Original article Postpartum depression- A study from a tertiary care hospital 1Dr.Ramalingam Kolisetty, 2 Dr.Neeli Uma Jyothi 1Professor, Department of Obstetrics & Gynaecology, NRI Medical College 2Associate Professor, Department of Psychiatry, Guntur Medical College, Government General Hospital, Guntur Corresponding author: Dr.Ramalingam Kolisetty, Professor, Department of Obstetrics & Gynaecology, NRI Medical College Abstract Background: Postpartum depression is a non psychotic depressive episode of mild to moderate severity. The preventive measures, early intervention and identification can reduce sufferings of the mother and minimize its potential harmful effects on the baby. Material & Methods: Present study was a hospital based cross sectional study conducted in the pot natal ward of a tertiary care hospital in Andhra Pradesh. A total of 100 postpartum women were selected from the postnatal ward using simple random sampling technique. Mothers were interviewed using a pre designed questionnaire based on DSM-IV diagnostic criteria for major depression. Results: The overall prevalence of postpartum depression was found to be 22% (n=22). Prevalence of depression was more among women who were less than 25 years age group and illiterate women (p<0.05). Primi parous women and women having single child also had more depression compared with multiparous women. Family support during pregnancy and delivery had significant impact on post partum depression and it was statistically significant (p=0.01). Conclusions: Special concentration needs to be given on counselling aspects during pregnancy especially for women who are young and pregnant for first time. Involvement of partner during ante natal visits would reduce the stress on the women. Keywords: postpartum depression, prevalence, factors, hospital Introduction: interaction and on the long term emotional and Affective disorders occur commonly in postpartum cognitive development of the baby. 4 Accurate period, ranging in severity from mild and transient estimates of PND prevalence are difficult to obtain baby blues experienced by 50 80 % of women as cultural norms may affect women s reporting of to postpartum psychosis which affects <1 % of their symptoms and methods used to determine women. 1 Postpartum major depression lies along prevalence rates impact their accuracy.the this spectrum of postnatal mood disorder. The preventive measures, early intervention and debilitating effects of postpartum depression (PPD) identification can reduce sufferings of the mother can involve an entire family 2, and women afflicted and minimize its potential harmful effects on the with PPD are at high risk for recurrent depression. 3 baby. The first step in preventing postpartum Postpartum depression (PPD) is a non psychotic depression is the identification of women who are depressive episode of mild to moderate severity, at risk for developing it. The present study has been beginning in or extending into the first postnatal designed with an objective of identifying the year. Postpartum depression is an important public prevalence of the postpartum depression and health problem, having a significant impact on the factors associated with it. mother, the family, her partner, mother-infant
Materials & Methods: Present study was a hospital based cross sectional study conducted in the pot natal ward of a tertiary care hospital in Andhra Pradesh. A total of 100 postpartum women were selected from the postnatal ward using simple random sampling technique. Duration of the study was four months from January 2015 to April 2015. Mothers were interviewed using a pre designed questionnaire based on DSM-IV diagnostic criteria for major depression. 5 Questionnaire also included variables to elicit the demographic, obstetric and family support: 1. Demographic details including age, educational qualification, family structure (nuclear/joint), occupation, environmental health status and socioeconomic status. 2. Obstetric history including number and gender of children, present pregnancy (fears and expectations regarding gender of child, mode of delivery, complications both during pregnancy and delivery), and any complication during previous pregnancies. 3. Relationship with and support from the family including relationship with the husband, parents, and in-laws. Informed consent was taken from the study participants. Data analysis was done using EPI INFO version 7 and appropriate statistical tests of significance were applied wherever necessary with p <0.05 considered statistically significant. Results: Demographic characteristics of the study population revealed that majority (54%) belonged to more than 25 years age group. Only about half of the population were literates. Majority were from Hindu religion, belonged to Joint/ three generation family and were home makers by occupation. Table No 1: Demographic characteristics of the study population (n=100) Demographic variable Number Percent Age <20 years 20-25 years >25 years 21 25 54 21% 25% 54% Literacy status Illiterate Literate 44 56 44% 56% Religion Hindu Others 77 23 77% 23% Type of family Nuclear Joint & three generation 39 61 39% 61% Employment Employed Home maker 17 83 17% 83% 278
