Little is known about the impact of life-threatening obstetric complications (‘near miss’) on women’s mental health in low and middle-income countries. This paper aims to examine the relationships between near miss and postpartum psychological distress in the Republic of Benin. The research consisted of a one-year prospective cohort using epidemiological and ethnographic techniques in a population of women delivering at health facilities. In total 694 women contributed to the study. Except when associated with perinatal death, near-miss events were not associated with greater risk of psychological distress in the 12 months postpartum compared with uncomplicated childbirth. Much of the direct effect of near miss with perinatal death on increased risk of psychological distress was shown to be mediated through wider consequences of traumatic childbirth. A live baby protects near-miss women from increased vulnerability by giving a positive element in their lives that helps them cope and reduces their risk of psychological distress. Near-miss women with perinatal death should be targeted early postpartum to prevent or treat the development of depressive symptoms.
The British Journal of Psychiatry (2010) 196, 18–25. [doi: 10.1192/bjp.bp.108.062489]