Postpartum depression in north Indian women: prevalence and risk factors

Legal interventions for perinatal depression in India: a qualitative study with clinical specialists having expertise in perinatal mental health

OBJECTIVES

To provide insights into the perspectives of clinical specialists (CSs) regarding the efficacy of existing legal interventions (health laws, policies, guidelines, etc) in addressing and managing perinatal depression (PND) in women in India, in the background of the existing policy gap.

STUDY DESIGN AND METHODS

After adopting the consultative participatory approach, a qualitative study involving online, semi-structured, in-depth interviews was conducted. Purposive, and snowball sampling techniques were used to identify and invite the participants. Thematic content analysis was performed. The findings were reported in alignment with the Standards of Reporting Qualitative Research checklist.

SETTING

India.

PARTICIPANTS

12 out of 38 invited CSs participated in the study. All invited participants either had a background in perinatal psychiatry or were experienced in working with the perinatal population and had undertaken evidence-based research regarding perinatal mental health (PMH), in the Indian setting.

RESULTS

Five themes emerged from the collected data including (1) the epidemiology of PND in the Indian context, (2) the management of PND in India and the efficacy of the existing legal frameworks, (3) the need for legal interventions for addressing and managing PND in India, (4) role of legislative instruments, globally, in managing maternal PND and (5) advocacy for PMH by lawyers, and advocates in India.

CONCLUSIONS

The existing policy gap is associated with the violation of women's rights. The Mental Health Care Act (MHCA), 2017 should be amended to recognise perinatal women as a vulnerable group and to prioritise their PMH needs. A nationwide policy should be introduced to ensure integrated PMH services.

The Prevalence and Risk Factors of Postpartum Depression in Western India: A Cross-Sectional Study

Background

Postpartum depression (PPD) is a nonpsychotic mental health condition associated with child birth. It poses a major global public health challenge as it remains unrecognized most of the time and impairs both the immediate and long-term health of both the mother and child. The study was conducted to estimate the prevalence and associated risk factors for PPD.

Materials and Methods

A cross-sectional study was conducted among 450 women who delivered babies within the past 1-12 months and attending a tertiary care hospital during April to November 2021. Systemic random sampling was used to obtain the desired sample size. Basic sociodemographic variables (age, duration of postpartum period, residence, religion, education, occupation, birth spacing, complication during pregnancy, desired gender of child, birth weight of baby) related to pregnancy were collected. The Edinburgh Postnatal Depression Scale was used to estimate the prevalence of PPD.

Results

The prevalence of PPD in the study was 14.2%. The mean ± standard deviation age of women was 27.1 ± 4.7 years. Sociodemographic factors such as maternal age, low level of education, and family type and obstetric factors such as age at first pregnancy, parity, and history of abortion were significantly associated with PPD (P < 0.05).

Conclusion

Risk factors related to sociodemographic and obstetric history were found to be significantly associated with PPD. To prevent major depression in postpartum, early detection and timely referral are needed.

Stress and parental behaviors

In nearly all mammalian species, newborn pups are weak and vulnerable, relying heavily on care and protection from parents for survival. Thus, developmentally hardwired neural circuits are in place to ensure the timely expression of parental behaviors. Furthermore, several neurochemical systems, including estrogen, oxytocin, and dopamine, facilitate the emergence and expression of parental behaviors. However, stress can adversely affect these systems, impairing parental behaviors. In this review, we will summarize our current knowledge regarding the impact of stress on pup-directed behavior circuits that lead to infant neglect, abuse, and, in extreme cases, killing. We will discuss various stressors that influence parental behaviors at different life stages and how stress induces changes in the neurochemical systems that support parental care, ultimately leading to its poor performance.

Postpartum Depression and Its Determinants: A Cross-Sectional Study

Background Postpartum depression (PPD) is the most prevalent psychological disorder after childbirth associated with a negative impact on the daily functioning of mothers and the cognitive development of infants. Inequitable primary mental health access in lower-middle-income countries (LMICs) further aggravates this major public health problem. Objective The objective of this study is to estimate the prevalence and determinants of PPD among women reporting to secondary care facilities in Delhi, India. Methods A cross-sectional study was conducted in the outpatient settings of two secondary care (one government and one private) hospitals in the Delhi-National Capital Region among mothers of infants aged below six months. The study was conducted from January to June 2023. Data were collected by a single trained investigator using a self-designed interview schedule, while PPD was measured by administering the Edinburgh Postnatal Depression Scale (EPDS). Data were analyzed with Stata statistical software, version 15.1 (StataCorp LLC, College Station, TX). P < 0.05 was considered statistically significant. Results The mean age of the study participants was 28.49 ± 3.77 years with 53 (18.28%) detected as having possible postpartum depression on screening with the EPDS. On adjustment for covariates, the participants with husbands consuming alcohol (adjusted odds ratio, 6.97; 95% confidence interval {CI}, 2.73-17.8), those who underwent C-section (adjusted odds ratio, 4.39; 95% CI, 1.02-18.85), and those giving birth in private hospitals (adjusted odds ratio, 5.48; 95% CI, 1.53-19.55) had significantly higher odds of having PPD. In contrast, mothers staying at home (not employed) (adjusted odds ratio, 0.08; 95% CI, 0.02-0.41), without specific preference for the newborn's gender (adjusted odds ratio, 0.07; 95% CI, 0.01-0.78), and those living in nuclear families (adjusted odds ratio, 0.03; 95% CI, 0.005-0.19) had significantly lower odds of PPD. Conclusion Nearly one in five mothers were screened for having possible PPD. Prioritizing birth preparedness during the antenatal period and strengthening health system screening protocols may prevent and mitigate the effects of PPD.

Call For Action: The Obstetrician's Role In Peripartum Mental Health

Peripartum mental health is an underdiagnosed and undertreated entity; obstetricians are in a dilemma when patients present with signs of any mental disturbance. The peripartum period is fraught with triggers that can cause, or exacerbate, mental illness, and obstetricians need to be aware of diagnoses and treatment of blues, depression, psychosis and other problems. Key strategies that can be adopted are discussed in this review, along with the scenario in India.

