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A STUDY OF POSTPARTUM DEPRESSION IN A FAST DEVELOPING COUNTRY:
PREVALENCE AND RELATED FACTORSAbdulbari Bener*1,2,3 ,F.Tuna Burgut4
Suhaila Ghuloum5, Javaid Sheikh4
1Dept. of Medical Statistics & Epidemiology, Hamad General Hospital, Hamad Medical
Corporation, Dept. Of Public Health, Weill Cornell Medical College, Doha, Qatar2 Dept. Evidence for Population Health Unit, School of Epidemiology and Health Sciences,
The University of Manchester, Manchester, UK3Dept. of Public Health & Medical Education, Weill Cornell Medical College, Qatar
4Dept. of Psychiatry, Weill Cornell medical College, Qatar5Dept. of Psychiatry, Hamad Medical Corporation, Doha, Qatar.
INTRODUCTION
Mental diseases are one of the most common complications associated with pregnancies and childbirth.
It was reported that postpartum depression (PPD) is one of the important public health problems affecting maternal and child health.
INTRODUCTION
Postpartum psychological disorders lead to maternal disability and disturbed mother-infant relationship.
Postpartum depression is a serious
disorder which has been estimated to
affect 13-20% of women in industrialised
nations.
INTRODUCTION (Contd…)
It was identified that past history of psychopathology, psychological disturbance during pregnancy, poor marital relationship, poor social support and stressful life events are the primary risk factors for developing postpartum depression.
This is the first study examining the prevalence of postpartum depression and associated risk factors among Arab women in Qatar.
INTRODUCTION (Contd…)
OBJECTIVES
The aim of this study was to determine the
prevalence and identify the risk factors of
postpartum depression among Arab
women in Qatar using Edinburgh
Postnatal Depression Scale (EPDS).
SUBJECTS &
METHODS
Design: This is a prospective cross-sectional study.
Setting: The study was conducted at Primary Health Care Centers in Qatar.
Period of Study: January 2010 to May 2011.
Subjects: A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study.
SUBJECTS & METHODS
Data Collection:
The survey instrument was initially
tested on 100 patients who visited the
health centres and thus validated the
questionnaire.
The study excluded mothers whose
postnatal period was over 6 months
and who refused to give consent to
take part in the study.
SUBJECTS & METHODS (Contd…)
A validated structured questionnaire
was used to collect the socio-
demographic variables, psychiatric
history, interpersonal relationship, life
events and obstetric risks with the help
of qualified nurses.
Data Collection (Contd…):
SUBJECTS & METHODS (Contd…)
The Edinburgh postpartum depression
scale (EPDS) was used to identify the
risk cases.
The EPDS is a 10-item self-report scale,
specifically designed to screen for
postpartum depression in primary
care.
SUBJECTS & METHODS (Contd…)
The EPDS is a reliable and valid
instrument, it has been used in a
number of international settings
The EPDS is a reliable and valid instrument, it has been used in a number of international settings
SUBJECTS & METHODS (Contd…)
The EPDS questionnaire has items such as:
1. Having been able to laugh.
2. Having looked forward with enjoyment
to things.
3. Having blamed oneself unnecessarily.
4. having been anxious or worried for no
good reason.
5. Having felt scared or panicky for no
good reason.
6. Experiencing overload.
7. Having been so unhappy that it has
caused sleeping problems.
8. Having felt miserable or sad.
9. Having been so unhappy as to have
cried.
10.Thoughts of harming oneself.
The EPDS questionnaire has items (contd..)
Each item is scored on a 4-point scale
(0–3), the minimum and maximum total
score ranging from 0 to 30, respectively.
A score of ≥12, the most commonly
used cut off, is used to distinguish
women suffering from depression from
those who are not.
The EPDS questionnaire has items (contd..)
EDINBURG POSTNATAL DEPRESSION SCALE: SCORING SAMPLE
STATISTICAL ANALYSIS
Student-t test was used to ascertain the
significance of differences between
mean values of two continuous
variables.
Chi-square analysis was performed to
test for differences in proportions of
categorical variables between two or
more groups.
STATISTICAL ANALYSIS
Multivariate logistic regression analysis using the forward inclusion and backward deletion method was used to assess the relationship between dependent and independent variables and to adjust for potential confounders and orders the importance of risk factors (determinant) for postpartum depression.
The level p<0.05 was considered as the cut-off value for significance.
STATISTICAL ANALYSIS (Contd…)
STUDY FINDINGS
STUDY FINDINGS
The prevalence of postpartum
depression among the study
sample was 17.6%.
