Cultural and Social Factors Associated with Generalized Anxiety Disorder Among Adolescent Mothers During the Postpartum Period in Malawi: a Cross-sectional Survey

Overview

Journal BMC Glob Public Health

Specialty Public Health

Date 2024 Dec 16

PMID 39681924

Authors

Chimwemwe Tembo

Linda Portsmouth

Sharyn Burns

Affiliations

Soon will be listed here.

Abstract

Background: The postnatal period is an important time for adolescent mothers to regain their health as they adjust to life with their infants. However, it is also a time when mothers are vulnerable to mental health problems. Generalized anxiety disorders (GADs) are among the common mental disorders that can impact mothers. Anxiety disorders can have adverse effects on a child's cognitive development. However, there is a scarcity of studies pertaining to anxiety disorders among adolescent mothers in Malawi.

Methods: A cross-sectional survey was conducted among adolescent postnatal mothers aged ≤ 19 years to establish the prevalence of probable GAD and identify cultural and social factors that influence anxiety in this population. Adolescent mothers were recruited from the Mitundu Rural Hospital catchment area in Lilongwe district, Malawi. A two-stage random sampling method was employed: clinics were randomly selected, and participants were recruited via systematic random sampling. The Generalized Anxiety Disorder (GAD-7) scale was used to assess anxiety. Data were analyzed using SPSS version 27.

Results: Of the 395 adolescent mothers who participated, 34% were aged 14-17. The prevalence of probable GAD (GAD-7 ≥ 10) was 31.9%. Increased social support decreased the odds of probable GAD (aOR 0.95, 95% CI: 0.91-0.98, p < 0.001). Experiencing intimate partner violence (IPV) increased the likelihood of probable GAD (aOR 4.80, 95% CI: 1.23-18.82, p = 0.02), while those who had contact with a health worker postnatally (aOR 0.38, 95% CI: 0.17-0.83, p = 0.02) and those who were "not prayerful" (aOR, 0.43, 95% CI: 0.21-0.87, p = 0.02) were less likely to report probable GAD.

Conclusions: Given that the prevalence of probable GAD among adolescent mothers in Malawi is higher compared to the global estimates of their peers, policies and guidelines that prioritize the maternal mental health of adolescent mothers in Malawi are required. The findings also highlight the importance of enhancing social support among family and community. Co-designed mental health promotion, prevention, and early interventions to involve health workers and religious leaders are recommended.

Citing Articles

COVID-19 prevention strategies and compliance among postnatal adolescent mothers with postnatal depression and generalised anxiety in rural Malawi: a cross-sectional study.

Tembo C, Burns S, Portsmouth L BMJ Open. 2025; 15(2):e093624.

PMID: 39929511 PMC: 11815402. DOI: 10.1136/bmjopen-2024-093624.

References

van der Zee-van den Berg A, Boere-Boonekamp M, Groothuis-Oudshoorn C, Reijneveld S . Postpartum depression and anxiety: a community-based study on risk factors before, during and after pregnancy. J Affect Disord. 2021; 286:158-165. DOI: 10.1016/j.jad.2021.02.062. View

Fairbrother N, Corbyn B, Thordarson D, Ma A, Surm D . Screening for perinatal anxiety disorders: Room to grow. J Affect Disord. 2019; 250:363-370. DOI: 10.1016/j.jad.2019.03.052. View

Paine Hughes L, Austin-Ketch T, Volpe E, Campbell-Heider N . Identification and Treatment of Adolescents With Perinatal Anxiety and Depression. J Psychosoc Nurs Ment Health Serv. 2017; 55(6):23-29. DOI: 10.3928/02793695-20170519-03. View

Kumar M, Huang K, Othieno C, Wamalwa D, Madeghe B, Osok J . Adolescent Pregnancy and Challenges in Kenyan Context: Perspectives from Multiple Community Stakeholders. Glob Soc Welf. 2018; 5(1):11-27. PMC: 5937539. DOI: 10.1007/s40609-017-0102-8. View

Hinton D . Multicultural challenges in the delivery of anxiety treatment. Depress Anxiety. 2012; 29(1):1-3. DOI: 10.1002/da.20889. View