From the womb to the world: a study of pregnancy narratives by celebrity moms in India

This article examines how celebrity moms in India are self-constructing their public persona through their pregnancy narratives. As a form of personal narrative, pregnancy narratives provide important insights into the unnarrated private world of pregnancy and its nuanced experiences. Although pregnancy and motherhood are glorified in India, it is subjected to a regime of cultural control thereby influencing women's disclosure of pregnancy behaviour and their narrative freedom. Despite being a life-altering event for women, pregnancy experiences and their narrativisation in India have largely been confined to the domestic spaces. However, some recent developments suggest the modernisation of maternity in India and point towards the emergence of a new cultural phenomenon as celebrity mothers through their pregnancy narratives are questioning the traditional beliefs and scientific practices which restrict women and their narrative freedom during pregnancy and childbirth. They are also documenting their obstetric violence, postpartum changes and the alternative means adopted by them to give birth. Through a narrative analysis of Kareena Kapoor's Pregnancy Bible (2021), Tahira Kashyap's The 7 Sins of Being a Mother (2021) and Kalki Koechlin's The Elephant in the Womb (2021), this article examines how modern maternity is being constructed in India and how it is entering popular discourse through personal narratives. In the process, it investigates how these celebrity mothers, to make themselves more acceptable, subvert the existing discourse of maternity and modernise it while retaining its necessary traditionalism. Most importantly, the article develops an understanding of the role of these narratives in encouraging the performance of maternity beyond the domestic setup.

India's Silent Struggle: A Scoping Review on Postpartum Depression in the Land of a Billion Mothers

Background

Postpartum emotional issues, including postpartum blues, postpartum psychosis, and postpartum depression (PPD), affect many mothers worldwide. The prevalence of postpartum blues ranges from 300 to 750 per 1,000 mothers, while postpartum psychosis has a prevalence of 0.89-2.6 cases per 1,000 births. PPD affects 100-150 new mothers per 1,000 births, and its prevalence can go above 25% globally. Depression in mothers can have long-lasting impacts on children and the next generation, affecting their growth, development, and relationships. However, the condition of PPD is frequently misdiagnosed, and women who suffer from it do not receive treatment. There is a lack of solid systematic evidence that looks at the overall burden of PPD and the risk factors that are associated with it in India. The awareness of PPD is critical in managing the symptoms and seeking professional support, and studies are needed to evaluate and assess the situation in India.

Methodology

This study is a systematic literature review with a scoping review approach aimed at providing existing evidence on the awareness and prevalence of PPD in India. The search strategy for the electronic bibliographic search included a list of related terms and factors of awareness and prevalence of PPD. The search encompassed six prominent databases. The assessment tools used in studies from 2012 to 2023 study the factors using the Postpartum Depression Literacy Scale (PoDLiS) and the Edinburgh Postpartum Depression Scale, which measure the awareness and prevalence of PPD.

Results

The study found a significantly low volume of studies conducted in India to determine the prevalence of PPD. The materials or studies accessible are hospital-based research with a minimal number of samples. The reported prevalence rate of postpartum depression (PPD) in India varies across different studies, ranging from 4% to 48.5%. Among mothers who gave birth either naturally or by cesarean section in a hospital setting, one study reported the lowest prevalence rate (4%). The prevalence of PPD among women in India is estimated to be 18% based on the average score across all research. A study that evaluated the moms in the community found that PPD was prevalent in new mothers at a rate of 21.5%. There are three studies, in particular, that focus on how aware people are of PPD. Two studies found that 54% of the family members of postpartum moms and women undergoing tertiary pediatric care are aware of PPD.

Discussion

Many studies point to the lack of social support as a significant risk factor for mental health complications after delivery. History of depression, anxiety, adverse life events, partner abuse, low economic status, complications at childbirth, and a traumatic childbirth experience are some of the associated factors identified in the studies. Studies have also shown that women who undergo a cesarean section have a higher risk of developing PPD than those with a vaginal delivery.

A Cross-Sectional Study Exploring Postpartum Depression at a Tertiary Care Center in Eastern Uttar Pradesh, India

Background Postpartum depression (PPD) is a significant public health concern globally characterized by a spectrum of mood disturbances ranging from mild mood swings to severe depressive episodes initiating within four weeks post childbirth and potentially persisting up to 12 months. Besides affecting the mother, it also affects the mental health and development of the babies born to affected mothers. Despite its considerable burden and potential adverse effects on both maternal and child well-being, PPD often goes undetected and untreated. Materials and methods A cross-sectional study was conducted from January 2024 to March 2024 at a tertiary care center in Gorakhpur to assess PPD in 280 postpartum women. The Edinburgh Postnatal Depression Scale (EPDS) score ≥ 10 was used to confirm depression. Data collection involved a pretested, structured questionnaire. Data were analyzed using SPSS version 22 (IBM Corp., Armonk, NY). A p-value < 0.05 was considered statistically significant. Results The prevalence of PPD was 12.14%. Age and education were significant sociodemographic risk factors (p < 0.05). In psychosocial factors, adverse life events (p < 0.001), wishing for a male child but giving birth to a female (p = 0.01), domestic violence (p = 0.005), relationship issues, an alcoholic spouse (p = 0.01), and poor in-law relations (p < 0.001) were found to be linked to PPD. Obstetric factors such as complicated antenatal history, physical illness, cesarean section, complicated intranatal history, and postpartum complications were also found to be important factors. Conclusion PPD affects many women, emphasizing the need for effective measures. Initiatives like the appointment of healthcare counselors and PPD screening programs in healthcare settings are essential to detect and support affected mothers.

