Email updates

Keep up to date with the latest news and content from BMC Psychiatry and BioMed Central.

Open Access Research article

Mental health related determinants of parenting stress among urban mothers of young children – results from a birth-cohort study in Ghana and Côte d’Ivoire

Nan Guo1, Carola Bindt2, Marguerite Te Bonle3, John Appiah-Poku4, Cecilia Tomori1, Rebecca Hinz5, Dana Barthel5, Stefanie Schoppen5, Torsten Feldt5, Claus Barkmann2, Mathurin Koffi6, Wibke Loag7, Samuel Blay Nguah8, Kirsten A Eberhardt5, Harry Tagbor9, Judith K Bass10, Eliezer N’Goran11, Stephan Ehrhardt15* and The International CDS Study Group

Author Affiliations

1 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

2 Department of Child and Adolescent Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

3 Centre de Guidance Infantile, Institut National de Santé Publique, Abidjan BP V 47, Côte d’Ivoire

4 Department of Behavioural Sciences, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

5 Clinical Research Unit, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

6 Jean Lorougnon Guede University, Daloa, Côte d’Ivoire

7 Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany

8 Department of Child Health, Komfo Anokye Teaching Hospital, Kumasi, Ghana

9 Department Community Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana

10 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA

11 Research Unit of Parasitology and Parasite Ecology at Unité de Formation et de Recherche en Biosciences, Université de Cocody, Abidjan, Côte d’Ivoire

For all author emails, please log on.

BMC Psychiatry 2014, 14:156  doi:10.1186/1471-244X-14-156

Published: 29 May 2014



There are limited data on the parenting stress (PS) levels in sub-Saharan African mothers and on the association between ante- and postnatal depression and anxiety on PS.


A longitudinal birth cohort of 577 women from Ghana and Côte d’Ivoire was followed from the 3rd trimester in pregnancy to 2 years postpartum between 2010 and 2013. Depression and anxiety were assessed by the Patient Health Questionnaire depression module (PHQ-9) and the Generalized Anxiety Disorder (GAD-7) at baseline, 3 month, 12 month and 24 month postpartum. PS was measured using the Parenting Stress Index-Short Form (PSI-SF) at 3, 12 and 24 month. The mean total PS score and the subscale scores were compared among depressed vs. non-depressed and among anxious vs. non-anxious mothers at 3, 12 and 24 month postpartum. The proportions of clinical PS (PSI-SF raw score > 90) in depressed vs. non-depressed and anxious vs. non-anxious mothers were also compared. A generalized estimating equation (GEE) approach was used to estimate population-averaged associations between women’s depression/anxiety and PS adjusting for age, child sex, women’s anemia, education, occupation, spouse’s education, and number of sick child visits.


A total of 577, 531 and 264 women completed the PS assessment at 3 month, 12 month and 24 month postpartum across the two sites and the prevalences of clinical PS at each time point was 33.1%, 24.4% and 14.9% in Ghana and 30.2%, 33.5% and 22.6% in Côte d’Ivoire, respectively. At all three time points, the PS scores were significantly higher among depressed mothers vs. non-depressed mothers. In the multivariate regression analyses, antepartum and postpartum depression were consistently associated with PS after adjusting for other variables.


Parenting stress is frequent and levels are high compared with previous studies from high-income countries. Antepartum and postpartum depression were both associated with PS, while antepartum and postpartum anxiety were not after adjusting for confounders. More quantitative and qualitative data are needed in sub-Saharan African populations to assess the burden of PS and understand associated mechanisms. Should our findings be replicated, it appears prudent to design and subsequently evaluate intervention strategies.

Africa; Children; Mothers; Parenting stress; Depression; Perinatal; Antepartum; Post-partum; Pregnancy; Generalized estimating equation