Misri S, Abizadeh J, Sanders S, Swift E . Perinatal Generalized Anxiety Disorder: Assessment and Treatment. J Womens Health (Larchmt). 2015; 24(9):762-70. PMC: 4589308. DOI: 10.1089/jwh.2014.5150. View

Morales-Munoz I, Ashdown-Doel B, Beazley E, Carr C, Preece C, Marwaha S . Maternal postnatal depression and anxiety and the risk for mental health disorders in adolescent offspring: Findings from the Avon Longitudinal Study of Parents and Children cohort. Aust N Z J Psychiatry. 2022; 57(1):82-92. PMC: 9791327. DOI: 10.1177/00048674221082519. View

Atilola O . Child mental-health policy development in sub-Saharan Africa: broadening the perspectives using Bronfenbrenner's ecological model. Health Promot Int. 2014; 32(2):380-391. DOI: 10.1093/heapro/dau065. View

Yurdakul M . Perceived social support in pregnant adolescents in Mersin area in Turkey. Pak J Med Sci. 2018; 34(1):115-120. PMC: 5856994. DOI: 10.12669/pjms.341.14221. View

10.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

11.

Peter P, de Mola C, de Matos M, Coelho F, Pinheiro K, da Silva R . Association between perceived social support and anxiety in pregnant adolescents. Braz J Psychiatry. 2016; 39(1):21-27. PMC: 7112740. DOI: 10.1590/1516-4446-2015-1806. View

12.

Dennis C, Falah-Hassani K, Shiri R . Prevalence of antenatal and postnatal anxiety: systematic review and meta-analysis. Br J Psychiatry. 2017; 210(5):315-323. DOI: 10.1192/bjp.bp.116.187179. View

13.

Simpson W, Glazer M, Michalski N, Steiner M, Frey B . Comparative efficacy of the generalized anxiety disorder 7-item scale and the Edinburgh Postnatal Depression Scale as screening tools for generalized anxiety disorder in pregnancy and the postpartum period. Can J Psychiatry. 2014; 59(8):434-40. PMC: 4143300. DOI: 10.1177/070674371405900806. View

14.

Bert S . The influence of religiosity and spirituality on adolescent mothers and their teenage children. J Youth Adolesc. 2010; 40(1):72-84. DOI: 10.1007/s10964-010-9506-9. View

15.

Fontoura F, Cardoso M, Rodrigues S, de Almeida P, Carvalho L . Anxiety of mothers of newborns with congenital malformations in the pre- and postnatal periods. Rev Lat Am Enfermagem. 2018; 26:e3080. PMC: 6248767. DOI: 10.1590/1518-8345.2482.3080. View

16.

De Sousa Machado T, Chur-Hansen A, Due C . First-time mothers' perceptions of social support: Recommendations for best practice. Health Psychol Open. 2020; 7(1):2055102919898611. PMC: 7008558. DOI: 10.1177/2055102919898611. View

17.

Swift E, Pierce M, Hope H, Osam C, Abel K . Young women are the most vulnerable to postpartum mental illness: A retrospective cohort study in UK primary care. J Affect Disord. 2020; 277:218-224. DOI: 10.1016/j.jad.2020.08.016. View

18.

Furtado M, Chow C, Owais S, Frey B, Van Lieshout R . Risk factors of new onset anxiety and anxiety exacerbation in the perinatal period: A systematic review and meta-analysis. J Affect Disord. 2018; 238:626-635. DOI: 10.1016/j.jad.2018.05.073. View

19.

Kohler I, Payne C, Bandawe C, Kohler H . The Demography of Mental Health Among Mature Adults in a Low-Income, High-HIV-Prevalence Context. Demography. 2017; 54(4):1529-1558. PMC: 5640263. DOI: 10.1007/s13524-017-0596-9. View

20.

Shlomi Polachek I, Huller Harari L, Baum M, Strous R . Postpartum anxiety in a cohort of women from the general population: risk factors and association with depression during last week of pregnancy, postpartum depression and postpartum PTSD. Isr J Psychiatry Relat Sci. 2014; 51(2):128-34. View