Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings
Abstract
:1. Background
2. Methods
2.1. Study Design
2.2. Predictor Selection
2.3. Model Building Strategy
- Core emotional symptoms: depressed mood, anhedonia, loss of appetite, psychic anxiety, and somatic anxiety.
- Somatic symptoms: loss of weight, psychomotor retardation, hypochondriasis, suicidal ideation, and somatic symptoms.
- Insomnia symptoms: early, middle, and late insomnia.
- Atypical symptoms: hypersomnia, hyperphagia, and weight gain.
2.4. Internal Validity
2.5. Utility of Prognostic Tool
2.6. Sample Size Calculation
3. Results
4. Discussion
5. Implications for Future Practice
6. Strengths and Limitations
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Disclaimer
References
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Characteristics | Subgroup | Mean (SD) | Frequency | Percentage |
---|---|---|---|---|
Outcome | ||||
Perinatal women with depression post-intervention assessed using the DSM-IV criteria | Enhanced Usual Care | 211 | 52.8% | |
Thinking Healthy Program | 97 | 23.2% | ||
Maternal demographic characteristics | ||||
Mother age at baseline | 26.74 (5.11) | |||
Maternal education level | 4.06 (4.011) | |||
Paternal education level | 7.02 (3.965) | |||
Socioeconomic condition | ||||
Socioeconomic class | Richest | 12 | 1.3% | |
Rich | 81 | 9.0% | ||
Normal | 343 | 38.0% | ||
Poor | 270 | 29.9% | ||
Poorest | 197 | 21.8% | ||
Household debt | No | 371 | 41.1% | |
Yes | 529 | 58.6% | ||
Not reported | 3 | 0.3% | ||
Sufficient money for food | No | 120 | 13.3% | |
Yes | 783 | 86.7% | ||
Sufficient money for basic needs | No | 189 | 20.9% | |
Yes | 714 | 79.1% | ||
Financial Empowerment | Not empowered | 425 | 47.1% | |
Empowered | 478 | 52.9% | ||
Family structure | ||||
Parity | 0 | 171 | 18.9% | |
1 to 3 | 520 | 57.6% | ||
More than 4 | 212 | 23.5% | ||
Family structure | Nuclear | 373 | 41.3% | |
Joint | 530 | 58.7% | ||
Living with mother or mother-in-law | No | 451 | 49.9% | |
Maternal | 59 | 6.5% | ||
Paternal | 393 | 43.5% | ||
Perceived levels of social support | 45.04 (16.44) | |||
Clinical profile | ||||
Hamilton depression scores at baseline | 14.63 (4.09) | |||
Chronicity (months) | 5.15 (9.08) | |||
Disability scores (BDQ) | 8.21 (2.69) | |||
Global assessment of functioning (GAF) | 62.05 (5.22) | |||
Insomnia symptom dimension of HDRS | 2.33 (1.81) | |||
Somatic symptom dimension of HDRS | 2.47 (1.47) | |||
Core emotional symptoms dimension of HDRS | 8.37 (.65) | |||
Atypical symptoms dimension of HDRS | 0.17 (0.57) | |||
Major perinatal life events | ||||
Child death | None | 518 | 57.4% | |
Yes | 385 | 42.6% | ||
Still birth | None | 607 | 67.2% | |
Yes | 296 | 32.8% | ||
Treatment | ||||
Enhanced Usual Care | 440 | 48.7% | ||
Thinking Healthy Program | 463 | 51.3% |
Variables | Coefficients | Robust S.E. | Coefficients Adjusted for Optimism | z | Predictor Importance | p | 95% CI |
---|---|---|---|---|---|---|---|
Socioeconomic class | 0.1495407 | 0.0909545 | 0.139072851 | 1.64 | 6 | 0.1 | (−0.0287269 to 0.3278083) |
Maternal empowerment | −0.4992032 | 0.1969697 | −0.464258976 | −2.53 | 3 | 0.011 | (−0.8852568 to −0.1131496) |
Living with mother or mother-in-law | |||||||
Maternal | −0.0800688 | 0.3280223 | −0.074463984 | −0.24 | 4 | 0.807 | (−0.7229807 to 0.5628432) |
Paternal | −0.4495611 | 0.2246094 | −0.418091823 | −2 | 0.045 | (−0.8899834 to −0.009388) | |
Family structure | −0.1090834 | 0.230452 | 0.101447562 | −0.47 | 7 | 0.64 | (−0.5607609 to 0.3425942) |
Symptom dimensions of depression | |||||||
Core emotional symptoms | 0.1402178 | 0.0332881 | 0.130402554 | 4.21 | 2 | <0.001 | (0.0749744 to 0.2054612) |
Insomnia | 0.1261017 | 0.0478054 | 0.117274581 | 2.64 | 5 | 0.008 | (0.0324048 to 0.2197985) |
Atypical symptoms | 0.0794525 | 0.1272977 | 0.073890825 | 0.62 | 8 | 0.533 | (−0.1700464 to 0.3289514) |
Treatment | −1.4283 | 0.208072 | −1.328319 | −6.86 | 1 | <0.001 | (−1.836114 to −0.2638574) |
Constant | −1.372766 | 0.5657802 | −1.31 | −2.43 | 0.015 | (−2.481675 to −0.2638574) | |
Linear predictor = −0.61 (SD 0.98); Linear predictor adjusted for optimism = −0.599 (0.91) |
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Waqas, A.; Sikander, S.; Malik, A.; Atif, N.; Karyotaki, E.; Rahman, A. Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings. J. Pers. Med. 2022, 12, 1046. https://doi.org/10.3390/jpm12071046
Waqas A, Sikander S, Malik A, Atif N, Karyotaki E, Rahman A. Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings. Journal of Personalized Medicine. 2022; 12(7):1046. https://doi.org/10.3390/jpm12071046
Chicago/Turabian StyleWaqas, Ahmed, Siham Sikander, Abid Malik, Najia Atif, Eirini Karyotaki, and Atif Rahman. 2022. "Predicting Remission among Perinatal Women with Depression in Rural Pakistan: A Prognostic Model for Task-Shared Interventions in Primary Care Settings" Journal of Personalized Medicine 12, no. 7: 1046. https://doi.org/10.3390/jpm12071046