematic review. International Review of Financial Analysis, 62, 150–156.
https://doi.org/10.1016/j.irfa.2018.09.008
Gadanya, M. A., Abulfathi, A. A., & Ahmad, F. A. (2018). Anxiety and depression in pregnancy: prevalence and associated risk factors among pregnant women attending antenatal clinic in Aminu Kano Teaching Hospital Kano, Nigeria. Annals of African Medical Research, 1(1), 12–15.
https://doi.org/10.4081/aamr.2018.13
Garey, L., Reitzel, L. R., Anthenien, A. M., Businelle, M. S., Neighbors, C., Zvolensky, M. J., Wetter, D. W., & Kendzor, D. E. (2017). Support Buffers Financial Strain's Effect on Health-related Quality of Life. American Journal of Health Behavior, 41(4), 497–510.
https://doi.org/10.5993/AJHB.41.4.14
Goin, D. E., Izano, M. A., Eick, S. M., Padula, A. M., DeMicco, E., Woodruff, T. J., & Morello-Frosch, R. (2021). Maternal Experience of Multiple Hardships and Fetal Growth: Extending Environmental Mixtures Methodology to Social Exposures. Epidemiology, 32(1), 18–26.
https://doi.org/10.1097/EDE.0000000000001272
Hayes, A. F. (2022). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach (3rd ed.). Guilford Press.
Hernandez, D. C., Marshall, A., & Mineo, C. (2014). Maternal depression mediates the association between intimate partner violence and food insecurity. Journal of Women’s Health, 23(1), 29–37.
https://doi.org/10.1089/jwh.2012.4224
Kariuki, S. M., & Newton, C. R. J. C. (2022). The importance of perinatal maternal depression as a public health problem in Africa. The Lancet Psychiatry, 9(7), 527–528.
https://doi.org/10.1016/S2215-0366(22)00197-3
James-Hawkins, L., Shaltout, E., Nur, A. A., Nasrallah, C., Qutteina, Y., Abdul Rahim, H. F., Hennink, M., & Yount, K. M. (2019). Human and economic resources for empowerment and pregnancy-related mental health in the Arab Middle East: A systematic review. Archives of Women's Mental Health, 22(1), 1–14.
https://doi.org/10.1007/s00737-018-0843-0
Ladan, S. I., & Badaru, S. B. (2021). Food Security and National Insecurity: Pathways to Averting an Impending Food Crisis in Nigeria. Direct Research Journal of Agriculture and Food Science, 9(11), 350–359.
http://dx.doi.org/10.26765/DRJAFS88706683
Lange, B. C. L., Da'u, A. L. B. T., Goldblum, J., Alfano, J., & Smith, M. V. (2017). A mixed methods investigation of the experience of poverty among a population of low-income parenting women. Community Mental Health Journal, 53, 832–841.
https://doi.org/10.1007/s10597-017-0093-z
Levis, B., Negeri, Z., Sun, Y., Benedetti, A., & Thombs, B. D. (2020). Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ, 371, m4022.
https://doi.org/10.1136/bmj.m4022
Lubbers, M. J., Small, M. L., & García, H. V. (2020). Do networks help people to manage poverty? Perspectives from the field. Annals of the American Academy of Political & Social Sciences, 689(1), 7–25.
https://doi.org/10.1177/0002716220923959
Lucero J. L., Lim S., & Santiago A. M. (2016). Changes in economic hardship and intimate partner violence: A family stress framework. Journal of Family & Economic Issues, 37, 395–406.
https://doi.org/10.1007/s10834-016-9488-1
Lund, C., & Cois, A. (2018). Simultaneous social causation and social drift: longitudinal analysis of depression and poverty in South Africa. Journal of Affective Disorders, 229, 396–402.
https://doi.org/10.1016/j.jad.2017.12.050
Luo, Y., Zhang, K., Huang, M., & Qiu, C. (2022) Risk factors for depression and anxiety in pregnant women during the COVID-19 pandemic: Evidence from meta-analysis. PLoS ONE, 17(3), e0265021.
