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.