Prevalence and risk factors for depression among antenatal women during third trimester of pregnancy in a tertiary care centre


  • Reena Ravindran P. Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala, India
  • Megha Jayaprakash Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala, India
  • Amrutha M. Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala, India
  • Ambujam K. Department of Obstetrics and Gynecology, Government Medical College, Thrissur, Kerala, India



PHQ-9 scale, Prevalence of depression, Risk factors of depression, Screening for antenatal depression


Background: With the rising incidence of Maternal deaths due to suicide as evident from reports of Kerala state confidential review of maternal deaths, there is a felt need for screening for depression in study antenatal population. Though there have been various screening tools used, a simplified tool validated in study population was not used in study antenatal women till now. The objective of this study was to estimate the prevalence of depression among antenatal women admitted in the department of obstetrics and gynecology, Government Medical College, Thrissur and also to study the risk factors associated with depression in the study population.

Methods: A questionnaire based cross sectional observational study was conducted among 100 antenatal women in their third trimester. PHQ-9 questionnaire was used to screen for depression and the information regarding risk factors was collected from the patient, her caregivers and from clinical records. Data analysis was done using EPI-INFO/SPSS software.

Results: Prevalence of depression among hospitalized mothers: 53%. Most cases (70%) had: mild depression (PHQ Score: 5-9). Only very few (2%) of them had severe depression (PHQ score: more than 20). 9% had: moderately severe depression (PHQ score: 15-19). 19% had: moderate depression (PHQ score: 10-14). Statistically significant risk factors identified in this study were fetal gender preference, anxiety about labour process, anxiety about labour pain, anxiety about making the baby a part of their life and anxiety about baby’s health.

Conclusions: The prevalence of depression among hospitalized mothers using PHQ-9 scale is high (53%). Screening for depression was found to be feasible and can be made a part of routine antenatal care so that appropriate interventions can be provided to improve maternal mental health and thereby prevent the maternal mortality occurring due to suicides.


Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; Licence: CC BY-NC-SA 3.0 IGO. 2017.

Pereira PK, Lovisi GM, Lima LA, Legay LF, Fernandes J, Santos C , Santos SA, Daianna Lima Thiengo and Elie Valencia. Depression during pregnancy: review of epidemiological and clinical aspects in developed and developing countries, psychiatric disorders - trends and developments, Dr. Toru Uehara (Ed.). 2011:ISBN: 978-953-307-745-1.

Cantwell R, Clutton-Brock T, Cooper G, Dawson A, Drife J, Garrod D. Saving mothers' lives: reviewing maternal deaths to make motherhood safer: 2006-2008. The eighth report of the confidential enquiries into maternal deaths in the United Kingdom. BJOG. 2011;118 Suppl 10:1-203

The WHO application of ICD-10 to deaths during pregnancy, childbirth and puerperium: ICD MM. World Health Organization; 2012

Paily VP, Ambujam K, Thomas B. Second report of confidential review of maternal deaths Kerala 2006 to 2009. Why Mothers Die Kerala 2006-2009 Observations, Recommendations.2nd ed. Kerala Federat Obstet Gynaecol. 2012:37-47.

ACOG Committee Opinion 757, Screening for Perinatal Depression Interim Update; 2018.

Indu PS, Anilkumar TV, Vijayakumar K, Kumar KA, Sarma PS, Remadevi S, et al. Reliability and validity of PHQ-9 when administered by health workers for depression screening among women in primary care. Asian J Psychiat. 2018;37:10-4.

Joshi D, Shrestha S, Shrestha N. Understanding the antepartum depressive symptoms and its risk factors among the pregnant women visiting public health facilities of Nepal. PLoS One. 2019;14(4):e0214992.

Sheeba B, Nath A, Metgud CS, Krishna M, Venkatesh S, Vindhya J, et al. Prenatal depression and its associated risk factors among pregnant women in bangalore: a hospital based prevalence study. Front Public Health. 2019;7:108.

Lancaster CA, Gold KJ, Flynn HA, Yoo H, Marcus SM, Davis MM. Risk factors for depressive symptoms during pregnancy: a systematic review. Am J Obstet Gynecol, 2010;203,e16.






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