https://doi.org/10.1371/journal.pone.0265021
Macrotrends (2023). Ibadan, Nigeria Metro Area Population 1950-2023. Retrieved September 28, 2023, from
https://www.macrotrends.net/cities/21990/ibadan/population
Marcil, L. E., Campbell, J. I., Silva, K. E., Hughes, D., Salim, S., & Nguyen, H. T., Kissler, K., Hole, M. K., Michelson, C. D., & Kistin, C. J. (2020). Women's Experiences of the Effect of Financial Strain on Parenting and Mental Health. Journal of Obstetric, Gynecologic, and Neonatal Nursin, 49(6), 581–592.
https://doi.org/10.1016/j.jogn.2020.07.002
Marshall, G. L., & Tucker-Seeley, R. (2018). The association between hardship and self-rated health: does the choice of indicator matter? Annals of Epidemiology, 28(7), 462–467.
https://doi.org/10.1016/j.annepidem.2018.03.013
Mitchell, A. M., & Christian, L. M. (2017). Financial strain and birth weight: the mediating role of psychological distress. Archives of Women's Mental Health, 20, 201–208.
https://doi.org/10.1007/s00737-016-0696-3
National Bureau of Statistics (2020). Poverty and inequality in Nigeria: Executive summary. Retrieved November 17, 2022, from www.nigerianstat.gov.ng
National Bureau of Statistics (2022). Nigeria Multidimensional Poverty Index. Retrieved November 17, 2022, from
https://nigerianstat.gov.ng/elibrary/read/1241254
National Institute of Mental Health (2020). Perinatal Depression.
https://www.nimh.nih.gov/health/publications/perinatal-depression
Nguyen, T. H., Ngo, T. V., Nguyen, V. D., Nguyen, H. D., Nguyen, H. T. T., Gammeltoft T., Meyrowitsch, D. W., & Rasch, V. (2018). Intimate partner violence during pregnancy in Vietnam: prevalence, risk factors and the role of social support. Global Health Action, 11(Sup3), Article 1638052.
https://doi.org/10.1080/16549716.2019.1638052
Reesor-Oyer, L., Cepni, A. B., Lee, C. Y., Zhao, X., & Hernandez, D. C. (2021). Disentangling food insecurity and maternal depression: which comes first? Public Health Nutrition, 24(16), 5506–5513.
https://doi.org/10.1017/S1368980021000434
Riley, D., & Eckenrode, J. (1986). Social ties: Subgroup differences in costs and benefits. Journal of Personality and Social Psychology, 51(4), 770–778.
https://doi.org/10.1037//0022-3514.51.4.770
Ryu, S., & Fan, L. (2023). The Relationship between Financial Worries and Psychological Distress Among U.S. Adults. Journal of Family and Economic Issues, 44, 16–33.
https://doi.org/10.1007/s10834-022-09820-9
Shadare, G. A. (2022). The Governance of Nigeria’s Social Protection: The Burdens of Developmental Welfarism? Societies, 12(1), Article 20.
https://doi.org/10.3390/soc12010020
Schafer, M. H., & Vargas, N. (2016). The dynamics of social support inequality: Maintenance gaps by socioeconomic status and race? Social Forces, 94(4), 1795–1822.
https://doi.org/10.1093/sf/sow024
Samuel, L. J., Szanton, S. L., Weiss, C. O., Thorpe, R. J. Jr., Semba, R. D., & Fried, L. P. (2012). Financial Strain Is Associated with Malnutrition Risk in Community-Dwelling Older Women. Epidemiology Research International, Article 696518.
https://doi.org/10.1155/2012/696518
Schneider, M., Baron, E., Davies, T., Munodawafa, M., & Lund, C. (2018). Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis. Global Mental Health, 5, e13.
https://doi.org/10.1017/gmh.2018.1
Shamblaw, A. L., Cardy, R. E., Prost, E., & Harkness, K. L. (2019). Abuse as a risk factor for prenatal depressive symptoms: a meta-analysis. Archives of Women's Mental Health, 22, 199–213.
https://doi.org/10.1007/s00737-018-0900-8
Sherin, K. M., Sinacore, J. M., Li, X. Q., Zitter, R. E., & Shakil, A. (1998). HITS: a short domestic violence screening tool for use in a family practice setting. Family Medicine, 30(7), 508–512.
