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  • Systematic Review
  • Open access
  • Published:

Common mental disorders and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis

BMC Psychiatry volume 25, Article number: 430 (2025) Cite this article

Abstract

Background

Common mental disorders are the most common public health problems, especially in low and middle-income countries. The burden is high among pregnant women. However, the concern given to this problem is less and isn’t assessed during the antenatal period. In Ethiopia, there was no summarized evidence about the problem in this particular population. Therefore, this systematic review and meta-analysis aimed to assess the pooled magnitude of common mental disorders among pregnant mothers and their associated factors in Ethiopia.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to write this review and meta-analysis. Only primary studies published in English were included. The Egger’s test and funnel plot were done to assess the publication bias Heterogeneity was assessed by I2 and subgroup analysis was conducted to identify the source. A random effect model was used to perform the analysis. An association was declared with a pooled adjusted odds ratio with 95% CI.

Result

A total of 11 studies were included and the pooled magnitude of common mental disorders was 27.00 [95% CI: 20.47, 33.53]. Unplanned pregnancy [pooled AOR: 2.82 with 95% CI (2.23, 3.58)], intimate partner violence [pooled AOR: 2.81 with 95% CI (2.29, 3.46), substance use [pooled AOR: 2.97 with 95% CI (2.29, 3.85)], chronic disease [pooled AOR: 3.60; 95% CI (2.19, 5.91)], obstetric complications [pooled AOR: 2.78 with 95% CI (1.89, 4.07)] and family history of psychiatric illness [pooled AOR: 4.03 with 95% (2.58, 6.30)] were significant predictors for common mental disorders.

Conclusion

In this meta-analysis, the pooled magnitude of common mental disorders was high as compared to the global report. Substance use, chronic disease, unplanned pregnancy, intimate partner violence, having a history of obstetric complications, and a family history of psychiatric illness were significantly associated with common mental disorders. The Federal Ministry of Health should design a strategy that helps to assess the mental health of pregnant women during their antenatal care follow-up. Moreover, healthcare providers should focus on and support pregnant women who have the above factors.

Peer Review reports

Background

Depression, anxiety, and physical symptoms that are not explained by medicine are all included under the umbrella term “common mental disorders” (CMD) [1]. It is among the top ten global causes of disease burden [2]. The percentage of daily adjusted life years (DALYs) linked to mental disorders also rose from 3.1% (95% UI 2.4–3.9) to 4.9% (3.9–6.1) [2].

Globally, 970 million, or one in every eight individuals suffered from CMD in 2019; the most prevalent conditions were anxiety and depressive disorders [3]. The burden is worse in low- and middle-income countries (LMICs), with approximately 80% of all people living with CMD residing in this region [4]. Nonetheless, CMD in low- and middle-income countries (LMICs) is a neglected public health issue that significantly increases the morbidity and mortality rates of mothers and newborns [5]. CMD is more common in women especially during pregnancy [6, 7]; it ranges from 12 to 43% [8, 9].

Pregnancy-related CMD increases cortisol levels in mothers, decreases antenatal care service-seeking behavior, causes postnatal psychosis, and has detrimental social, economic, and psychological effects on affected people, their families, and the community [10,11,12]. Moreover, it is linked to low neurodevelopmental outcomes, premature birth, hypoglycemia in neonates, placental malformations, small-for-gestational-age fetuses, and stillbirth [13].

Previous studies have reported unplanned pregnancy [14], intimate partner violence [15,16,17], husband’s educational status [14], substance use [18, 19], absence of support [20], poor nutrition and self-care [14, 21], low socioeconomic status [15], and marital status [22] as factors associated with CMD during pregnancy.

To decrease the burden of CMD, the World Health Organization (WHO) designed a comprehensive mental health action plan from 2013 to 2030 [23]. By promoting mental health and well-being, Sustainable Development Goal Objective 3.4 aims to reduce premature death from non-communicable diseases by one-third by 2030 [24]. Moreover, LMICs such as Ethiopia designed national strategies to strengthen efforts to meet prevailing mental health needs [23].

However, CMD among pregnant mothers remains a neglected public health problem, especially in developing countries such as Ethiopia [12]. In Ethiopia, CMD is not assessed during pregnancy, and the national demographic and health survey does not include maternal mental status as an expected health outcome, and there is no national data on this problem [25]. Moreover, primary studies conducted nationwide reported a varied magnitude of CMD, ranging from 12 [26] to 46.6% [27].

In Ethiopia, where access to mental health resources may be limited, CMD among pregnant mothers remains unclear and underestimated [28]. Therefore, it is vital to understand the pooled magnitude of CMD among pregnant women and the factors that contribute to these conditions. Therefore, we aimed to assess the pooled magnitude of CMD and its associated factors in pregnant mothers in Ethiopia.

