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Table of Contents
ORIGINAL ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 2  |  Page : 67-71

Factors associated with postnatal depression among primi mothers


Assistant Professor, Government College of Nursing, Thiruvananthapuram, Kerala, India

Date of Web Publication21-Jan-2020

Correspondence Address:
Dr. D Jija
Government College of Nursing, Thiruvananthapuram, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_28_19

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  Abstract 


Introduction: Postnatal depression poses a heavy burden to the society because of its significant impact on the health of the baby, mother, and its negative effect on the family. During the postnatal period, the emotional status and social support of women has to be assessed. The present study aimed at identifying the factors associated with postnatal depression. Materials and Methods: A descriptive cross-sectional study was conducted in two hospitals in Thiruvananthapuram Corporation, Kerala. Primi mothers (n = 610) at 6 weeks after delivery attending the immunization clinic were included in the study. Consecutive sampling technique was used. The research tool used were sociodemographic data sheet, life events inventory, questionnaire on social support, and Edinburgh Postnatal Depression Scale. Results: The proportion of postnatal depression among the primi mothers was 9.5% (95% confidence interval [CI] 7.2–11.8). The factors associated with postnatal depression among primi mothers included alcoholism of husband (OR 3.01; 95% CI, 1.1–8.24), unplanned pregnancy (OR 2.32; 95% CI, 1.16–4.64), conflict with parents (OR 4.19; 95% CI, 0.9–19.63), conflict with in-laws (OR 5.16; 95% CI, 1.01–26.23), and lack of support from husband (OR 3.33; 95% CI, 1.26–8.81), mother (OR 15.02; 95% CI, 5.66–39.87), mother-in-law (OR 2.38; 95% CI, 1.06–5.34), and friends and neighbors (OR 2.01; 95%CI, 1–4.04). Conclusion: Health professionals at the periphery level of health care should be educated about the risk factors of postnatal depression.

Keywords: Factors, postnatal depression, primi mothers


How to cite this article:
Jija D. Factors associated with postnatal depression among primi mothers. Indian J Psy Nsg 2019;16:67-71

How to cite this URL:
Jija D. Factors associated with postnatal depression among primi mothers. Indian J Psy Nsg [serial online] 2019 [cited 2020 Aug 5];16:67-71. Available from: http://www.ijpn.in/text.asp?2019/16/2/67/276351




  Introduction Top


The postnatal period is associated with an increased risk for the development of mental disorders. Postpartum depression is defined as an episode of nonpsychotic depression with onset within 1 year of childbirth.[1]

Postnatal depression has been found to correlate with lower infant weight gain during the first 4 months after birth in the offspring,[2] poorer infant motor development by 15 months,[3] and stunted growth at 2 years.[4]

Maternal mental health has been identified as fundamental in attaining the Millennium Development Goals. Public health nurses have a vital role in supporting families with newborn babies.[5]

The general assessment of maternal well-being has to be performed at 6 weeks by the midwife as a routine essential care for improving maternal and newborn health.[6]

Midwives and nurses are the closest people to the mother during the postpartum period. Nurses have to consider the social and psychological requirements of the family, as well as that of the mother and the newborn in the postpartum period.[7]

During the postpartum period, the nurse is the ideal health professional to assess the psychological status of women by the virtue of her close proximity, rapport, and time for longitudinal observation of the women's behavior.

If postnatal depression has to be prevented, it is vital that the factors associated have to be identified. Investigator felt the need to determine the factors associated with postnatal depression so that the nursing community and the public can be sensitized to the psychological issues of women during the postpartum period.

Objective

The objective of the study was to identify the factors associated with postnatal depression among primi mothers.


  Materials and Methods Top


A cross-sectional study was carried out in two hospitals of Thiruvananthapuram Corporation, Kerala. Stratified random sampling technique was adopted for selecting the setting of the study. The study sample consisted of 610 primi mothers who attended immunization clinic at 6 weeks postpartum and were recruited consecutively. Primi mothers who had multiple pregnancies and had preterm deliveries were excluded from the study.

The study was approved by the Ethics Committee, Government Medical College, Thiruvananthapuram. Participants were informed of the nature and purpose of the study and they were also assured of the confidentiality of data. Written informed consent was obtained before the data collection.

An interview schedule was used to elicit information related to sociodemographic and obstetrical variables. Life events inventory was prepared by the investigator to identify the life events that were experienced by the primi mothers during the past 1 year.