Stylianou, A. M. (2018). Economic abuse within intimate partner violence: A review of the literature. Violence and Victims, 33(1), 3–22.
https://doi.org/10.1891/0886-6708.vv-d-16-00112
Tabachnick, B. G., & Fidell, L. S. (2013). Using Multivariate Statistics (6th ed.). Pearson.
Thayer, Z. M., & Gildner, T. E. (2021). COVID-19-related financial stress associated with higher likelihood of depression among pregnant women living in the United States. American Journal of Human Biology, 33(3), e23508.
https://doi.org/10.1002/ajhb.23508
Thompson, O., & Ajayi, I. (2016). Prevalence of Antenatal Depression and Associated Risk Factors among Pregnant Women Attending Antenatal Clinics in Abeokuta North Local Government Area, Nigeria. Depression Research and Treatment, Article 4518979.
https://doi.org/10.1155/2016/4518979
Van Heyningen, T, Myer, L., Onah, M., Tomlinson, M., Field, S., & Honikman, S. (2016). Antenatal depression and adversity in urban South Africa. Journal of Affective Disorders, 203, 121–129.
http://dx.doi.org/10.1016/j.jad.2016.05.052
Van Niel, M. S., & Payne, J. L. (2020). Perinatal depression: A review. Cleveland Clinic Journal of Medicine, 87(5), 273–277.
https://doi.org/10.3949/ccjm.87a.19054
Umukoro, O. S., & Okurame, D. E. (2022). Influence of financial strain on intimate partner violence and the moderating role of employment status among wives in Nigerian military homes. Military Psychology, 35(3), 215–222.
https://doi.org/10.1080/08995605.2022.2104587
Wegbom, A. I., Edet, C. K., Ogba, A. A., Osaro, B. O., Harry, A. M., Pepple, B. G., & Fagbamigbe, A. F. (2023). Determinants of Depression, Anxiety, and Stress among Pregnant Women Attending Tertiary Hospitals in Urban Centers, Nigeria. Women, 3(1), 41–52.
https://doi.org/10.3390/women3010003
Wickham, S., Whitehead, M., Taylor-Robinson, D., & Barr, B. (2017). The effect of a transition into poverty on child and maternal mental health: a longitudinal analysis of the UK Millennium Cohort Study. The Lancet Public Health, 2(3), e141-e148.
https://doi.org/10.1016/S2468-2667(17)30011-7
Woldetensay, Y. K., Belachew, T., Biesalski, H. K., Ghosh, S., Lacruz, M. E., Scherbaum, V., & Kantelhardt, E. J. (2018). The role of nutrition, intimate partner violence and social support in prenatal depressive symptoms in rural Ethiopia: community based birth cohort study. BMC Pregnancy & Childbirth, 18, Article 374.
https://doi.org/10.1186/s12884-018-2009-5
World Bank (2020). The World Bank in Nigeria. Retrieved August 11, 2022, from
https://www.worldbank.org/en/country/nigeria
World Health Organization (2017). Depression and other common mental disorders: Global health estimates.
https://www.who.int/publications/i/item/depression-global-health-estimates
Yang, K., Wu, J., & Chen, X. (2022). Risk factors of perinatal depression in women: a systematic review and meta-analysis. BMC Psychiatry, 22, Article 63.
https://doi.org/10.1186/s12888-021-03684-3
Yenerall, J., & Jensen, K. (2021). Food Security, Financial Resources, and Mental Health: Evidence during the COVID-19 Pandemic. Nutrients, 14(1), Article 161.
https://doi.org/10.3390/nu14010161