Research questions

What is the pooled magnitude of CMD among pregnant women in Ethiopia?

What factors are associated with CMD among pregnant women in Ethiopia?

Methods

In conducting this systematic review and meta-analysis on common mental disorders and associated factors among pregnant women in Ethiopia, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline [29] was followed to ensure a comprehensive and transparent approach.

Eligibility criteria

We have used the PICO (Population Intervention Comparator Outcome) criteria to describe our research question. However, we had no intervention and comparators.

Population

studies conducted on pregnant women in Ethiopia were included.

Outcomes

The primary outcome of interest was the magnitude of CMD, and the secondary outcome was associated risk factors.

Study designs

Observational studies (cross-sectional, cohort, case-control studies) were included. However, editorials, opinions, trials, and case reports were excluded.

Time frame

studies conducted since 2010 were included.

Publication status

Both published and unpublished studies were considered.

Language

Studies only published in the English language were included.

Information source and search strategy

A comprehensive search was conducted across multiple databases such as PubMed, MEDLINE, PsycINFO, HINARI, Science Direct, African Journal of Online (AJOL), Web of Science and Google Scholar databases, and Google.

The search strategy included a combination of relevant keywords and Medical Subject Headings (MeSH terms) related to common mental disorders, pregnancy and Ethiopia. The keywords were “prevalence OR magnitude OR burden OR proportion AND common mental disorders OR psychological stress AND pregnant women AND Ethiopia” for objective one. To rifle articles for objective two, we used the following words “Determinants OR predictors OR associated factors OR risk factors AND common mental disorders OR psychological stress AND pregnant women AND Ethiopia” (supplementary file 1). The primary articles’ references were also examined. The reason why we considered only the term common mental disorder and psychological stress in this study was due to our interest to know the exact and specific pooled proportion of CMD. The Endnote version X6 program was utilized to arrange citations and look for duplicate articles.

Selection of studies

After retrieving the relevant articles, a systematic screening process was implemented to select studies based on predefined inclusion and exclusion criteria. The screening process involved assessing titles, abstracts, and full texts of the identified articles. BG, MS and AG separately evaluated the eligibility of studies in an unblended and undistinguishable manner. Any disagreements that surfaced throughout the research selection process were settled through discussion or by averaging the assessments from the three assessors.

Data extraction

Data from the selected studies were extracted using a standardized form. Two formats for data extraction were used by us. The primary data extraction arrangements were the author’s name, publication year, region, study design, sampling process, sample size, response rate, quality score, and prevalence of CMD. The author’s name, the year of publication, and the adjusted OR with 95% CI were extracted to identify associated factors.

Quality assessment

The quality of the included studies was assessed using validated tools to evaluate their risk of bias and methodological rigor. The Newcastle-Ottawa Scale (NOS) was used to check the included studies’ quality [30] which holds three sections; selection, comparability and outcome. Each study was awarded a certain number of stars in each section, contributing to an overall quality score. A high-quality study typically receives the greatest number of stars possible, usually up to a maximum of 9 stars (4 stars for Selection, 2 stars for Comparability, and 3 stars for Outcome). In this systemic review and meta-analysis, studies scored seven and above on the NOS were included.

Effect measures

Two research questions were examined in this review and meta-analysis. The magnitude of CMD was computed by dividing the total number of pregnant mothers with CMD by the total number of pregnant mothers. For the second research question, significant factors for CMD reported in at least three primary studies were considered for meta-analysis and pooled adjusted OR was used to express the pooled effect. In the included studies, CMD was assessed by se1f reporting questionnaire 20 (SRQ-20) and psychological stress was by Kessler 6.

Synthesis methods

A meta-analysis was performed to quantitatively synthesize the findings of the included studies. Statistical methods were employed to calculate pooled estimates of the prevalence of common mental disorders and to analyze the associated factors. Heterogeneity was evaluated by the I2 test and classified as low, moderate, or high if it was 50%, 50–75%, or greater than 75%, respectively [31]. We used STATA version 16 for analysis. A random effect model was employed. A subgroup analysis was conducted to identify the source of heterogeneity [32,33,34]. Egger’s statistical test [35] and funnel plot were done to check publication bias [36]. An adjusted pooled OR with a 95% CI was employed to declare association. The findings of this systematic review and meta-analysis were presented using tables, texts, and forest plots.

Result

Search results

Full-text papers and human studies published since 2010 were searched. A total of 1426 primary articles were scrutinized from the African Journal of Online (AJOL), Science Direct, PsycINFO, MEDLINE, PubMed, Web of Science databases, and Google. Due to duplication and by reading titles and abstracts a total of 870 and 527 studies were removed, respectively. A total of 19 studies were chosen for a systematic examination. However, 8 studies were disregarded due to the similarity of findings, study area, conducted during COVID 19 period, assessed perceived stress and population [37,38,39,40,41,42,43,44]. Finally, eleven articles that fulfill the eligibility criteria have been selected for the meta-analysis [Figure 1].