The social support questionnaire prepared by the investigator measured the help that the primi mother had received from her husband, mother, mother-in-law, relatives, friends, and neighbors. This questionnaire includes 26 statements which were based on five domains of the sources of support for the primi mothers. Content validity of the tool was established by experts in the field of nursing, psychology, sociology, and psychiatry. Based on the suggestion of experts, modifications were made and the tool was finalized. The reliability of the social support questionnaire was determined by split-half method using Spearman–Brown formula. The reliability coefficient for the social support scale was 0.92.

Edinburgh Postnatal Depression Scale (EPDS) is a self-report instrument to detect the postnatal depression. EPDS is a standardized tool developed by Cox et al.[8] which has 10 items with a total score of 30. Each item had four responses, ranging from 0 to 3 according to the severity. Seven of its items were reverse scored. In the present study, a cutoff score of ≥13 on the Malayalam version of EPDS was used to determine the postnatal depression.

Multiple logistic regression test was adopted to identify the independent factors that determine the postnatal depression. Postnatal depression was taken as the dependent variable, and all variables having P < 0.20 at the univariate level were considered as independent variable for the multiple logistic regression analysis.


  Results Top


Sociodemographic and obstetrical variables

Among the primi mothers studied, 50.3% belonged to 22–25 years and 76.7% of primi mothers were homemakers. With regard to education, 35.2% of primi mothers had higher secondary education and 10.2% had professional education [Table 1].
Table 1: Sociodemographic characteristics of primi mothers (n=610)

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Majority of primi mothers (69.51%) were Hindus, whereas 11.15% of them were Muslims and 19.34% were Christians [Figure 1].
Figure 1: Distribution of primi mothers according to the religion

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When the distribution of primi mothers with respect to the type of family was analyzed, it was observed that 59% of them belonged to the joint family and 41% belonged to the nuclear family [Figure 2].
Figure 2: Percentage distribution of primi mothers based the on type of family

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Regarding the habits of husband, 81.1% were not having any bad habits, 12.5% of them had the habit of smoking, and 6.4% had the habit of alcoholism [Figure 3].
Figure 3: Distribution of primi mothers based on the habits of husband

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Among the primi mothers studied, 71.5% of primi mothers had planned pregnancy. Based on the mode of delivery, majority (75.2%) of them had vaginal delivery [Table 2].
Table 2: Frequency and percentage distribution of the sample according to the obstetrical characteristics

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[Table 3] depicts that majority of primi mothers (94.3%) received good support from their husbands. Majority of the primi mothers (92.1%) had good social support from their mothers. Among the primi mothers, 85.2% received good social support from mother-in-laws. When the distribution of primi mothers was analyzed based on the social support from relatives, majority of the primi mothers (77.4%) had good social support. Majority of the primi smothers (78.2%) had good social support from friends, mothers and neighbors.
Table 3: Frequency and percentage distribution of primi mothers based on the social support

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Proportion of postnatal depression

[Table 4] reveals that the proportion of postnatal depression among the sample studied was 9.5% (95% CI, 7.2–11.8).
Table 4: Proportion of postnatal depression among primi mothers

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Factors associated with postnatal depression

Bivariate analysis revealed that education of primi mother, alcoholism of husband, and pregnancy intention had a significant association with postnatal depression [Table 5].
Table 5: Bivariate analysis of association between postnatal depression and sociodemographic variables

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Social support from husbands, mothers, mother-in-laws, relatives, friends, and neighbors had a significant association with postnatal depression [Table 6].
Table 6: Bivariate analysis depicting the association between postnatal depression and social support

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Multiple logistic regression was used to identify the factors associated with postnatal depression. Eight variables which had a significant impact on the occurrence of postnatal depression were identified by the backward selection method of logistic regression. The extracted variables were alcoholism of husband (OR 3.01; 95% CI, 1.1–8.24), unplanned pregnancy (OR 2.32; 95% CI, 1.16–4.64), conflict with parents (OR 4.19; 95% CI, 0.9–19.63), conflict with in-laws (OR 5.16; 95% CI, 1.01–26.23), and lack of support from husband (OR 3.33; 95% CI, 1.26–8.81), mother (OR 15.02; 95% CI, 5.66–39.87), mother-in- law (OR 2.38; 95% CI, 1.06–5.34), and friends and neighbors (OR 2.01; 95% CI, 1–4.04). The R2 of the logistic regression indicates that 38% of the variation of occurrence of postnatal depression among women is determined by the selected eight variables [Table 7].
Table 7: Factors associated with postnatal depression (multiple logistic regression)

