248 - Mental Health and Self-Efficacy in Mothers with Very Low Birthweight Infants in Zimbabwe

Publication Number: 1235.248

Allie K. Westley, University of Zimbabwe, Tiburon, CA, United States; Gwendoline Lilly. Chimhini, University of Zimbabwe, Harare, Harare, Zimbabwe; Karen N/A. Muchezana, Ingutsheni Central Hospital, Harare, Harare, Zimbabwe; Margaret Saungweme, University of Zimbabwe, Harare, Harare, Zimbabwe; Hilda Angela. Mujuru, University of Zimbabwe, Harare, Harare, Zimbabwe; Gary Darmstadt, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States

Background: Maternal mental health is an under-addressed public health concern in low- and middle-income countries (LMICs). Postpartum depression (PPD) is more prevalent in LMICs, given that many risk factors including preterm birth are exacerbated in these settings. Research is lacking on mental health in mothers with preterm and/or very low birthweight (VLBW) infants ( < 1500 grams) in LMICs.

Objective: Our primary objective was to determine the incidence proportion of PPD in mothers with VLBW infants hospitalized in the Neonatal Care Unit at Sally Mugabe Central Hospital (SMCH) in Harare, Zimbabwe, at six weeks postpartum.

Design/Methods: We conducted a descriptive, prospective cohort study to understand baseline rates of postpartum depression (PPD) [Edinburgh Postnatal Depression Scale (EPDS) ≥12] and anxiety [Generalized Anxiety Disorder 7-item scale (GAD-7) ≥10] in mothers with VLBW infants who survived the early neonatal period at the Sally Mugabe Central Hospital Neonatal Care Unit in Harare from March to October 2025. Secondary outcomes included maternal self-efficacy, social support, and perceived stress from the NICU experience. Mothers were screened at discharge (if the hospital stay was < 6 weeks) and 6 weeks postpartum.

Results: Nearly one-third (28 of 93, 30.1%) of mothers ever screened positive for PPD, of which 14/82 (17.1%) and 19/93 (20.4%) screened positive for PPD at hospital discharge and at six weeks postpartum, respectively. Five of the 14 who screened positive at discharge screened positive again at 6 weeks. Rates of anxiety were lower: 8.5%, 11.8%, and 16.1% at six weeks, hospital discharge, and period prevalence, respectively. Preliminary analysis shows no relationship between maternal self-efficacy and PPD at hospital discharge or six weeks postpartum. Perceived NICU stress was associated with PPD only at hospital discharge (p=0.0084), whereas low levels of social support were associated with PPD only at six weeks (p=0.0008).

Conclusion(s): Preliminary findings demonstrate a high burden of PPD in mothers of hospitalized VLBW infants in Zimbabwe. Factors associated with PPD may be time-dependent, with different stressors, suggesting that addressing mental health concerns in this population may require screening and intervention at strategic time points and contexts in the postpartum period.

Table 1. Prevalence of Postpartum Depression and Anxiety at Hospital Discharge and Six Weeks Postpartum
Prevalence of postpartum depression (EPDS ≥12) and anxiety (GAD-7≥10) at hospital discharge and six weeks postpartum for mothers with VLBW infants. McNemar's paired test was used to determine if there was a significant change in PPD or PPA prevalence between hospital discharge and six weeks.

Table 2. Individual Postpartum Depression Screening Status Across Time Points (Hospital Discharge vs. Six Weeks Postpartum)
This table shows the cross-tabulation of how participants' PPD screening status (positive vs. negative) changed between the two time points measured (hospital discharge and six weeks postpartum). Eleven participants were only screened at six weeks given that they were still admitted at this point.

Table 3. Associations Between Postpartum Depression and Secondary Outcomes (Self-Efficacy, Social Support, & Perceived Stress) at Hospital Discharge and Six Weeks
Associations presented between postpartum depression and other psychosocial measures. Maternal self-efficacy, social support, and perceived stress from the NICU experience were assessed using the Perceived Maternal Parenting Self-Efficacy (PMP S-E tool), the Multidimensional Scale of Perceived Social Support (MSPSS), and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU), respectively. Variables are presented as mean (SD) or median [IQR] depending on the distribution.