Perinatal Mental Disorders: The ‘Non Liquet’ Facet of Mental Health Legislative Instruments in India

Due to the impetus provided by the Millennium Development Goals and the Sustainable Development Goals, maternal health has become the subject matter of various legislative instruments worldwide. However, perinatal mental disorders have remained an underestimated public health issue in many countries. High prevalence rates of such perinatal disorders in India have been reported by various evidence-based studies. This makes it imperative to analyse the provisions of the mental healthcare legislative instruments that have been brought into force in India. This article aims to evaluate and analyse coverage of perinatal mental disorders under the provisions of the legislative instruments, especially statutes, providing for mental health in India. Websites of the Government of India, various Indian Ministries and other government agencies were visited to obtain relevant documents regarding the mental health policy and legislation. None of the mental health legislative instruments in India underscore perinatal mental disorders as a public health concern, whereby failing to identify the unique characteristics of perinatal mental disorders. They consequently do not provide for nationwide detection and treatment measures. There is an immediate and pertinent need to highlight perinatal mental disorders through legislative instruments. The National Mental Health Policy, 2014 provides for comprehensive healthcare services; however, it excludes measures for perinatal mental health services. The Mental Healthcare Act, 2017 should be amended to explicitly include women during the perinatal period, along with originally provided mental health services for children and elderly individuals.

Prevalence and risk factors of postpartum depression in sub-Himalayan region

Background

Postpartum depression (PPD) is a common problem faced by women after childbirth. The adverse effects of PPD upon the maternal-infant relationship and child development reinforce the need for early identification and effective treatment models. This study intends to add to the existing knowledge about the prevalence of PPD and its associated risk factors in the hilly region in Himachal Pradesh.

Methods

A hospital-based cross-sectional study was conducted on 426 women presenting for a postpartum visit at 6 weeks postpartum. Sociodemographic characteristics were recorded on a pretested questionnaire. Women were screened for postpartum depression using a validated EPDS (Edinburgh postnatal depression scale) prestructured questionnaire with 10 questions. Women were divided into two groups based on screening results.

Results

The overall prevalence of PPD in the study was 17.4%. Out of sociodemographic factors, age (0.010) and family structure (0.008) were found to be significant. Nuclear family women were more prone to PPD. Domestic abuse (<0.001) is also a leading factor for PPD. By comparing obstetric and gender issues, it was found that the total number of previous living children (p-value <0.001), gender of previous living children (<0.001), and gender of newborns (<0.001) are the major determining factors of PPD. Another factor that was significantly related to PPD was an unwanted pregnancy.

Conclusions

We have found a high prevalence of PPD in our region that does not have screening protocols for the screening of such patients. We, therefore, propose routine screening for postpartum depression at 6 weeks postpartum.

Depression among currently married ever pregnant adolescents in Uttar Pradesh and Bihar: Evidence from understanding the lives of adolescents and young adults (UDAYA) survey, India

Background

Depression is a major public health concern among Indian adolescents. Pre- and post-natal depression can often alter fetal development and have negative consequences on the physical and mental health of the mother. This paper aims to draw attention to the prevalence of depression and its correlates among currently married, ever-pregnant adolescents from two Indian States, i.e. Uttar Pradesh and Bihar.

Methods

This study utilizes data from a subsample (n = 3116) of the prospective cohort study Understanding the Lives of Adolescents and Young Adults (UDAYA) among 10 to 19 year-old adolescents. Bivariate analysis was performed to assess the prevalence of depression by sociodemographic and behavioral characteristics. To further access the predictors associated with depression a logistic regression model was applied.

Results

Around one-tenth (9%) of pregnant adolescents had depression. Regression analysis indicated that substance use, religion, autonomy, considering attempting suicide, premarital relationship, violence, dowry, adverse pregnancy outcome, menstrual problem, and parental pressure for the child immediately after marriage were significantly associated with depression.

Conclusions

This study confirms the pre-existing annotation that teen pregnancy is linked with depression. Findings indicate that Adolescent mothers experiencing violence, and a history of adverse pregnancy outcomes are at increased risk of developing depression. These study findings call for an urgent need to address depression among adolescent mothers.

Prevalence of postpartum major depression and depressive symptoms in Spanish women: A longitudinal study up to 1 year postpartum

OBJECTIVE

Depression is a prevalent mental disorder in the postpartum period, with consequences for both the mother and her offspring. However, longitudinal studies determining the moments of greatest vulnerability and severity of depression during the postpartum period are scarce. The aims of this research were to determine the prevalence and trajectories of probable depression and major depression during the first year postpartum.

DESIGN

Longitudinal study.

SETTING

Interviews were conducted personally at three times: 2 months, 6 months and 1 year postpartum.

PARTICIPANTS

561 postpartum women.

MEASUREMENTS AND FINDINGS

Depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Structured Clinical Interview (SCID) for the Diagnostic and Statistical Manual of Mental Disorders (DSM). Descriptive and comparative analyses have been carried out. The prevalence of probable depression at 2 months, 6 months and 1 year postpartum, using a cut-off point ≥ 10, was 30.3%, 26.0% and 25.3%, respectively; and that of major depression using SCID was 10.3%, 10.9% and 14.8, respectively. The prevalence of probable depression was highest at 2 months postpartum and that of major depression at 1 year postpartum. Probable depression followed a downward trajectory and major depression followed an upward trajectory.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The clinical relevance of this research is that it has made it possible to demonstrate that depression is very prevalent in the first year postpartum and that, far from subsiding, the prevalence remains very high even at 1 year postpartum. Our findings highlight the importance of taking mental health care into account throughout at least the first year postpartum.

SMARThealth PRegnancy And Mental Health study: protocol for a situational analysis of perinatal mental health in women living in rural India

Introduction

The situation for women experiencing mental health problems during pregnancy and postpartum in rural India is critical: a high burden of disease, a high estimated number of women are undiagnosed and untreated with mental health problems, a substantial gap in research on women's perinatal health, and severe stigma and discrimination. The SMARThealth Pregnancy study is a cluster randomised trial using a digital intervention to identify and manage anaemia, hypertension, and diabetes in the first year after birth in rural India. Within this study, the SMARThealth Pregnancy and Mental Health (PRAMH) study is a situational analysis to understand mental health problems during pregnancy and in the first year following birth in this population.

