Postpartum Depression and HIV Infection Among Women in Malawi

Dow, Anna PhD*; Dube, Queen MD; Pence, Brian W. PhD*; Van Rie, Annelies MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0000000000000050
Epidemiology and Prevention

Background: HIV-infected women face several risk factors related to postpartum depression (PPD). We aimed to describe the prevalence and cumulative incidence of PPD in the low-income setting of Malawi and to determine the association between maternal and infant HIV and PPD.

Methods: This longitudinal cohort study included 156 HIV-uninfected and 373 HIV-infected Malawian women enrolled 10–14 weeks after delivery who returned at 6, 9, 12, 15, and 18 months for follow-up visits. PPD was assessed at all visits. The prevalence of PPD at all visits was estimated using the Edinburgh Postnatal Depression Scale (EPDS). Association between PPD at 10–14 weeks and maternal and infant HIV status was assessed using log binomial regression. Cumulative incidence of PPD was assessed using Kaplan–Meier curves.

Results: Prevalence of PPD was highest (11%) at 10–14 weeks postpartum and decreased to 2.9% at 18 months. There was no association between maternal HIV status and PPD (prevalence ratio, 1.18; 95% confidence interval: 0.68 to 2.08). Among HIV-infected women, prevalence of PPD was higher among women whose infants had acquired HIV (prevalence ratio, 2.0; 95% confidence interval: 1.1 to 3.6). The cumulative probability of experiencing PPD over the first 12 months postpartum was estimated to be 33.5% for HIV-infected mothers with HIV-infected infants vs. 22.5% for HIV-infected mothers with uninfected infants and 23.2% for HIV-uninfected mothers.

Conclusions: PPD prevalence did not differ between HIV-infected and -uninfected mothers but increased among women with an HIV-infected infant. Our findings suggest that it may be important to monitor PPD among women with HIV-infected infants.

Author Information

*Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC; and

Malawi-Liverpool-Wellcome Trust Clinical Research Programme, University of Malawi College of Medicine, Blantyre, Malawi.

Correspondence to: Anna Dow, PhD, Department of Epidemiology, University of North Carolina at Chapel Hill, 2104-F McGavran-Greenberg Hall, 135 Dauer Drive, Campus Box 7435, Chapel Hill, NC 27599-7435 (e-mail:

Supported by the Fogarty International Center and NICHD under Award Number R01HD053216. The Malawi-Liverpool-Wellcome Trust is supported by a core grant from the Wellcome Trust.

A.D. and A.V.R contributed to the study design, analysis, and manuscript development. Q.D. contributed to study design and manuscript development. B.P. contributed to analysis and interpretation of the data and manuscript development. All authors approved the final draft of the manuscript.

The authors declare no conflicts of interest.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Received October 25, 2013

Accepted October 25, 2013

© 2014 by Lippincott Williams & Wilkins