Interpretations
Our results indicate there were no significant associations between antenatal depression and anxiety and early pregnancy BMI within this population. There is limited literature on the association between maternal BMI and depression and anxiety in the UK, with one study also showing no significant association in either mental health condition.28 However, meta-analysis4of studies across international, mainly high-income, settings showed significantly increased odds of depression during pregnancy among women with overweight and obese BMIs, compared with women of recommended BMI. It also found significantly increased odds of anxiety in women with obesity, compared with women of recommended BMI, but no significant association for overweight.4
The difference in statistical significance of the results between this study and the meta-analysis4 could be due the outcome measurement tool. The GHQ was not used in any of the studies included in the meta-analysis4 which mostly used either the Centre for Epidemiological Studies Depression Scale (CES-D)29,30 or EPDS31,32 for depression and The State-Trait Anxiety Inventory (STAI) for anxiety.30 This can introduce variation in the classification of depression and anxiety between this study and other literature.
In this study, depression rates are higher in South Asian women compared with White British, whereas, anxiety rates are lower. Gater et al33 found that depressive disorder was more common in Pakistani women compared with White women. Mckenzie et al34 found higher rates of suicide among older South Asian women, compared to White women. In relation to anxiety, there is a lack of published literature examining rates of anxiety within South Asian women in the UK. However, Weich et al35 found that rates of common mental disorders (anxiety and depression) were higher in Pakistani women compared to White women of similar age. The contradicting results for anxiety may be partly methodological, since Weich et al35 used the Revised Clinical Interview Schedule (CIS-R), whereas, this study used the GHQ which is not recommended for epidemiological assessment in South Asian women23. It may also be explained by the study settings, this study was set in Bradford which has a high density of South Asian’s. These large social networks have been shown to be beneficial for mental health due to feelings of shared identity and provision of support36. Therefore, in this study population, general anxiety symptoms may be managed by these large social networks among South Asian women.
Smoking during pregnancy has been associated with increased antenatal depression and anxiety in the literature.37,38 This may be due to the negative impact of nicotine on psychiatric symptoms38 but also related to increased guilt for not being able to quit and health concerns for the baby.38Although this study found that less South Asian women smoke during pregnancy, the impact of smoking tends to be higher among South Asian women due to cultural and religious stigma attached to it39. This could play a role in higher depression rates found in South Asian women.
Lack of education has been shown to be a risk factor for antenatal depression in many studies.40,41,42 However, in a study of South Asian women, it reduced antenatal anxiety and depression43 which is also highlighted in this study. This could be explained by gender roles in South Asian culture in which women are expected to be more involved in taking care of the family than earning money or getting educated44. Therefore, South Asian women with less education tend to be more accepted by their in-laws as they fulfil their roles and responsibilities within the family. This may reduce the amount of stress and conflict within the family.