Obstetric history of the post natal women found that, majority were primi parous having single child at the time of interview. About 44% underwent either instrumental or caesarean section during the present delivery and about 45% had some kind of complications during delivery. Postpartum depression and factors associated with it: The overall prevalence of postpartum depression among the study population was found to be 22% (n=22). Association between the depression and elicited. Prevalence of depression was more among women who were less than 25 years age group and illiterate women (p<0.05). Primi parous women and women having single child also had more depression compared with multiparous women. Mode of delivery and any complications during the delivery had no significant association with postpartum depression (p>0.05). Family support during pregnancy and delivery had significant impact on post partum depression and it was statistically significant (p=0.01) various demographic & obstetric factors was Table No 2: Factors associated with post partum depression Risk factor With depression Without depression p value (n=22) (n=78) Age <25 years 15 31 0.01 * >25 years 07 47 Literacy status Illiterate 16 28 0.002 * Literate 06 50 Parity status Primipara 19 21 <0.001 * Multipara 03 57 Total number of children 1 17 32 0.002 * >1 05 46 Mode of delivery Caesarean/instrumental 12 32 0.2 Normal 10 46 Complication during delivery Yes 08 37 0.3 No 14 41 Family support Yes 04 37 0.01 * No 18 41 * p <0.05 (statistically significant) 279
Discussion Present study which was done with an objective of determining the prevalence of post partum depression and factors associated with it found that the overall prevalence was 22%. Some of the identified risk factors in the study were age (<25 years age group), literacy status (illiterates), women delivered for the first time (primi parous), lower family support especially from partner. Study by Swapan et al in Delhi found that the overall prevalence of post partum depression at 15.8%. Factors such as education status, lower socio economic status, more than one girl child, pressure to have a male child, lower family support were significantly associated with post partum depression. 6 Another study by Nimisha D et al in Gujarat observed that the prevalence rate of postpartum depression (PPD) was 12.5%. Women who delivered a girl child were observed to have higher odds of getting PPD, also multigravida, women having past history of miscarriage, women feeling tense during pregnancy, women who could not confide in partner and absence of someone other than mother and partner in whom the woman could confide were found to be the strongest predictors for developing postpartum depression. 7 A qualitative study from rural south India on post partum depression found that 26.3% were diagnosed to have post-partum depression. The following factors were associated with post-partum depression after adjusting for age and education: age less than 20 or over 30 years, schooling less than five years, thoughts of aborting current pregnancy, unhappy marriage, physical abuse during current pregnancy and after childbirth, husband's use of alcohol, girl child delivered in the absence of living boys and a preference for a boy, low birth weight, and a family history of depression. 8 Conclusions: Higher prevalence rate of post partum depression was seen among women who delivered for first time, illiterate, younger age group women and who had low family support. Hence special concentration needs to be given on counselling aspects during pregnancy especially for women who are young and pregnant for first time. Involvement of partner during ante natal visits would reduce the stress on the women and also improve the concept of male participation in the Planned Parenthood movement. References 1. Stowe ZN, Nemeroff CB. Women at risk for postpartum-onset major depression. Am J Obstet Gynecol. 1995; 173:639 45. 2. Weinberg MK, Tronick EZ. Maternal depression and infant maladjustment: a failure of mutual regulation. In: Nospitz JD, editor. Handbook of child and adolescent psychiatry. New York: Wiley; 1997. p. 177 91. 3. Cohen LS, Altshuler LL. Pharmacologic management of psychiatric illness during pregnancy and the postpartum period. Psychiatry Clin North Am. 1997; 4:21 60. 4. Beck CT. Postpartum depression: It isn t just the blues. Am J Nurs 2006; 106: 40-50. 5. American Psychiatric Association, Diagnostic and statistical manual of mental disorders, fourth edition, text revised. American Psychiatric Press, Washington, DC, 2000. 280
6. Gupta Swapan,Kishore Jugal, Mala Y. M., Ramji S, Aggarwal Reshma. Postpartum Depression in North Indian Women: Prevalence and Risk Factors. The Journal of Obstetrics and Gynecology of India (July August 2013) 63(4):223 229. 7. Desai Nimisha D, Mehta Ritambhara Y, Ganjiwale Jaishree. Study of prevalence and risk factors of postpartum depression. National Journal of Medical Research. 2012. 2 (2): 194-198. 8. Savarimuthu R.J.S, Ezhilarasu P, Charles H, Antonisamy B, Kurian S, Jacob K.S. Post-Partum Depression in the Community: a Qualitative Study From Rural South India. Int J Soc Psychiatry 2010; 56: 94-102. 281 278