STUDY FINDINGS
There were statistically significant
differences observed between
depressed and non-depressed
mothers in their socio-demographic
characteristics;
STUDY FINDINGS
Mothers of age above 35 years (49.9% vs
39.2%; p<0.001),
Low education below intermediate level (51%
vs 35.8%; p<0.001),
Housewives (38.7% vs 29%; p=0.03),
Low monthly income (QR 5000-9999) (43.2% vs
32.2%;p<0.001)
Maternal complications (38.7% vs 26.1%;
p<0.001) and caesarean section (36.2% vs
28.8%; p=0.022) were significantly higher
among depressed mothers compared to non-
depressed women.
STUDY FINDINGS
Financial difficulties (OR=2.04; p<0.001),
prematurity (OR=1.64; p=0.025),
poor family support (OR=1.52; p=0.016),
dissatisfaction in marital life (OR=1.26;
p=0.005),
poor marital relationship (OR=1.13; p=0.05)
were the main predictors of postpartum
depression.
STUDY FINDINGS
Table 1: Socio-demographic characteristics of the studied women according to PPD Status (N=1379)
Variable
Total
N=1379
n(%)
Post partum Depression
p-valueYes
EPDS≥12
N=243
n(%)
No
EPDS<12
N=1136
n(%)
Age(Mean±SD) 33.5±6.5 33.3±7.1 33.5±6.4 0.560
Age in Years
<25 Years 204(14.8) 48(19.8) 156(13.7)
<0.00125-34 Years 633(45.9) 74(30.3) 535(47.1)
>35 Years 542(39.3) 121(49.9) 445(39.2)
Education Level
Illiterate 104(7.5) 27(11.1) 77(6.8)
<0.001
Primary 200(14.5) 50(20.6) 150(13.2)
Intermediate 276(20.0) 47(19.3) 180(15.8)
Secondary 440(31.9) 64(26.4) 405(35.7)
University 359(26.0) 55(22.6) 324(28.5)
Occupation
House Wife 424(30.7) 94(38.7) 330(29.0)
0.030
Professional 573(41.6) 90(37.0) 483(42.5)
Manual 126(9.1) 24(9.9) 102(9.0)
Business Women 180(13.1) 23(9.5) 157(13.8)
Army/police 76(5.5) 12(4.9) 64(5.6)
Variable
Total
N=1379
n(%)
Post partum Depression
p-valueYes
EPDS≥12
N=243
n(%)
No
EPDS<12
N=1136
n(%)
Family income*QR
Less 5000 141(10.2) 66(27.2) 75(6.6)
<0.0015000-9999 471(34.2) 105(43.2) 366(32.2)
10,000-14,999 326(23.6) 40(16.5) 286(25.2)
>15,000 441(32.0) 32(13.2) 409(36.0)
Consanguinity
Yes 518(37.6) 108(44.4) 410(36.1)0.015
No 861(62.4) 135(53.6) 726(63.9)
Baby’s Gender
Boys 692(50.2) 119(49.0) 573(50.4)0.678
Girls 687(49.8) 124(51.0) 563(49.6)
Transportation Access
Yes 1172(85.0) 188(77.4) 984(86.6)<0.001
No 207(15.0) 55(22.6) 152(13.4)
How many Bedrooms at your home 5.0±2.3 5.3±2.5 5.0±2.1 0.043
How many people living at your home 6.0±3.1 6.5±3.3 6.0±3.0 0.020
Table 1: Socio-demographic characteristics of the studied women according to PPD Status. (Contd…)
Life Events
Post partum Depression
P-ValueYes(EPDS≥12)
N=243
No (EPDS<12)
N=1136
Relationship Problem n(%) n(%)
Relationship with your husband Good 68(28.0) 405(35.7)0.022
Bad 172(72.0) 731(64.3)
Relationship with mother in law Good 72(29.6) 489(43.0)<0.001
Bad 171(70.4) 647(57.0)
Strong family support Good 182(74.9) 984(86.5)<0.001
Bad 61(25.1) 152(13.4)
Nanny to take of your child Yes 97(39.9) 472(41.5)0.639
No 146(60.1) 664(58.5)
No Of Children’s (Mean±SD) Boys 2.0±1.2 2.0±1.2 0.945
Girls 1.6±1.0 1.5±1.0 0.691
Difficult to Manage with Income Yes 186(76.5) 789(69.5)0.028
No 57(23.5) 347(30.5)
Satisfaction in your married life Good 154(63.5) 895(78.8)<0.001
Bad 89(36.5) 241(25.7)
History of Depression Yes 28(11.5) 142(12.5)0.674
No 215(88.5) 994(87.5)
Family history of depression Yes 42(17.3) 181(15.9)0.604
No 201(82.7) 955(84.1)
Table 2. Association between stressful life events and postpartum depression in studied women according to the PPD Status (N=1379)
Maternal Characteristics
Post partum Depression
P-ValueYes
EPDS≥12
N=243
n(%)
No
EPDS<12
N=1136
n(%)
Planned Pregnancy Yes 117(48.1) 617(54.3)0.530
