Proportion and risk factors of postnatal depression among women delivering in a government tertiary care hospital in Kerala, India

Naheeda Mohammed K. T.; Lalithambica Karunakaran; Varghese P. Punnoose

doi:10.18203/2320-1770.ijrcog20212182

Authors

Naheeda Mohammed K. T. Department of Obstetrics and Gynaecology, Government T. D. Medical College, Alappuzha, Kerala, India
Lalithambica Karunakaran Department of Psychiatry, Government T. D. Medical College, Alappuzha, Kerala, India
Varghese P. Punnoose Department of Psychiatry, Government T. D. Medical College, Alappuzha, Kerala, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20212182

Keywords:

Edinburgh postnatal depression scale, Postnatal depression, Postnatal mothers, Psychosocial factors, Reproductive and clinical factors

Abstract

Background: The burden of postpartum depression is significant because it remains unrecognized and it not only affects the mother adversely but also has a negative consequence on the family life and the development of the infant. This research aims to aid the early diagnosis of postnatal depression using Edinburgh postnatal depression scale (EPDS) and the psychosocial and reproductive risk factors of postnatal depression among women delivering in a tertiary hospital in Kerala state, India.

Methods: 500 women were subjected to a standard questionnaire for assessing psychosocial and reproductive characteristics. The diagnosis of postnatal depression was made using a pretested and validated Malayalam version of EPDS with a score cut off of 13 or more.

Results: The proportion of postnatal depression six weeks after delivery at TD Medical College, Alappuzha was found to be 8.6%. Marital harmony (p value=0.002) was significantly associated with postnatal depression. Diabetes (p value=0.037), hypertensive disorders (p value=0.013), antepartum hemorrhage (p value=0.036), neurological disorders (p value <0.001), type of delivery (p value=0.042), postpartum complications (p value=0.003), mode of infant feeding (p value=0.001), infant illness (p value=0.001), symptoms of maternity blues (p value <0.0001), premenstrual syndromes (p value=0.008) and infertility treatment (p value=0.03) were significantly associated with postnatal depression.

Conclusions: Early screening of the women and counselling of women and their family will reduce the maternal morbidity and adverse child outcomes.

Metrics

Metrics Loading ...

References

Ministry of health to formulate policies integrating mental and reproductive health. New Pathways New Hope. 2014.

Hatton DC, Harrison-Hohner J, Coste S, Dorato V, Curet LB, McCarron DA. Symptoms of postpartum depression and breastfeeding. J Hum Lact. 2005;21(4):444-9.

Lanes A, Jennifer LK, Hala T. Prevalence and characteristics of postpartum symptomatology among Canadian women. BMC Public Health. 2011;11:302.

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th Ed, text rev. Washington, DC: American Psychiatric Association. 2002.

Evins GG, Theophrastus JP, Galvin SL. Postpartum depression: A comparison of screening and routine clinical evaluation. Am J Obstet Gynecol. 2000;182:1080-2.

Dennis CE, Stewart DE. Treatment of postpartum depression, Part 1: A critical review of biological interventions. J Clin Psychiatr. 2004;45:1242-51.

LaMonde LG. Feeling blue or is it something more? A review of postpartum depression. Super twins. 2006;16(4):53-4.

Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR. Prevalence of depression during pregnancy: systematic review. Obstet Gynecol. 2004;103(4):698-709.

Evans J, Heron J, Patel RR, Wiles N. Depressive symptoms during pregnancy and low birth weight at term: longitudinal study. Br J Psychiatry. 2007;191:84-5.

National Institute for Health and Clinical Excellence. Antenatal and postnatal mental health; Clinical management and service guidance (Brief record). London: NICE. 2007.

Beck CT. Predictors of postpartum depression. An Update. Nursing Res. 2001;50:275-85.

Alici-Evcimen Y, Sudak DM. Postpartum Depression. Psy Update. 2003;10:2106.

Patel V, Rahman A, Jacob KS, Hughes M. Effect of maternal mental health on infant growth in low income countries: New evidence from South Asia. BMJ. 2004;328:820-3.

Chandran M, Tharyan P, Muliyil J, Abraham S. Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Incidence and risk factors. Br J Psychiatry. 2002;181:499-504.

Chandra PS. Post-partum psychiatric care in India: The need for integration and innovation. World Psychiatry. 2004;3:99-100.

Patel V, Rodrigues M, DeSouza N. Gender, Poverty, and Postnatal Depression: A Study of Mothers in Goa, India. Am J Psychiatry. 2002;159:43-7.

Norhayati MN, Nik Hazlina NH, Asrenee AR, Wan Emilin WMA. Magnitude and risk factors for postpartum symptoms: A literature review. J Affect Disord. 2015;175:4-52.

Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol. 1989;57(2):269-74.

Halbreih U. Postpartum disorders: Multiple interacting underlying mechanism and risk factors. J Affect Disord. 2005;88(1):1-7.

Räisänen S, Lehto SM, Nielsen HS, Gissler M, Kramer MR, Heinonen S. Fear of childbirth predicts postpartum depression: a population-based analysis of 511 422 singleton births in Finland. BMJ Open. 2013;3(11):e004047.

Ross LE, Dennis CL. The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: a systematic review. J Womens Health. 2009;18(4):475-86.

Robertson E, Grace S, Wallington T, Stewart DE. 2004. Antenatal risk factors for postpartum depression: a synthesis of recent literature. Gen Hosp Psychiatry. 2004;26(4):289-95.

Ruohomäki A, Toffol E, Upadhyaya S, Keski-Nisula L, Pekkanen J, Lampi J, et al. The association between gestational diabetes mellitus and postpartum depressive symptomatology: A prospective cohort study. J Affect Disord. 2018;241:263-8.

Warner R, Appleby L, Whitton A, Faragher B. Demographic and obstetric risk factors for postnatal psychiatric morbidity. Br J Psychiatry. 1996;168(5):607-11.

Hamdan A, Tamim H. The relationship between postpartum depression and breastfeeding. Int J Psychiatry Med. 2012;43(3):243-59.

Figueiredo B, Dias CC, Brandão S, Canário C, Nunes-Costa R. Breastfeeding and postpartum depression: state of the art review. J Pediatr (Rio J). 2013;89(4):332-8.

Britton JR. Infant temperament and maternal anxiety and depressed mood in the early postpartum period. Women Health. 2011;51(1):55-71.

Thome M. Predictors of postpartum depressive symptoms in Icelandic women. Arch Womens Ment Health. 2000;3(1):7-14.

Giannandrea SAM, Cerulli C, Anson E, Chaudron LH. Increased risk for postpartum psychiatric disorders among women with past pregnancy loss. J Womens Health (Larchmt). 2013;22(9):760-8.

Johnstone SJ, Boyce PM, Hickey AR, Yatees AD, Harris MG. Obstetric risk factors for postnatal depression in urban and rural community samples. Australian New Zealand J Psych. 2001;35:69-74.