Fig. 1
figure 1

Flow diagram of the included studies to assess the pooled magnitude of CMD and associated factors among pregnant women in Ethiopia, 2024

Full size image

Characteristics of the included articles

Our study was conducted on a total of 8126 pregnant women. A total of 11 studies were included [26, 27, 45,46,47,48,49,50,51,52,53]. Among the included primary studies only one study was longitudinal in design [26]. Half of the included studies were conducted before 2020. Similarly, around half (6) of the included studies were conducted at the institutional level. Both the maximum and minimum sample size was used in studies done in the southern part of the country [26, 27]. The minimum and maximum magnitudes of CMD were reported by studies done in the Southern part of Ethiopia [27] and the Sidama region [26], respectively. Lastly, almost all of the included studies used the SRQ-20 tool to assess the dependent variable [Table 1].

Table 1 Characteristics of the included studies to assess the pooled magnitude of CMD among pregnant mothers in Ethiopia, 2024 (n = 11)
Full size table

Results of syntheses and reporting bias

As seen in Fig. 2, the pooled magnitude of CMD was 27.00 with a 95% CI of 20.47, 33.53 In the current review and meta-analysis, there was high heterogeneity (I2 = 98.1 with a p value < 0.01). The Egger’s test (P = 0.004) and funnel plot were done to assess the publication bias. The funnel plot was asymmetric [Figure 3]. Therefore, we have evidence to say there was publication bias.

Fig. 2
figure 2

Forest plot to assess the pooled magnitude of CMD among pregnant women in Ethiopia, 2024 (n = 11)

Full size image
Fig. 3
figure 3

Funnel plot to assess publication bias for CMD among pregnant women in Ethiopia, 2024 (n = 11)

Full size image

To assess the source of heterogeneity, subgroup analysis was done based on region and design. There was high heterogeneity (98.9% with a p-value < 0.01) among studies done in Amhara. However, the highest pooled magnitude of CMD was seen in studies done in Oromia (31.90 with 95% CI (22.47, 41.34) and I2 = 96.1%) [Figure 4]. Besides, there was high heterogeneity and pooled magnitude of CMD among community-based cross sectional studies [32.85 with 95% CI (17.58, 48.12) and I2 = 99.0%] [Figure 5].

Fig. 4
figure 4

Subgroup analysis based on region to assess source of heterogeneity for CMD among pregnant women in Ethiopia, 2024 (n = 11)

Full size image
Fig. 5
figure 5

Subgroup analysis based on design to assess source of heterogeneity for CMD among pregnant women in Ethiopia, 2024 (n = 11)

Full size image

Factors associated with common mental disorders among pregnant women

In the present review and meta-analysis, variables reported as factors for CMD in at least three primary studies were considered to identify the more significant factors. The rationale why we limited our inclusion criteria to only variables associated with three studies was to identify the most pertinent variables that have a high impact. A total of six factors intimate partner violence, unplanned pregnancy, family history of psychiatric illness, history of chronic disease, substance use, and history of obstetric complications were eligible and included. After meta-analysis, all the above factors were significantly associated with CMD.

Pregnant women whose pregnancy unplanned had 2.8 [2.82; 95%CI (2.23, 3.58)] times more risk to CMD as compared to those planned their pregnancy. Participants who had a history of intimate partner violence were 2.8 [2.81; 95% CI (2.29, 3.46)] times more likely to evident CMD as compared to their comparison group. Pregnant women who were substance users had 2.97 [2.97; 95% CI (2.29, 3.85)] times more odds of CMD as compared to non-users.

Moreover, pregnant women who had a history of chronic disease [3.60; 95% CI (2.19, 5.91)], obstetric complications [2.78; 95% CI (1.89, 4.07)], and family history of psychiatric illness [4.03; 95% (2.58, 6.30)] had more risk for CMD as compared to their contrary [Table 2].

Table 2 Meta-analysis for factors associated with CMD among pregnant women in Ethiopia, 2024
Full size table

Discussion

In this review and meta-analysis, the pooled magnitude of CMD was 27.00 [95% CI: 20.47, 33.53]. Moreover, six factors; intimate partner violence, unplanned pregnancy, family history of psychiatric illness, chronic disease, substance use, and history of obstetric complications were significant factors for CMD among pregnant women in Ethiopia.

