Prevalence of Stress, Depression, Alcohol Use, and Social Support among HIV Infected and Uninfected Pregnant Women in Uganda

Background: Psychosocial factors are an important area to assess during pregnancy. Studies demonstrate that stress, depression, alcohol use, and lack of social support during pregnancy are commonly associated with low birth weight and perinatal mortality and morbidity. This may be more marked in communities with low social economic status. In this era of the HIV/AIDS pandemic, psychosocial problems are common among affected populations. These issues may have indirect influence through affecting antenatal care attendance, coping capacity, and adherence to medication; or directly affect the physiology of pregnancy. Methods: This was a cross-sectional analysis (n=610) of the data from a survey of pregnant women conducted in Uganda from June to October 2006. The Brief Evaluation of Perceived Stress Instrument (BEPSI), Social support ISEL-12 and Edinburgh Depression Scales were translated into Luganda and used. Descriptive and correlation statistics are reported. Reliability and factor analysis were utilized to assess instrument psychometrics. Results: Demographics of the study population are described. Nearly 9% were HIV positive. There was a significant difference between HIV positive and negative participants on age, educational, marital status and religion (p<0.05). 34.4% of the participants had a history of alcohol consumption prior to pregnancy. HIV positive participants had significantly higher odds of ever used alcohol (OR 2.21). The Edinburgh scale and BEPSI scale had good internal reliability in the Ugandan setting with Cronbach's alpha of 0.76 and 0.81 respectively. The ISEL-12 scale for social support had a Cronbach's alpha of 0.60. The prevalence of depressive symptoms was 31%. Being HIV positive was significantly associated with depression (OR 2.64, 95%CI 1.4, 4.84) The HIV positive participants reported higher stress than the HIV negative participants (p<0.001). Social support was not associated with HIV status. Stress and depression were highly correlated (r=0.49, p< 0.001). The relationship between stress, depression, and alcohol use will also be examined. Conclusion: Psychosocial problems in pregnant women were common and associated with HIV status. This research has important implications for women and health care providers in Uganda. Education and counseling prior to and during pregnancy may have an effect on pregnancy outcomes.