The relationship between reduced child spacing and depression in mothers: A cross-sectional study in Karachi, Pakistan

Short inter-birth intervals may increase maternal psychological stress and have been hypothesized to contribute to depressive symptoms. We assessed the association between recent birth spacing and depression in mothers in Karachi, Pakistan. We conducted a cross-sectional, interviewer-administered survey of mothers recruited via convenience sampling from public parks and shopping malls in Karachi. Eligible participants were mothers with ≥2 children who had delivered within the past five years; women who were currently pregnant or <2 months postpartum were excluded. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9); the primary outcome was PHQ-9 ≥ 10. Birth spacing was calculated as the interval between the two most recent live births and categorized as <24 months, 24–32 months, and ≥33 months (reference). We used logistic regression to estimate crude and adjusted odds ratios (aOR), adjusting for maternal age, education (formal vs none), number of children (2 vs ≥ 3), and household income (<50,000 vs ≥ 50,000 PKR). Of 202 completed questionnaires, 15 were excluded due to missing key exposure data, leaving 187 mothers for analysis; adjusted models included 181 participants. Overall, 37/187 (19.8%) screened positive for probable depression (PHQ-9 ≥ 10). Compared with spacing ≥33 months, the adjusted odds of PHQ-9 ≥ 10 were aOR 2.39, 95% CI 0.84–6.75 for spacing 24–32 months, and aOR 2.17, 95% CI 0.79–5.96 for <24 months. No formal education was associated with higher odds of PHQ-9 ≥ 10 (aOR 4.62, 95% CI 1.50–14.20). In this sample of mothers in Karachi, shorter birth spacing was not significantly associated with higher odds of probable depression. Larger, probability-based studies are needed to clarify the relationship between birth spacing and depression.