Methods/design

This situational analysis aims to analyse and to assess the context of perinatal mental health, health services, barriers, facilitators, and gaps in Siddipet district of Telangana state in India, to develop an implementation framework for a future intervention. A tested, standardised situational analysis tool will be adapted and applied to perinatal mental health in rural India. A desktop and policy review will be conducted to identify and analyse relevant mental health and pregnancy care policies at the national and state levels. We will conduct in-depth interviews with policymakers, planners, mental health professionals and other experts in perinatal mental health (n = 10-15). We will also conduct focus group discussions with key stakeholders, including women with perinatal mental health problems, their families and carers, and community health workers (n = 24-40). A theory of change workshop with key stakeholders will be conducted which will also serve as a priority setting exercise, and will clarify challenges and opportunities, priorities, and objectives for a pilot intervention study. The analysis of qualitive data will be done using thematic analysis. Based on the data analysis and synthesis of the findings, an implementation framework will be developed to guide development, testing and scale up of a contextually relevant intervention for perinatal mental health.

Discussion

The situational analysis will help to establish relationships with all relevant stakeholders, clarify the context and hypotheses for the pilot intervention and implementation.

Association between Gestational Diabetes Mellitus and Postpartum Depression among Women in Eastern India: A Cohort Study

Background

The study was planned to evaluate the association between Gestational Diabetes Mellitus (GDM) and Postpartum Depression (PPD) in a rural population of Odisha, Eastern India.

Material and Methods

Pregnant women in the first trimester were recruited and followed up till six weeks of postpartum. Gestational Diabetes Mellitus was assessed with 75 grams glucose challenge test and PPD was assessed at six weeks after delivery with Edinburgh Postnatal Depression Scale. Statistical difference between variables was assessed using Chi-square test, Fischer's exact test, and unpaired T-test. Covariates were adjusted using bivariate and multivariate logistic regression to estimate the association between GDM and PPD.

Results

Out of 436 pregnant women recruited, 347 (89.6%) remained in the study. Prevalence of GDM was 13.9% (95% CI: 10.7-17.3) and PPD was 9.8% (95% CI: 6.6-12.9). Incidence of PPD in the GDM group was 14.58% (95% CI: 4.2-24.9) and in women without GDM was 9.06% (95% CI: 5.76-12.3). However, the association was not significant on multivariate logistic regression (Risk Ratio (RR) = 1.56, 95% C.I: 0.61-6.16; P-value = 0.35).

Conclusion

This study demonstrated that women with GDM were at higher risk of developing PPD suggesting that an "at risk" approach should be implemented for screening.

Prevalence and related factors of perinatal depression in Egyptian mothers

Background

Early detection of perinatal depression and its cultural determinants could reduce its sequalae on mothers and their babies. This study investigated the prevalence of perinatal depression in Egyptian mothers and compare women with and without perinatal depression regarding the psychosocial factors.

Three-hundred one women were recruited (166 were pregnant and 135 were in postpartum period) from a primary healthcare unit. Full sociodemographic data, Social Classification Scale, Dyadic Adjustment Scale (DAS), and the Edinburgh Postnatal Depression Scale (EPDS) were completed. Subjects with EPDS score > 9 answered the structured clinical interview (SCID-I) for diagnosis of depression and Hamilton Rating Scale for Depression (HRSD) for depression severity.

Results

Depression with mild to moderate severity was reported in 5.4% and 3.7% of women during pregnancy and postpartum period, respectively. There was a statistically significant association between depression and employment (p = 0.031), mother-in-law disputes (p = 0.002), stigma of being the second wife (p = 0.047), and having financial burdens (p = 0.001). Marital satisfaction was a protective factor for depression (p < 0.001).

Conclusions

Prevalence of perinatal depression was comparable to other developing countries. It was strongly linked to culturally related factors including marital women’s employment, mother-in-law disputes, being the second wife, and socioeconomic burdens. Early detection of perinatal depression and its culturally related factors is important for its management.

Postpartum depression and its clinico-social correlates – A community-based study in aligarh

Context

Postpartum depression (PPD) is onset of depressive symptoms in postpartum period from 2 weeks to 1 year. It causes maternal morbidity and long-term negative effects on growth and development of infant and child. It is often unreported and underdiagnosed.

Aims

(1) To estimate the prevalence of PPD, (2) To determine socio-demographic, clinical, and obstetric correlates of the same.

Settings and Design

A cross-sectional study was done in urban and rural areas of District Aligarh.

Methods

A total of 304 females between 6 weeks and 6 months' postpartum period giving consent were included in this study. Sociodemographic, obstetric, and clinico-social factors were recorded using predesigned, pretested questionnaire. Edinburgh Postnatal Depression Scale (EPDS) score ≥10 was used to screen for PPD and International Classification of Disease (ICD-10) criteria for confirmation.

Statistical Analysis Used

Correlates of PPD were determined using logistic regression analysis.

Results

The prevalence of PPD was 9.5% using EPDS and was confirmed by ICD-10 criteria. History of abortion (adjusted odds ratio [AOR]: 6.0, 95% Confidence Interval [CI] 2.2-16.5), poor relationship with in-laws (AOR: 5.1; 95% CI 1.3-20.5), marital conflict (AOR: 13.3; 95% CI 2.2-77.6), and substance abuse in husband (AOR: 3.1; 95% CI 1.1-9.0) were found to be significant correlates for PPD.

Conclusions

About one in every 10 postpartum females suffered from depression but did not seek health care for the same. Women facing social pathologies such as substance abuse in husband, marital conflict, and poor relationship with in-laws are more at risk of PPD. Screening for PPD should be included in the maternal and child health care programs to ensure early diagnosis and treatment.

