JOURNAL OF INTERNATIONAL ACADEMIC RESEARCH FOR MULTIDISCIPLINARY Impact Factor 3.114, ISSN: , Volume 5, Issue 3, April 2017

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1 PREVALENCE OF POSTPARTUM DEPRESSION AMONG WOMEN-A CROSS SECTIONAL STUDY MRS.RAJESWARI.H* *Professor & HOD, Dept. of Mental Health Nursing, Narayana College of Nursing, Chinthareddypalem, Nellore, Andhrapradesh, India Abstract Postpartum depression (PPD) refers to a non-psychotic depressive episode that begins in or extends into the postpartum period. To identify the prevalence of post partum depression and its associated risk factors among women and to associate the prevalence of post partum depression with the socio demographic variables among women. Cross sectional research design was adopted. Data was collected from 120 postnatal mothers who were attending NMCH. Tool used for the study was Self administered questionnaire and Edinburgh Postnatal Depression Scale. Prevalence of PPD was 43%.Maternal variables such as obstetric score, high risk pregnancy, family history of depression had significant association at p<0.01.infant variables like sex of the baby, gestational age, problems with breastfeeding had significant association at p<0.01. Postpartum depression is highly prevalent among the women. Mental health assessment must be made mandatory for the women undergoing pregnancy so that early identification and interventional strategies can be formulated Keywords: Postpartum Depression (PPD), Post Natal Mothers, Women. Introduction Women under go lot of emotional changes during pregnancy and in post partum period. It s common for women to experience the baby blues. Postpartum depression (PPD) refers to a non-psychotic depressive episode that begins in or extends into the postpartum period. Almost 1 in 7 women experience a much more serious mood disorder postpartum depression. Postpartum depression (PPD) affects 10%--15% of mothers within the first year after giving birth. Postpartum depression can occur in women due to changes in hormone levels after childbirth, previous experience of depression or anxiety, family history of depression or mental illness, stress involved in caring for a newborn and managing new life changes, having a challenging baby who cries more than usual, having a baby with special needs (premature birth, medical complications, illness),primi or elderly primi gravid, emotional 58

2 stressors like death of a loved one or family problems, financial or employment problems, isolation and lack of social support. Need for the Study It is estimated that globally the prevalence rate of postpartum depression is 10-42%.Asian women have a higher prevalence of PPD than comparing to the women in other countries.ppd have a severe impact on the women herself, infant and the family. Though there is demographic, economic, psychosocial, obstetric and medical risk factors involved in PPD, certain unique factors like as birth of female baby, protective influence of traditional rituals, financial insecurity, marital violence, lack of social support have emerged as risk factors for PPD in low and medium income countries like India Andrea leans (2011) marital stress and lack of prenatal care contribute to a high prevalence of PPD. Health care professionals need do have a knowledge regarding the prevalence and the predictors of PPD so that an early identification measures and preventive strategies can be implemented. Objectives: 1. To identify the prevalence of post partum depression and its associated risk factors among women 2. To associate the prevalence of post partum depression with the socio demographic variables among women Materials and Methods Using a quantitative research approach-cross sectional study design was adopted to accomplish the study objective. The study was carried out among postnatal mothers who came for follow up between 4-8 weeks and attending the OBG outpatient department of Narayana Medical College Hospital, Nellore. Data was collected from 120 postnatal mothers and mothers were selected by using non probability convenience sampling technique. Informed consent was obtained from the mothers after explaining the nature and purpose of the study. A self-administered questionnaire reflecting important socio demographic, maternal and infant variables and Edinburgh Postnatal Depression Scale (EPDS) was used to screen for postnatal depression symptoms. The EPDS is a 10-item selfreport scale, specifically designed to screen for postnatal depression. The scale rates the intensity of depressive symptoms present within the previous 7 days. Each item is scored on a 59

3 4-point scale (from 0 to 3 reflecting increased severity of symptoms). The minimum and maximum total scores are 0 and 30, respectively, in which 0-10 is normal and >10 is postpartum depression. Face to face interviews was conducted among mothers who could not read and write the questionnaire Data was analyzed using SPSS Version 16. Results were expressed as frequencies and proportions for categorical variables and mean and standard deviations for continuous variables. Chi-square test was used to associate the prevalence of PPD with the sociodemographic variables RESULTS: Table No: 1 Frequency and percentage distribution of socio demographic variables of postnatal mothers (N=120) Socio demographic Variables Number Percentage Age in years % % % >30 3 3% Educational status Illiterate 25 21% Primary 33 28% Secondary 32 26% High school 13 11% Graduate 17 14% Occupational status Housewife 58 48% Working 62 52% Type of family Nuclear 94 78% Joint 21 18% Extended 5 4% Socioeconomic status Below poverty line 24 20% Above poverty line 96 80% Religion Hindu 65 54% Christian 43 36% Muslim 12 10% 60

