Flooding and elevated prenatal depression in rural Bangladesh: A mixed methods study

Prenatal depression can have lasting adverse impacts on child health. Little is known about the impact of floods on prenatal depression in low- and middle-income countries. We conducted a cross-sectional survey of 881 pregnant women from September 24, 2023 to July 19, 2024 in riverine communities in rural Bangladesh. We recorded participant-reported flooding in the past 6 months, administered the Edinburgh Postnatal Depression Scale (EPDS), and obtained water level data and remote sensing data on distance to surface water. We fit generalized linear and log-linear models adjusting for month, wealth, education, age, and gestational age. We conducted 2 focus group discussions with 20 adult women. 3.6% of compounds were flooded in the past 6 months. Flooding of compounds was associated with elevated depression (adjusted prevalence ratio (aPR) = 2.08, 95% CI 1.24, 3.51) and thoughts of self-harm (aPR = 8.40, 95% CI 4.19, 16.10). Latrine flooding was associated with higher depression (aPR = 3.58, 95% CI 2.22, 5.75)). Higher water levels and shorter distance to permanent surface water were significantly associated with mean EPDS scores. Focus groups revealed that domestic violence, inadequate sanitation, gendered vulnerabilities in accessing latrines, childcare difficulties, and food insecurity were key drivers of depression due to floods. Flood preparedness strategies included relocation, storing food, and home modifications. In summary, in rural Bangladesh, flooding, higher water levels, and proximity to water bodies were associated with prenatal depression, and depression following floods was strongly influenced by inadequate sanitation and hygiene infrastructure.