Assessment of difference in postpartum depression among caesarean and vaginally delivered women at 6-week follow-up in hospitals in Pune District, India: an observational cohort study

OBJECTIVES

To compare the proportion of postpartum depression at 6 weeks among women who had caesarean delivery and women who had vaginal delivery and to assess its association with some sociodemographic factors.

DESIGN

This is a descriptive comparative study with prospective enrolment. We followed the enrolled women and assessed them for postpartum depression 6 weeks after delivery.

SETTING

We conducted the study in Pune District, India from July 2017 to December 2018. The study sites were all non-teaching government hospitals performing five or more caesarean sections per month and two teaching hospitals: one government and one private.

PARTICIPANTS

We included in the study group women who have undergone caesarean section in the participating hospitals and were residents of Pune District. Women who delivered vaginally and matched in age and parity were included in the comparison group. We followed 1556 women in each group.

MAIN OUTCOME MEASURES

An Edinburgh Postnatal Depression Scale score of 10 or more for each woman was the primary outcome. χ2 test and multivariable binary logistic regression were performed to assess the effect of mode of delivery on postpartum depression.

RESULTS

The proportion of postpartum depression at 6 weeks was 3.79% among women who had caesarean delivery and 2.35% among those who had vaginal delivery (χ2=4.50, p=0.03). The adjusted OR was 1.86 (95% CI 1.14 to 3.03). Women of age less than 25 years had higher risk of postpartum depression. The adjusted OR was 2.10 (95% CI 1.21 to 3.65). The study did not observe any association between postpartum depression and income, education, occupation or sex of the newborn child.

CONCLUSIONS

We conclude that young women particularly those who had caesarean delivery should be screened 6 weeks after delivery.

Exploring Intimate Partner Violence Before, During, and After Pregnancy in Bangladesh

Intimate partner violence (IPV) against pregnant or postpartum women is known to have multiple detrimental effects on women and their children. Although results from past research suggest much continuity in trajectories of IPV, it is unclear whether pregnancy interrupts or augments these patterns. Little is known about how physical, sexual, and psychological IPV change and overlap throughout a woman's transition to parenthood. Relying on population-based data, this study examines the prevalence, co-occurring nature, and the changing patterns of physical, sexual, and psychological IPV before, during, and after pregnancy in Bangladesh. Cross-sectional survey data were collected between October 2015 and January 2016 in the Chandpur District of Bangladesh from 426 new mothers, aged 15 to 49 years, who were in the first 6 months postpartum. IPV was assessed with a validated set of survey items. The frequencies of different types of IPV victimization according to the period of occurrence were calculated separately and in a cumulative, co-occurring manner. The prevalence of physical IPV before, during, and after pregnancy was 52.8%, 35.2%, and 32.2%, respectively. The comparative figures for psychological IPV were 67.4%, 65%, and 60.8%, and for sexual IPV were 21.1%, 18.5%, and 15.5%, respectively. The results demonstrate a notable continuity in IPV victimization before, during, and after pregnancy. Psychological IPV is the only type to exhibit a significant reduction during and after pregnancy, compared with before pregnancy, but it commonly overlaps with physical IPV, which shows a significant change during pregnancy and little change in the postpartum period. At the same time, pregnancy and childbirth offer little protection against IPV for women in relationships characterized by psychological or sexual victimization, both of which commonly overlap with physical IPV. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV and to offer necessary help and support.

Depressed Motherhood: Prevalence and Covariates of Maternal Postpartum Depression among Urban Mothers in India

BACKGROUND

The prevalence of Postpartum Depression (PPD) in the world is estimated to range from 10 to 30%. In India, about 22% of mothers suffer from postpartum depression.

PURPOSE

Study objective is to examine the prevalence and covariates of postpartum depression among new mothers; and find the association between the indices of social support, partner support and attention shifting with experience of postpartum depression.

METHODS

A cross-sectional hospital-based study design was used. The sample for this study included 240 postnatal mothers from Pune urban areas selected randomly from three hospitals who attended postnatal check-ups or immunizations in the city. Postpartum depression was assessed using Marathi validated Edinburgh Postpartum Depression Scale (EPDS). Support from the respondents mother, mother-in law, husband, relatives was assessed for estimating Social Support Index. The husband's support was assessed for Partner Support Index; and shift of attention from mother to baby was for Attention Shift Index. Mothers who scored ≥13 on the EPDS scale were categorised as depressed. Reliability and validity of the scales and indices was checked using Chronbach's alpha. Univariate, bivariate, and logistic regression were used to determine the association of various indices with PPD.

RESULTS

Of the 240 mothers surveyed, 63 (26.3%) mothers scored ≥13 on EPDS and thus, were categorised as depressed. A strong statistical association was found between social support with postpartum depression (AOR:3.037; 95% CI:1.486-6.208) and unadjusted models (UOR: 2.269; 95% CI:1.056-4.87), partner support (AOR:4.979;95%CI:1.348-18.388) and attention shift from mother to baby with PPD (Both adjusted to AOR:2.618; 95%CI:1.441-4.858; and unadjusted UOR: 2.373; 95%CI:1.072-5.254). However, no significant association was found between socio-demographic variables and postpartum depression.

CONCLUSION

Higher levels of postpartum depression in urban mothers affect the women and their children's health. Screening of expecting mothers for possible symptoms of depression during antenatal care could reduce the chances of depression during postpartum period. Considering its prevalence, depression should be addressed in national mental health programmes. More robust research is required for better understanding of the factors responsible for postpartum depression in urban India.

Pain, stress, analgesia and postpartum depression: Revisiting the controversy with a randomized controlled trial

BACKGROUND

Pain and depression are associated, but it is uncertain if effective pain relief during labor by labor analgesia reduces the incidence of postpartum depression (PPD). This randomized, controlled study assessed whether combined spinal-epidural (CSE) labor analgesia is associated with a decreased risk of PPD. Other reported risk factors for PPD were also assessed.

