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Mapping a Syndemic of Psychosocial Risks During Pregnancy Using Network Analysis

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Abstract

Background

Psychosocial risks during pregnancy impact maternal health in resource-limited settings, and HIV-positive women often bear a heavy burden of these factors. This study sought to use network modeling to characterize co-occurring psychosocial risks to maternal and child health among at-risk pregnant women.

Methods

Two hundred pregnant HIV-positive women attending antenatal care in South Africa were enrolled. Measured risk factors included younger age, low income, low education, unemployment, unintended pregnancy, distress about pregnancy, antenatal depression, internalized HIV stigma, violence exposure, and lack of social support. Network analysis between risk factors was conducted in R using mixed graphical modeling. Centrality statistics were examined for each risk node in the network.

Results

In the resulting network, unintended pregnancy was strongly tied to distress about pregnancy. Distress about pregnancy was most central in the network and was connected to antenatal depression and HIV stigma. Unintended pregnancy was also associated with lack of social support, which was itself linked to antenatal depression, HIV stigma, and low income. Finally, antenatal depression was connected to violence exposure.

Conclusions

Our results characterize a network of psychosocial risks among pregnant HIV-positive women. Distress about pregnancy emerged as central to this network, suggesting that unintended pregnancy is particularly distressing in this population and may contribute to further risks to maternal health, such as depression. Prevention of unintended pregnancies and interventions for coping with unplanned pregnancies may be particularly useful where multiple risks intersect. Efforts addressing single risk factors should consider an integrated, multilevel approach to support women during pregnancy.

Trial Registration

ClinicalTrials.gov identifier: NCT03069417

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Acknowledgements

We are grateful to study participants and MatCH Research Unit staff on this project and support from the Prince Mshiyeni Memorial Hospital. We thank Jonas Haslbeck for his initial guidance on mixed graphical models. We thank Elsa Sweek for her generous submission support.

Funding

This study was funded by a National Institute of Mental Health grant (K23 MH096651) to Dr. Psaros, and Dr. Safren’s time was supported by grant K24 DA040489.

Author information

Authors and Affiliations

  1. Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA, 02114, USA

    Karmel W. Choi

  2. Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

    Karmel W. Choi, Jessica N. Coleman & Christina Psaros

  3. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Karmel W. Choi

  4. Maternal Adolescent and Child Health (MatCH) Research Unit, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, KwaZulu-Natal, South Africa

    Jenni A. Smit & Nzwakie Mosery

  5. School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa

    Jenni A. Smit & Nzwakie Mosery

  6. Department of Psychology and Neuroscience, Duke University, Durham, NC, USA

    Jessica N. Coleman

  7. Duke Global Health Institute, Duke University, Durham, NC, USA

    Jessica N. Coleman

  8. MGH Center for Global Health, Massachusetts General Hospital, Boston, MA, USA

    David R. Bangsberg

  9. School of Public Health, Oregon Health and Science University-Portland State University, Portland, OR, USA

    David R. Bangsberg

  10. Department of Psychology, University of Miami, Miami, FL, USA

    Steven A. Safren

Authors
  1. Karmel W. Choi
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  2. Jenni A. Smit
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  3. Jessica N. Coleman
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  4. Nzwakie Mosery
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  5. David R. Bangsberg
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  6. Steven A. Safren
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  7. Christina Psaros
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Corresponding author

Correspondence to Karmel W. Choi.

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The authors declare that they have no conflict of interest.

Ethical Approval

This study has been approved by the appropriate ethics committees—Ethics Committee at University of Witwatersrand (Johannesburg, South Africa) and Partners (Massachusetts General Hospital) Human Research Committee (Boston, USA)—and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Choi, K.W., Smit, J.A., Coleman, J.N. et al. Mapping a Syndemic of Psychosocial Risks During Pregnancy Using Network Analysis. Int.J. Behav. Med. 26, 207–216 (2019). https://doi.org/10.1007/s12529-019-09774-7

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