Postnatal Depression by HIV Status Among Women in Zimbabwe Dixon Chibanda, M.D., 1,2 Walter Mangezi, MBChB, 1 Mufuta Tshimanga, MBChB, 1 Godfrey Woelk, Ph.D., 1,2 Simbarashe Rusakaniko, Ph.D., 1,2 Lynda Stranix-Chibanda, MBChB, 1,3 Stanley Midzi, MBChB, 4 and Avinash K. Shetty, M.D. 5 Abstract Background: Postnatal depression (PND) is a serious public health problem in resource-limited countries. Re- search is limited on PND affecting HIV-infected women in sub-Saharan Africa. Zimbabwe has one of the highest antenatal HIV infection rates in the world. We determined the prevalence and risk factors of PND among women attending urban primary care clinics in Zimbabwe. Methods: Using trained peer counselors, a simple random sample of postpartum women (n ¼ 210) attending the 6-week postnatal visit at two urban primary care clinics were screened for PND using the Shona version of the Edinburgh Postnatal Depression Scale (EPDS). All women were subsequently subjected to mental status ex- amination using the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for major depression by two psychiatrists who had no knowledge of the EPDS test results. Results: Of the 210 mothers (31 HIV positive, 148 HIV negative, 31 unknown status) enrolled during the postpartum period, 64 (33%) met DSM-IV criteria for depression. The HIV prevalence was 14.8%. Of the 31 HIV- infected mothers, 17(54%) met DSM-IV criteria for depression. Univariate analysis showed that multiparity (prevalent odds ratio [OR] 2.22, 95% confidence intervals [CI] 1.15-4.31), both parents deceased (OR 2.35, 95% CI 1.01-5.45), and having experienced a recent adverse life event (OR 8.34, CI 3.77-19.07) were significantly asso- ciated with PND. Multivariate analysis showed that PND was significantly associated with adverse life event (OR 7.04, 95% CI 3.15-15.76), being unemployed (OR 3.12, 95% CI 1.23-7.88), and multiparity (OR 2.50, 95% CI 1.00-6.24). Conclusions: Our data indicate a high burden of PND among women in Zimbabwe. It is feasible to screen for PND in primary care clinics using peer counselors. Screening for PND and access to mental health interventions should be part of routine antenatal care for all women in Zimbabwe. Introduction P ostnatal depression (PND) is an important public health problem that affects many women globally. 1,2 The adverse consequences of PND are well documented for mothers and infants. 3 PND is associated with insecure mother-child attachment and problems in child cognitive, behavioral, and emotional development. 4 Recent studies from South Asia indicate that PND is also associated with adverse infant growth outcomes. 5,6 PND affects 10%–15% of women in resource-rich coun- tries. 7 In contrast, the prevalence of PND is higher in low- income and middle-income countries. 1 In a study from India, maternal depression was found in 23% of women at 6–8 weeks after childbirth. 8 Likewise, a South African periurban survey reported a high rate (35%) of PND. 9 Data on PND are limited in Zimbabwe. 10 In one published study on PND in Zimbabwe, the prevalence of postnatal mental disorders was 16%. 10 In that study, the investigators used the Shona Symptom Questionnaire (SSQ), an indigenous psychiatric 1 University of Zimbabwe College of Health Sciences, Harare, Zimbabwe. 2 Zimbabwe AIDS Prevention Project-University of Zimbabwe, Department of Community Medicine, Harare, Zimbabwe. 3 UZ-UCSF Collaborative Program in Women’s Health, Harare, Zimbabwe. 4 Ministry of Health and Child Welfare, Harare, Zimbabwe. 5 Wake Forest University Health Sciences, Winston-Salem, North Carolina. JOURNAL OF WOMEN’S HEALTH Volume 19, Number 11, 2010 ª Mary Ann Liebert, Inc. DOI: 10.1089=jwh.2010.2012 2071