MATERIALS AND METHODS

Parturients were randomly assigned to either CSE labor analgesia or normal vaginal delivery (n = 65 each). CSE parturients received 0.5 ml of 0.5% hyperbaric bupivacaine intrathecally and PCEA with continuous infusion of 0.1% levobupivacaine and 2 μg/ml fentanyl @5 ml/h along with patient-controlled boluses with a lockout interval of 15 min. Parturients of both the groups were assessed using Edinburgh Postnatal Depression Scale (EPDS) for depressive symptoms at day 3 and PPD at 6 weeks (primary outcome; defined as EPDS score ≥10 at 6 weeks postpartum). Secondary outcomes included pain scores, maternal satisfaction, and Apgar scores at 1 and 5 min. Parturients were also screened for several risk factors for PPD.

RESULTS

Incidence of PPD was 22.3%. The difference in incidence of PPD between the CSE group vs. control group was not significant (27.7% vs. 16.9%; Fisher's exact P = 0.103). Of all the risk factors analyzed in logistic regression model, perceived stress during pregnancy was the only significant predictor of the development of PPD (adjusted Odds Ratio 11.17, 95% Confidence interval 2.86-43.55; P = 0.001).

CONCLUSION

CSE analgesia in laboring parturients does not reduce PPD at 6 weeks. Instead, perceived high stress during pregnancy appears to be the most important factor.

Postnatal depression and its association with adverse infant health outcomes in low- and middle-income countries: a systematic review and meta-analysis

Background

Postnatal Depression (PND) is a mood disorder that steals motherhood and affects the health and development of a newborn. While the impact of PND on motherhood and newborn in developed countries are well described, its epidemiology and health consequences in infant is not well known in middle-and low-income countries. The objective of this review was to determine the burden and association of PND with adverse infant health outcomes in low-and middle- income countries.

Methods

We searched observational studies written in the English language and conducted in middle-and low-income countries between December 1st, 2007, and December 31st, 2017. The CINHAL, MEDLINE, Emcare, PubMed, Psych Info, and Scopus databases were searched for the following search terms: PND, acute respiratory infection, pneumonia, diarrhea, exclusive breastfeeding, common infant illnesses, and malnutrition. We excluded studies in which the primary outcomes were not measured following a standardized approach. We have meta-analyzed the estimates from primary studies by adjusting for possible publication bias and heterogeneity. The analysis was conducted in Stata 14. The study was registered in PROSPERO protocol number CRD42017082624.

Result

Fifty-eight studies on PND prevalence (among 63,293 women) and 17 studies (among 32,454 infants) on infant health outcomes were included. PND prevalence was higher in the low-income countries (Pooled prevalence (PP) = 25.8%; 95%CI: 17.9–33.8%) than in the middle-income countries (PP = 20.8%; 95%CI: 18.4–23.1%) and reached its peak in five to ten weeks after birth. Poor obstetric history and social support, low economic and educational status, and history of exposure to violence were associated with an increased risk of PND. The risk of having adverse infant health outcomes was 31% higher among depressed compared to non-depressed postnatal mothers (Pooled relative risk (PRR) = 1.31; 95%CI: 1.17–1.48). Malnutrition (1.39; 1.21–1.61), non-exclusive breastfeeding (1.55; 1.39–1.74), and common infant illnesses (2.55; 1.41–4.61) were the main adverse health outcomes identified.

Conclusions

One in four and one in five postnatal mothers were depressed in low and middle-income countries, respectively. Causes of depression could be explained by social, maternal, and psychological constructs. High risk of adverse infant health outcomes was associated with PND. Timely screening of PND and evidence-based interventions were a pressing need in low and middle-income countries.

The prevalence of peripartum depression and its relationship to mode of delivery and other factors among mothers in Ixopo, Kwazulu-Natal, South Africa

Peripartum depression is a common mental health condition among mothers, occurring between 4 and 6 weeks post-delivery. This study sought to evaluate the influence that mode of delivery and other related factors have on the development of peripartum depression. The study was carried out in Ixopo, in the KwaZulu-Natal province of South Africa. All women whose infants had been delivered within 4–6 weeks of the study were included until the sample size of 276 was reached. A demographic questionnaire and an Edinburgh postnatal depression scale were administered. Mothers with Edinburgh postnatal depression scale scores of ⩾10 were considered to be suffering from peripartum depression, and peripartum depression was ruled out in those with a score of <10. A total of 110 mothers had Edinburgh postnatal depression scale score ⩾10, thus presenting a prevalence of 39.9%. Of these, 51 (46.4%) had undergone normal vaginal delivery and 59 had a Caesarean section (53.6%). Of the latter group, 23 had elective Caesarean section and 36 had emergency Caesarean section. Logistic regression showed no significant association between peripartum depression and mode of delivery ( p = .074); women who had delivered their child by emergency Caesarean section were three times more likely to develop peripartum depression compared to those who had delivered via normal vaginal delivery (odds ratio: 2.733, confidence interval: 1.002–7.452). Unemployment was found to have a statistically significant association with peripartum depression ( p = .003) and single motherhood was not associated ( p = .425). Emergency Caesarean sections and unemployment were shown to be risk factors for peripartum depression.

Epidemiology of postnatal depression and its associated factors in Africa: A systematic review and meta-analysis

Introduction

Postnatal depression (PND) is a major cause of negative health-related behaviors and outcomes during infancy, childhood and adolescent period. In Africa, the burden of postnatal depression is high. However, it is under-investigated hence under-treated. To fill this information gap and to advise further interventions, we aimed at analyzing its epidemiology in Africa.

Methods

We searched observational studies conducted in Africa and published in between 01/01/2007 and 30/06/2018 in CINHAL, MEDLINE, PsycINFO, Psychiatry online, PubMed, SCOPES, and Emcare databases. We assessed the quality of the studies using the Newcastle Ottawa Scale (NOS) and included studies with good quality. We evaluated the heterogeneity using the Higgins I² statistics. We used a random-effects model to pool estimates. We assessed publication bias using the funnel plot and Egger's test statistics and adjusted using Tweedie’s and Duval Trim and Fill analysis. The protocol has been registered in the PROSPERO (Protocol No. CRD42018100461).