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  Discussion Top


The present study revealed that the proportion of postnatal depression was 9.5% (95% CI 7.2–11.8%) among the primi mothers. The prevalence of postnatal depression was 12.5%[9] in Gujarat and 6% in Delhi.[10] The present study findings may be due to the fact that more care is given to women when she is pregnant, especially for the first time in this culture. The study findings also revealed that primi mothers have received good social support during pregnancy and childbirth. Comparison between the studies based on the prevalence of postnatal depression is a difficult task due to the use of different assessment tools, different cutoffs for the same tool, and different timing of administration of tool.

Alcoholism, unplanned pregnancy, conflict with parents and in-laws, and support from husband, mother, mother-in-law, friends, and neighbors were the factors associated with postnatal depression. Similar findings are reported in which the strongest predictors of postnatal depression were a nonsupportive husband (OR = 2.5) and unwanted pregnancy (OR = 2.1).[11]

The limitation of the present study was that as it was a cross-sectional hospital-based study, it is not possible to reach meaningful conclusions regarding etiological factors. All the possible predictors of postnatal depression have also not been included in the study.


  Conclusion Top


The present study has identified alcoholism of husband, unplanned pregnancy, conflict with in-laws, and lack of support from husband, mother, mother-in-law, friends, and neighbors as the factors associated with postnatal depression. The study has highlighted the importance of psychosocial factors and social support in maintaining mental health of women during postnatal period. The findings of the study focusing on the identification of factors associated with postnatal depression can be utilized for prevention programs and integration of screening for mental health problems in the antenatal and postnatal period.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Robertson E, Celasun N, Stewart DE. Literature Review of Risk Factors and Intervention on Postpartum Depression. World Health Organization; 2008.  Back to cited text no. 1
    
2.
Wright CM, Parkinson KN, Drewett RF. The influence of maternal socioeconomic and emotional factors on infant weight gain and weight faltering (failure to thrive): data from a prospective birth cohort. Arch Dis Child 2006;91:312-7.  Back to cited text no. 2
    
3.
Avan B, Richter LM, Ramchandani PG, Norris SA, Stein A. Maternal postnatal depression and children's growth and behaviour during the early years of life: exploring the interaction between physical and mental health. Arch Dis Child 2010;95:690-5.  Back to cited text no. 3
    
4.
Cornish AM, McMahon CA, Ungerer JA, Barnett B, Kowalenko N, Tennant C. Postnatal depression and infant cognitive and motor development in the second postnatal year: The impact of depression chronicity and infant gender. Infant Behav Dev 2005;28:407-17.  Back to cited text no. 4
    
5.
World Health Organization. The Millennium Development Goals Report. World Health Organization; 2013. Available from: http://www.who.int/gho/maternal_health/en/. [Last accessed on 2018 Aug 28].  Back to cited text no. 5
    
6.
World Health Organization. Mental Health Aspects of Women's Reproductive Health. World Health Organization; 2009. Available from: http://whqlibdoc.who.int/publications/. [Last accessed on 2019 Jul 18].  Back to cited text no. 6
    
7.
Apay SE, Pasinlioglu T. Using Roy's model to evaluate the care given to postpartum women following caesarean delivery. Open J Nurs 2014;4:784-96.  Back to cited text no. 7
    
8.
Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh postnatal depression scale. Br J Psychiatry 1987;150:782-6.  Back to cited text no. 8
    
9.
Nimisha D, Ritambhara MY, Jaishree G. Prevalence and risk factors of postpartum depression. Natl J Med Res 2012;2:194-8.  Back to cited text no. 9
    
10.
Dubey C, Gupta N, Bhasin S, Muthal RA, Arora R. Prevalence and associated risk factors for postpartum depression in women attending a Tertiary hospital, Delhi, India. Int J Soc Psychiatry 2012;58:577-80.  Back to cited text no. 10
    
11.
Alasoom LI, Koura MR. Predictors of postpartum depression in the Eastern Province capital of Saudi Arabia. J Family Med Prim Care 2014;3:146-50.  Back to cited text no. 11
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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]



 

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