4 Fig No: 1 Percentage distribution of prevalence of postpartum depression of postnatal mothers (N=120) Table No: 2 Prevalence of postnatal depression with associated maternal variables among postnatal mothers (N=120) Maternal Variables Number Percentage Normal Depression p value Obstetric score Primigravida 95 79% Multigravida 25 21% 18 7 Mode of delivery Vaginal delivery 80 67% LSCS 40 33% High risk pregnancy Yes 22 18% 4 18 No 98 82% Family history of depression Yes 11 9% 1 10 No %

5 Table No: 3 Prevalence of postnatal depression with associated infant variables among postnatal mothers (N=120) Infant Variables Number Percentage Normal Depression p value Sex of the Baby Male 66 55% Female 54 45% Birth order of the baby First 72 60% Second 32 27% Third 16 13% 10 6 Gestational age Term % Preterm 14 12% 6 8 Separated from baby Yes 20 17% 12 8 No % Breast feeding Yes % No 8 7% 4 4 Problems with breast feeding Yes 12 11% 6 6 No % <0.01* <0.02* Discussion: It s is evident from the present study that the prevalence of postpartum depression among postnatal mothers is 43% as it could be attributed to the enormous amount of stress experienced by the women during peripartum period. This is comparable with the study conducted by Abbas Habibzadeh and Zohreh Habibzadeh (2016) which reports that the prevalence of postpartum depression is 40.3% among the postnatal mothers. As indicated, in relation to age of mother between years, the prevalence is said to be 47% which is considered to be high.this could be due to the reason where they are not completely aware of the child rearing process. The result can be compared with O'Hara MW, 62

6 Swain AM (2006) which revealed that although adolescent mothers were found to be associated with major PPDS (OR: 2.03, 95% CI: ). Working women attributed to a high prevalence of depression 33%.Women living in the nuclear family, 39% suffered with depression due to the non availability of the support system from the other family members. It is also felt that the women have to meet the infants care needs and the household chores. The prevalence of postnatal depression with associated maternal variables among postnatal mothers where in primi gravida mothers 38% are suffering with depression as it could to be due the fear and anxiety raised out of first pregnancy and it is significant at the level of p<0.01.vaginal delivery 25 % had depression which is significant at the level p as this is supported with the study done by Chaaya et al (2006) which showed that depression is lower among mothers with C-section surgery than mothers with natural childbirth. Maternal variables such as high risk pregnancy 16% had depression which correlates with the study finding by Kunwar.et al (2015) where 22.2% had pregnancy complications. Family history of depression 8% had depression which has a significant association at the level of p<0.01 The prevalence of postnatal depression with associated infant variables among postnatal mothers where mothers who delivered female baby 33% had depression where the family members were expecting it to be a male gender had significant association at the level of p.first birth order of the baby where 27% mothers had depression which is significant at the level of p. 37% of the mothers had a term delivery even though they had depression which is significant at the level of p<0.01.5% of the mothers had problems in breast feeding which also has attributed to depression which is significant at the level of p<0.01 which coincides by the study conducted by Mandy McCulloch(2009) who reported that women who breastfed longer had low levels of depression. Conclusion: Postpartum depression is highly prevalent among the women. Along with the other maternal and child care services, mental health assessment must be made mandatory for the women undergoing pregnancy so that early identification and interventional strategies can be formulated. Further studies can be conducted with interventional strategies to reduce the prevalence of postpartum depression. 63

7 References: 1. Abbas Habibzadeh, Zohreh Habibzadeh (2015).Evaluation of Effective Factors and its Prevalence on Postpartum Depression Among Women in the City of Qom, Iran Journal of Women s Health and Reproduction Sciences Vol. 4, No. 1, January 2016, Chaaya M, Campbell O, El Kak F, Shaar D, Harb H, Kaddour A. Postpartum depression: prevalence and determinants in Lebanon. Arch Womens Ment Health. 2002;5(2): doi: /s Kunwar D, Corey E K,Sharma P, Risal, Screening for Postpartum Depression and Associated Factors among Women who Deliver at a University Hospital, Nepal A KATHMANDU UNIVERSITY MEDICAL JOURNAL Page 44 VOL. 13 NO. 1 ISSUE 49 JAN-MAR Leitch S. Postpartum Depression: A Review of the Literature. St. Thomas, Ontario: Elgin-St. Thomas Health Unit; MMDR WKLY April 11, 2008 / 57(14); O'Hara MW, Swain AM. Rates and risk of postpartum depression-a meta-analysis. International Review of Psychiatry. 1996;8: doi: / Postpartum Depressive Symptoms among Colorado Women Colorado Department of Public Health and Environment, August 2009 No Shivalli S, Gururaj N (2015) Postnatal Depression among Rural Women in South India: Do Socio- Demographic, Obstetric and Pregnancy Outcome Have a Role to Play? PLoS ONE 10(4): e doi: /journal.pone