Results

Nineteen studies involving 40,953 postnatal mothers were part of this systematic review and meta-analysis. The overall pooled prevalence of PND was 16.84% (95% CI: 14.49% –19.19%). The odds of having PND was higher among women with a poor obstetric condition (POR = 2.11; 95% CI: 1.11–4.01) and history of adverse birth and infant health outcomes (POR = 2.85; 95% CI: 1.29–6.25). Having a history of common mental health disorders (POR = 2.47; 95% CI: 1.51–4.04), poor social support (POR = 2.06; 95% CI: 1.05–4.05), lower economic status (POR = 2.38; 95% CI: 1.75–3.23), and those who had exposure to a different form of intimate partner violence (POR = 2.87; 95% CI: 1.60–5.16) had higher odds of PND.

Conclusion

While robust prevalence studies are scarce, our review indicated a high prevalence rate of postnatal depression. The analysis also identified postpartum women at increased risk of PND. Therefore, there is a need to design and escalate comprehensive strategies to decrease its burden, focusing on those women at risk of PND.

Prevalence of postpartum depression and associated factors among postnatal care attendees in Debre Berhan, Ethiopia, 2018

BACKGROUND

Postpartum depression explains various groups of depressive symptoms and syndromes that can take place during the first 6 weeks following birth. The postpartum period is a critical time where both mild and severe mood disorders can occur. The familiar forms are baby blues and postpartum depression. Understanding the prevalence and associated factors of postpartum depression is mandatory for early detection and treatment.

METHODS

Institution based cross-sectional study was conducted from 1st May to June 30, 2018. The study participants were eligible women who came to Debre Berhan referral hospital and health centers for postnatal care and vaccination service. The Edinburgh postnatal depression scale was used to assess postpartum depression. A systematic random sampling technique was used to collect the data after determining the skip fraction (k = 2). The collected data were coded and entered into Epi-info version 7 and transported to SPSS version 20 for analysis. Both bivariate and multivariate binary logistic regression were done to identify associated factors. During bivariate analysis, variables with p-value < 0.05 were included in multivariate analysis. Odds ratios and their 95% confidence intervals were computed and variables with p-value less than 0.05 were considered to declare significantly associated factors (multivariate analysis).

RESULTS

A total of 308 mothers who attended postpartum care we're included, which was a 100% response rate. The prevalence of postpartum depression was found to be 15.6% (95%CI = 11.7, 19.8). Being widowed/widower, having poor social support, having a current hospitalized child, and experienced a death of family member or close relative were significantly associated with postpartum depression.

CONCLUSIONS

The prevalence of postpartum depression was lower than most studies done in different areas. Major life events and traumas are associated with an increased risk of postpartum depression. Health professionals should be aware of the mother's circumstances during the puerperium, they should initiate support to reduce the risk of depression in the postpartum period. Health care professionals working postpartum care clinics should give special attention to mothers who are widowed/widower, have poor social support, have a current hospitalized children, and experienced a death of family member or close relative.

Factors Associated with Postnatal Depression among Mothers Attending at Bharatpur Hospital, Chitwan

Postnatal depression is linked with adverse outcomes for mothers, offspring, and her entire family, which stands as a significant public health problem and is often taken as a neglected issue of maternal and child health in the developing world. Postnatal depression is often falsely interpreted as common consequences related to the recent delivery. The main objective of this study is to find out the status of postnatal depression and the factors associated with it among the postnatal mothers attending at Bharatpur Hospital. Methodology. A total of 242 postnatal women were included in a hospital-based cross-sectional descriptive study. A systematic random sampling technique was done to get the sampling interval. Face to face interview technique was used for data collection, and depressive symptoms were measured by the Edinburgh Postnatal Depression Scale. Data was entered in Epi-Data and imported to SPSS for analysis. The data were summarized in terms of frequency (percentage), mean (SD), or median (IQR) as per necessity for descriptive analysis. The chi-square test and binary logistic regression were performed to find out the association between the covariates and depression status, assuming significance at p value <0.05. Results. The study revealed that the prevalence of postnatal depression was 16.9% by EPDS at cutoff point ≥12. It was found that postnatal depression was associated with current age, smoking, pressure to conceive a child, intent of pregnancy, and delivery-related complications. Conclusion. Postnatal depression within six months of delivery was found among nearly one-fifth of women, where 13.6% also had suicidal thoughts. More than half of the postnatal women had an early marriage. It is recommended that mothers with high risk should be routinely screened for postnatal depression followed by necessary interventions as well as safe motherhood counseling.

The Relationship between Maternal Confidence, Infant Temperament, and Postpartum Depression

Background

Although several studies have emphasized the correlation of infant temperament and maternal confidence, this topic has not been explored in different culture and geographical contexts. We study association of maternal confidence, infant temperament, and postpartum depression among postnatal mothers.

Materials and Methods

This cross-sectional study was conducted at Sriramachandra Institute of Higher Education and Research, India from July 2017 to May 2018. The sample population comprised of mothers at 6 weeks of postnatal period attending the Immunization Clinic. The instruments used were standardized Karitane's Parenting Confidence Scale (KPCS), Bates Infant Characteristics Questionnaire (BICQ), and Edinburgh Postnatal Depression Scale (EPDS). A structured questionnaire was used to collect data from postnatal mothers. Data were analyzed with Statistical Package for the Social Sciences (SPSS) ver. 19, using analysis of variance, correlation coefficient, multivariable regression.

Results

In this study, 64.40% of the population had high level of confidence and 80% postnatal mothers had no depression. A significant association (t ₂= 18.15, p = 0.001) was seen between maternal confidence, family support, and place of living. Regression analysis showed that confidence of postnatal mothers has a significant influence (t ₂= 12.48, p < 0.005) on infant temperament.

