"Pain in my heart": Understanding perinatal depression among women living with HIV in Malawi

• Published in: PloS one 2020-06, Vol.15 (6), p.e0227935-e0227935
• Main Authors: LeMasters, Katherine, Dussault, Josée, Barrington, Clare, Bengtson, Angela, Gaynes, Bradley, Go, Vivian, Hosseinipour, Mina C, Kulisewa, Kazione, Kutengule, Anna, Meltzer-Brody, Samantha, Midiani, Dalitso, Mphonda, Steve, Udedi, Michael, Pence, Brian
• Format: Article
• Language: English
• Subjects: Adult; Biology and Life Sciences; Care and treatment; Data collection; Depression (Mood disorder); Depression - complications; Diseases; Drug therapy; Epidemiology; Female; Health aspects; Health screening; Heart; HIV; HIV Infections - psychology; HIV patients; HIV tests; Human immunodeficiency virus; Humans; Interviews; Low income groups; Malawi; Maternal & child health; Maternal health services; Medical diagnosis; Medicine; Medicine and health sciences; Mental depression; Mental disorders; Mental health; Narratives; Pain; Population; Postpartum depression; Postpartum period; Pregnancy; Pregnancy Complications, Infectious - psychology; Prenatal depression; Psychological aspects; Public health; Qualitative analysis; Risk factors; Setting (Literature); Social interactions; Social support; Suicidal behavior; Surveys and Questionnaires; Women; Women patients; Womens health
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0227935

Perinatal depression (PND) can interfere with HIV care engagement and outcomes. We examined experiences of PND among women living with HIV (WLWH) in Malawi. We screened 73 WLWH presenting for perinatal care in Lilongwe, Malawi using the Edinburgh Postnatal Depression Scale (EPDS). We conducted qualitative interviews with 24 women experiencing PND and analyzed data using inductive and deductive coding and narrative analysis. Women experienced a double burden of physical and mental illness, expressed as pain in one's heart. Receiving an HIV diagnosis unexpectedly during antenatal care was a key contributor to developing PND. This development was influenced by stigmatization and social support. These findings highlight the need to recognize the mental health implications of routine screening for HIV and to routinely screen and treat PND among WLWH. Culturally appropriate mental health interventions are needed in settings with a high HIV burden.