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Prevalence of antenatal depression in South Asia: a systematic review and meta-analysis
  1. Rahini Mahendran1,
  2. Shuby Puthussery2,
  3. Mahendran Amalan3
  1. 1 Smile Train Project, Faculty of Dental Sciences, University of Peradeniya, Peradeniya, Sri Lanka
  2. 2 Maternal and Child Health Research Centre, University of Bedfordshire, Luton, UK
  3. 3 Department of Statistics and Computer Science, Faculty of Science, University of Peradeniya, Peradeniya, Sri Lanka
  1. Correspondence to Dr Shuby Puthussery, Maternal and Child Health Research Centre, University of Bedfordshire, Luton, Bedfordshire, UK; shuby.puthussery{at}


Objective To estimate the prevalence of antenatal depression in South Asia and to examine variations by country and study characteristics to inform policy, practice and future research.

Methods We conducted a comprehensive search of 13 databases including international databases and databases covering scientific literature from South Asian countries in addition to Google Scholar and grey sources from 1 January 2007 to 31 May 2018. Studies reporting prevalence estimates of antenatal depression using a validated diagnostic/screening tool were identified, screened, selected and appraised. Primary outcome was proportion (%) of pregnant women identified as having antenatal depression.

Results Thirty-three studies involving 13 087 pregnant women were included in the meta-analysis. Twelve studies were rated as high quality and 21 studies were of moderate quality. Overall pooled prevalence of antenatal depression was 24.3 % (95% Confidence Interval (CI) 19.03 to 30.47). Studies showed a high degree of heterogeneity (I2=97.66%) and evidence of publication bias (p=0.668). Prevalence rates for India (17.74%, 95% CI 11.19 to 26.96) and Sri Lanka (12.95%, 95% CI 8.29 to 19.68) were lower compared with the overall prevalence, whereas prevalence rates for Pakistan (32.2%, 95% CI 23.11 to 42.87) and Nepal (50%, 95% CI 35.64 to 64.36) were higher.

Conclusions While robust prevalence studies are sparse in most South Asian countries, available data suggest one in four pregnant women is likely to experience antenatal depression in the region. Findings highlight the need for recognition of the issue in health policy and practice and for resource allocation for capacity building at regional and national levels for prevention, diagnosis and treatment.

  • antenatal depression
  • systematic review
  • meta-analysis
  • maternal health
  • South Asia

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  • RM and SP contributed equally.

  • Contributors RM and SP designed the study and SP oversaw its implementation. RM did the searches, study selection, and RM and SP did the data extraction and quality appraisal. MA developed and conducted the meta-analyses and developed the tables. RM and SP wrote the manuscript. All authors reviewed and approved the final draft of the manuscript before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Institute for Health Research Ethics Committee at the University of Bedfordshire.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement As this is a systematic review and meta-analysis, the data used in the study have already been published by the authors of the included studies. Further information can be obtained from the corresponding author.