No 126(51.9) 517(45.7)
History of Fertility Yes 32(13.2) 116(10.2)0.176
No 211(86.8) 1020(89.8)
Complication during pregnancy Yes 94(38.7) 295(26.1)<0.001
No 149(61.3) 841(73.9)
Maternal Complications*
Anaemia 23(9.4) 48(4.2) 0.001
Bleeding 65(26.7) 170(15.0) <0.001
Blood Pressure 25(10.2) 27(2.4) <0.001
GDM 24(9.9) 70(6.2) 0.051
Miscarriage 8(3.2) 25(2.2) 0.435
Threatened abortion 3(0.9) 4(0.4) 0.109
Urinary infection 9(3.7) 5(0.5) 0.001
Mode of last Delivery
Vaginal delivery 155(63.8) 809(71.2)0.022
C-Section 88(36.2) 327(28.8)
Table 3: Maternal and Infant characteristics of the studied women according to the PPD Status. (N= 1379)
Infant Characteristics
Post partum Depression
P-ValueYes
EPDS≥12
N=243
n(%)
No
EPDS<12
N=1136
n(%)
Normal weight and height
Yes Yes 205(84.4) 986(86.8)0.367
No No 38(15.6) 150(13.2)
Premature baby in ICU
Yes Yes 41(16.9) 135(11.9)0.034
No No 202(83.1) 1001(88.1)
Mode of Feeding
Solely breast fed 74(30.5) 424(37.3)
<0.001Breast fed and formula 114(46.9) 590(51.9)
Formula 55(22.6) 122(10.7)
Strong preference for the baby gender
Yes 88(36.2) 360(31.7)0.172
No 155(63.8) 776(68.3)
Table 3: Maternal and Infant characteristics of the studied women according to the PPD Status. ( Contd…)
Independent Variables
Odd
ratio
95%
Confidence
Interval
P Value
Difficulty to manage with income. 2.37 1.56 – 3.58 <0.001
Prematurity 1.64 1.06 – 2.54 0.025
Poor Family Support 1.52 1.0 – 2.14 0.016
Dissatisfaction in their married life. 1.26 1.0 – 1.47 0.005
Poor marital relationship 1.13 1.0 – 1.29 0.048
Table 4: Results of logistic Regression analysis
for predictors of Post partum Depression.
Table 5. Prevalence rate for postpartum depression according to the country
Country Age GroupSample
SizePrevalence rate (%) Year Reference
Australia 16-35 Years 4366 17.4% 2010 Yelland et al
Australia 18-44 Years 80 24.7% 2006 Miller et al
Australia 17-36 Years 52 25.1% 2007 Phillips et al
Brazil 14-47 Years 271 20.7% 2008 Tannous et al
Brazil 13-31 Years 410 19.0% 2000 Inacia et al
India Goa 18-37 Years 59 23% 2001 Patel et al
Pakistan 17-40 Years 149 36% 2006 Hussain et al
Morrocco 18-44 Years 144 18.7% 2005 Agoub et al
Oklahoma 18-35 Years 5586 26% 2005-2006 Crutcher et al
Turkey 15-44 Years 1447
29.0% at 0-2 Months
36.6% at 3-6 months
36.0 % a t 7-12 Months
42.7% at >13 Months
2004 Bugnayci et al
Dubai 25-34 Years 90 18.0% 1997 Abou Saleh and Ghubash
Bangladesh 17-41 Years 361 33% 2009 Gausia et al
USA 17-47 Years 192 23.4 1995 Hobfoll et al
Qatar 18-45 years 1379 17.6% 2010-2011 Bener et al
CONCLUSION
The present study revealed the following:
The prevalence of postpartum depression was higher than the rates observed in developed countries.
The prevalence of postpartum depression was greatest among mothers with lower socio-economic level such as advanced age, low education and illiteracy, housewives, low family income.
CONCLUSION
Among the psychosocial factors, lack of
family support, marital disharmony,
stressful life events were significantly
associated with postpartum depression.
Financial difficulties, prematurity, lack of
family support and poor marital
relationships have been reported as main
risk factors for developing postpartum
depression.
CONCLUSION (Contd…)
ACKNOWLEDGEMENTThis study was generously supported and funded
by the Qatar National Research Fund- QNRF NPRP 30-6-7-44 and Weill Cornell IRB Ethical Approval (WCMC-Q#2011-0008). The authors
would like to thank the Hamad Medical Corporation for their support and ethical
approval (HMC MRC #10119/10)
THANK YOU!