Antenatal depression and associated obstetric and psychosocial factors among pregnant women attending the public health clinics in Malaysia

BACKGROUND: Antenatal depression is a common but under reported complication of pregnancy and childbirth, particularly in low and middle-income settings. This study aimed to estimate the prevalence of antenatal depressive symptoms and identify associated obstetric and psychosocial factors among antenatal women attending public health clinics. METHODS: A multi-centre cross-sectional study was conducted in public health clinics. Participants completed self-administered questionnaire on sociodemographic characteristics, obstetric history and psychosocial factors. Depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) with a score ≥ 12 was used to indicate probable antenatal depression. Data were analysed using R Software version 4.5.2. RESULTS: A total of 572 women were included in the analysis, and prevalence of antenatal depression was 9.6%. In the multiple logistic regression adjusted for age, education, race and household income, antenatal depression was independently associated with unplanned pregnancy ( aOR 2.20, 95% CI 1.03 - 5.02), exposure to stressful event ( aOR 2.99, 95% CI 1.42 - 6.27), present of depressive symptoms in the past two weeks ( aOR 8.25, 95% CI 3.47 - 19.94) and self-perceived present of high worries ( aOR 4.56, 95% CI 1.84 - 13.18). Perceived maternal emotional support during upbringing was protective ( aOR 0.16, 95% CI 0.05 - 0.53). CONCLUSION: Around one in ten women were screened positive for probable antenatal depression which was associated with unplanned pregnancy, stressful life events, recent depressive symptoms and high worry, while maternal emotional support from upbringing was protective. Finding support routine brief mental health screening practices that also considers other symptoms such as anxiety to improve case-finding and guide targeted support for women at higher risk, alongside interventions that build supportive relationships and break intergenerational cycles of distress.