Perinatal Depression in Rural Kenya and the Associated Risk and Protective Factors: A Prospective Cohort Study Before and During the COVID-19 Pandemic

Background: Perinatal depression is a common mental disorder and a significant contributor to maternal and child morbidity and mortality. There is, however, a paucity of data on the incidence of perinatal depression, reflecting a lack of priority, screening, and mental health services capacity in many low- and middle-income countries. This study aimed to estimate the prevalence of perinatal depression and risk and protective factors in rural Kakamega, Kenya, in the context of the COVID-19 pandemic. Methods: The mixed-method study consisted of (i) longitudinal quantitative data collected from October 2019 to May 2021 of 135 pregnant and postpartum women aged 15–49 years who screened for depression monthly using the Edinburgh Postnatal Depression Scale (EPDS), and (ii) an ethnographic study conducted from March to July 2022 in which 20 women provided detailed insights into the risk and protective factors of perinatal depression. Bivariate and logistic regression evaluated the association between socioeconomic status, clinical and psychosocial variables, and perinatal depression. The ethnographic study aimed to describe the factors associated with maternal depression and provide detailed descriptions of risk and protective factors. Results: The cumulative prevalence of perinatal depression was 11%. Depression symptoms were reported in 7% of pregnant women and 13% of mothers. During COVID-19, the odds of depression increased with maternal complications (aOR = 7.05, 95% CI 1.66–29.94) and financial stress (aOR = 1.40, 95% CI 0.66–2.98). Live birth outcomes reduced the odds of depression (aOR 0.03, 95% CI 0.002–0.73). Risk factors included health and healthcare challenges, lack of spousal and social support, intimate partner violence, and financial difficulties. Protective factors included adequate spousal and social support and access to economic resources, including digital platforms for soft loans and income hiding. Conclusion: One in seven women experienced perinatal depressive symptoms. The increase in depression during the COVID-19 pandemic is indicative of the need for (i) financial and social safety nets to cushion perinatal women during emergencies, (ii) integration of depression screening into healthcare, and establishing confidential pathways for psychosocial support.