Trajectories of depressive symptoms and associated factors among reproductive age women in Khwisero, Western Kenya: a longitudinal community-based study

Background

In sub-Saharan Africa (SSA), maternal depression remains a public and social challenge. Available studies from high-income countries suggest that affected women do not constitute one homogeneous group in terms of severity, chronicity, and onset of symptoms. However, few studies have captured the distinct characteristics of such depression patterns in SSA. This study adds to the literature by examining depressive symptoms trajectories and associated factors among reproductive age women in Khwisero, western Kenya. It provides a unique contribution by generating evidence from community-based longitudinal data, using a semiparametric, group-based trajectory modeling to identify heterogenous subgroups of women, each following a distinct pattern of depressive symptom development over time, with their own trajectory pattern and growth parameters.

Methods

We used data collected from community-based longitudinal household surveys from 2019 to 2023. A total of 257 reproductive age (18–49 years) women were assessed for depressive symptoms using Center for Epidemiological Studies Depression (CES-D) scores and included in the analyses. Latent class growth curve mixture and generalized estimating equation models were used to identify trajectories of depressive symptoms and examine factors associated with each trajectory group, respectively. Bayesian information criterion, the probability of group memberships, average posterior probability, odds of correct classification, and biological plausibility were used to identify and determine the trajectory groups. A p-value of 0.05 was set to examine associations of each trajectory with factors.

Results

We found four distinct patterns of depressive symptoms among reproductive age women, namely moderately stable depression (19.8%, Group 1), mildly stable depression (56.8%, Group 2), higher but improving depression (18.6%, Group 3), and unstably high depression (4.8%, Group 4). We also found that reproductive age women who reported better self-rated health status and food security were less likely to experience unstable or moderately increasing depressive symptoms.

Conclusion

Reproductive age women exhibit distinct forms of depressive symptoms trajectories, underscoring the need to recognize and address heterogeneity in design, development, and delivery of maternal mental health interventions. These findings also provide deeper insights into the dynamic nature of depressive symptoms in under-researched rural African settings. Further research should focus on examining the effect of time varying factors and understanding potential mechanisms of underlying, proximal, and early life factors, including time varying factors, in a more diversified population using life course model and/or socioecological model. The differential impact of belonging in distinct groups of trajectories on women’s future health and their children’s health, development, and nutritional outcomes also requires further investigations.

Article Highlights

• This study identified four distinct trajectories of depressive symptoms among reproductive age women–moderately stable, mildly stable, initially high but improving, and persistently unstable at high levels.

• Women with more favorable self-rated health and greater food security demonstrated a lower likelihood of experiencing persistent or escalating depressive symptoms, emphasizing the impact of social and economic determinants on mental wellbeing.

• The presence of multiple depressive symptom trajectories highlights the necessity of personalized intervention strategies that acknowledge individual variations in mental health progression and risk exposure.

• Further investigation is required to examine the roles of dynamic, time-dependent influences, and early-life exposures on depressive trajectories using integrative life course and socioecological frameworks.

• A deeper understanding of how different depressive trajectories shape long-term maternal health and child development, and nutritional outcomes is essential for developing evidence-based public health policies and interventions.