Course of perinatal depressive symptoms among South African women: associations with child outcomes at 18 and 36 months

Emily Claire Garman*, Annibale Cois, Mark Tomlinson, Mary Jane Rotheram-Borus, Crick Lund

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

26 Citations (Scopus)
37 Downloads (Pure)


Purpose: Latent modelling was used to identify trajectories of depressive symptoms among low-income perinatal women in South Africa. Predictors of trajectories and the association of trajectories with child outcomes were assessed. 
Methods: This is a secondary analysis of data collected among women living in Cape Town settlements (N=446). Participants were eligible if pregnant and 18 years or older, and included in the analysis if allocated to the control arm (routine perinatal care). Participants were excluded in case of non-singleton birth and baby death. Follow-up assessments were at 2 weeks, 6-, 18-, and 36-month postpartum. Trajectories of depressive symptoms were based on the Edinburgh Postnatal Depression Scale scores until 18-month postpartum, using latent class growth analysis. Child physical, cognitive, socioemotional, and behavioural outcomes were assessed at 18 and/or 36 months. Univariate and multivariate regressions were used to identify predictors of trajectories and differences in child outcomes. 
Results: Four trajectories were identified: chronic low (71.1%), late postpartum (10.1%), early postpartum (14.4%), and chronic high (4.5%). Low social support, unwanted pregnancy, and risky drinking were associated with the chronic high trajectory; unemployment and HIV-positive status with the early postpartum trajectory; and intimate partner violence with the late postpartum trajectory. Weight-to-length and weight-for-age z-scores at 18 months, and weight-for-age z-scores, length-for-age z-scores, emotional symptom, and peer problem scores at 36 months differed across trajectories. 
Conclusions: Severe depressive symptoms in postpartum period have a lasting effect on child physical and socio-emotional outcomes. Multiple screening throughout pregnancy and 1-year postpartum is essential
Original languageEnglish
Pages (from-to)1111-1123
JournalSocial Psychiatry and Psychiatric Epidemiology
Issue number9
Early online date25 Feb 2019
Publication statusPublished - 01 Sept 2019
Externally publishedYes

Bibliographical note

Funding Information:
We would like to acknowledge Dr. Sujit Rathod, who provided insights into post-hoc analyses, and Ellen Almirol for providing support with access to the study materials and datasets. This study is an output of the PRogramme for Improving Mental health carE (PRIME). This work was supported by the UK Department for International Development (201446). The views expressed do not necessarily reflect the UK Government?s official policies.

Publisher Copyright:
© 2019, The Author(s).


  • Child development
  • Depression
  • Latent class growth analysis
  • Perinatal
  • Trajectories

ASJC Scopus subject areas

  • Epidemiology
  • Health(social science)
  • Social Psychology
  • Psychiatry and Mental health


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