This pooled magnitude was similar to a finding of systematic review and meta-analysis done on the general population of 63 countries [6]. However, it was high as compared to studies done in Brazil [54, 55], Uganda [56], and India [57], systematic review done in LMICs [9] and the global report [1], and low as compared to studies done in Brazil [58,59,60], Tanzania [61], South Africa [62], Vietnam [63], Pakistan [64], Jamaica [65] and Cameroon [17]. The similarity might be due to the use of similar assessment tools and comparable study methodologies. However, the difference might be due to alterations in population, socio-economic status, and healthcare service quality.

Pregnant women who had a history of intimate partner violence had more risk for CMD as compared to their counterparts. This finding is supported by studies conducted in Tanzania [66], Vietnam [67], Brazil [68], Cameroon [17] and India [69]. This could be a result of the direct relationship between intimate partner violence and prenatal mental diseases and intimate partner abuse can occur in conjunction with broad stressors such as low income and poor social support.

Women who had unwanted pregnancies had more odds for CMD as compared to those who had planned pregnancy. This finding is supported by studies done in Brazil [58, 70] and systematic review and meta-analysis done in LMICs [9]. A potential rationale for this could be the psychological despair brought on by the social and economic burden of an unplanned pregnancy.

In the current study, pregnant women who had a family history of psychiatric illness had higher menace as compared to their comparison group. This result is similar to a finding of a study conducted in Japan [71]. This might be due to long-term mental illness being inclined to develop in people with a family history of mental disorders.

The occurrence of CMD among pregnant women who had obstetric complications was high which is supported by a study done in Brazil. This similarity could be because pregnant women experience depressive symptoms, and having a complication during this period may make their condition worse [21]. This may be because pregnancy itself requires physiological, psychological, and social adaptations and it leads to significant mental disorders especially if there is a history of obstetric complications.

Moreover, pregnant women who were substance users were more likely to spectacle CMD. This finding is supported by one systematic review [72] and studies done in India [73], Jordan [74], the Netherlands [75]. This might be due to substance use increasing or triggering new symptoms of mental illness and it also limits emotional coping mechanisms and access to supportive networks.

Lastly, pregnant women who had chronic diseases were vulnerable to CMD. This result is similar to the findings of studies done in Brazil [55] and China [76]. This could be because women who have chronic illnesses often worry more about their well-being and are isolated from normal social interactions, which might result in mental health issues.

Even though this study was a systematic review and meta-analysis it had limitations. Firstly, there was high heterogeneity and publication bias. Secondly, our study included only studies published in English. Thirdly, almost all the included studies were cross-sectional studies which couldn’t show the temporal relationship between the outcome and independent variables. Lastly, to make our study more specific, we didn’t consider studies conducted to assess depression only among pregnant women.

Conclusion

In the present systematic review and meta-analysis, the pooled magnitude of common mental disorders was high as compared to the global report. Substance use, chronic disease, unplanned pregnancy, intimate partner violence, and having a history of obstetric complications and a family history of psychiatric illness were significantly associated with common mental disorders. Therefore, the Federal Ministry of Health, policymakers, and stakeholders should work together to revise and incorporate mental health assessments for pregnant women during their ante-natal care follow-up. Moreover, healthcare providers should focus on and support pregnant women who have intimate partner violence, chronic disease, unplanned pregnancy, and a history of obstetric complications.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

AOR:

Adjusted Odd Ratio

AJOL:

African Journal of Online

CI:

Confidence interval

CMD:

Common mental Disorders

LMICs:

Low and middle-income countries

NOS:

Newcastle Ottawa Scale

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

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Authors and Affiliations

  1. Department of Pediatrics and Child Health Nursing, School of Nursing and Midwifery, College of Medicine and Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia

    Bekahegn Girma, Wegayehu Zeneb Teklehaimanot, Leweyehu Alemaw Mengstie & Mohammed Tessema Gebeyehu

  2. Department of Nursing, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia

    Migbar Sibhat

  3. Department of Midwifery, College of Medicine and Health Sciences, Dilla University, Dilla, Ethiopia

    Addisu Getnet

  4. School of Nursing and Midwifery, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

    Jemberu Nigussie

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  1. Bekahegn Girma
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  5. Leweyehu Alemaw Mengstie
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  6. Mohammed Tessema Gebeyehu
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  7. Jemberu Nigussie
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BG conceived the idea, participated in data extraction, analysis, draft writing, and revision. JN, MS, AG, WZ, MTG and LA also participated in the manuscript preparation and revision. All authors read and approved the final version of the manuscript to be considered for publication.

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Girma, B., Sibhat, M., Getnet, A. et al. Common mental disorders and associated factors among pregnant women in Ethiopia: a systematic review and meta-analysis. BMC Psychiatry 25, 430 (2025). https://doi.org/10.1186/s12888-025-06880-7

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Keywords

BMC Psychiatry

ISSN: 1471-244X

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