Conclusions

Two-third of the postnatal mothers had high confidence level with no depression. A positive correlation between postpartum depression and infant temperament was found to be associated with income, parity, and maternal confidence. A significant association was also seen of infant temperament with type of family, income, place of living, and sex of the baby.

Postpartum depression and associated factors among mothers who gave birth in the last twelve months in Ankesha district, Awi zone, North West Ethiopia

BACKGROUND

Postpartum depression is the most common complication of childbearing age women and is a considerable public health problem. The transition into motherhood is a difficult period that involves significant changes in the psychological, social and physiological aspects, and has increased vulnerability for the development of mental illness. More than 1 in 10 pregnant women and 1 in 20 postnatal women in Ethiopia suffer from undetected depression.

METHODS

Community based cross sectional study was conducted among 596 postpartum mothers in Ankesha District, North West Ethiopia, from February 01 to March 2, 2018. One stage cluster sampling technique was employed to get the study participants. The objective was to assess the prevalence and associated factors of postpartum depression among mothers who gave birth in the last Twelve months in Ankesha District, Awi Zone, North West Ethiopia, 2018. The interviewer-administered questionnaire was used to collect data and Eden Burg Postpartum Depression Scale was used to assess postpartum depression with cutoff point ≥8. The data were entered into Epi data version 3.1 and exported to SPSS version 24 for analysis. All variables with P < 0.25 in the bivariate analysis were included in the final model and statistical significance was declared at P < 0.05.

RESULT

In this study, a total of 596 study participants were involved making a response rate of 97.4%, the prevalence of postpartum depression was 23.7% with 95%CI: 20.3-27.2. From the participant mothers who are divorced/widowed/unmarried (AOR = 3.45 95%CI: 1.35-8.82), unwanted pregnancy (AOR = 1.95 95%CI: 1.14-3.33), unpreferred infant sex (AOR = 1.79 95%CI: 1.13-2.86), infant illness (AOR = 2.08 95%CI: 1.30-3.34) and low social support (AOR = 3.16 95% CI: 1.55-6.43) was independent predictors of postpartum depression.

CONCLUSION

Almost a quarter (23.7%) of women suffers from postpartum depression. Marital status, unwanted pregnancy, unwanted infant sex, infant illness, and low social support were independent predictors of postpartum depression. Therefore, integration of mental illness with maternal and child health care is important, information communication education and behavioral change communications on postpartum depression are better been given attention.

Evaluation of Peripartum Depression in Females

Background

Depression is the most common mental health condition affecting perinatal women and mothers worldwide. Worldwide, about 10% of pregnant women and 13% of women who have given birth experience a mental disorder, primarily depression. In developing countries like India, this is even higher, i.e., 15.6% during pregnancy and 19.8% after childbirth. The present study was initiated with the objective of studying the prevalence of depression among women in the peripartum period and to find the association of peripartum depression and its risk factors.

Materials and Methods

This was a hospital-based cross-sectional study, including mothers in antenatal and postnatal period. A sample size of 200 was calculated using Daniels' formula. A questionnaire was administered by the investigator in vernacular language by an interview technique for assessing awareness and behavior of all participants. The Edinburgh Postnatal Depression Scale was used to identify the patients at the risk of depression. Written informed consent was taken from every participant.

Results

The prevalence of peripartum depression was 14%. Younger age group (not <18 years), working female, joint family, first pregnancy, social support from in-laws, and not having desire/pressure for a male child were found to be associated with a lower prevalence of peripartum depression. Other variables which were not significantly associated with peripartum depression were education of the participants and their husbands and urban/rural locality.

Conclusion

The prevalence of peripartum depression is quite high and is negatively associated with first pregnancy, joint family, and working status.

Association between unintended births and risk of postpartum depression: Evidence from Ethiopia, India, Peru and Vietnam

Previous studies have shown that unintended births adversely affect birth outcomes, child health and cognitive development in developing countries. However, only a few studies have examined the association between unintended births and risk of postpartum depression (PPD) in these countries. The study uses data from the first wave of Young Lives Study (YLS) conducted in 2002 in Ethiopia, India, Peru and Vietnam to examine the association between birth intention and the risk of PPD. Bivariate and multivariable logistic regressions are used to examine the association. Bivariate result indicates that the risk of PPD was substantially higher among mothers who reported an unintended birth as compared to mothers who reported an intended birth in each country. Results from multivariable logistic regression models indicate that unintended births were associated with higher risk of PPD in pooled data (odds ratio: 1.46, 95%CI. 1.29, 1.66), Ethiopia (odds ratio: 1.99, 95% CI. 1.58,2.50), and Peru (odds ratio: 1.29, 95% CI. 1.04, 1.59) compared with mothers having an intended birth. Results suggest that reducing unintended births might help in reducing the incidence of PPD among mothers in these countries. One of the most cost-effective interventions for reducing the incidence of unintended births is the availability of effective family planning programme.

Review of the prevalence of postnatal depression across cultures

The purpose of this review was to examine articles related to recent epidemiological evidence of the prevalence of maternal postnatal depression (PND) across different countries and cultures and to identify specific epidemiological studies that have been carried out exclusively in Malaysia on the prevalence of maternal PND. The review was undertaken in two stages, an initial review and an updated review. At both stages systematic literature searches of online databases were performed to identify articles on the prevalence of maternal PND. A total of 124 articles concerning research conducted in more than 50 countries were included in the final analysis. There were wide variations in the screening instruments and diagnostic tools used although the Edinburgh Postnatal Depression Scale (EPDS) was the most common instrument applied to identify PND. The prevalence of maternal PND ranged from 4.0% to 63.9%, with Japan and America recording the lowest and highest rates, respectively. Within continents, a wide variation in reported prevalence was also found. The reported rates of maternal PND in Malaysia were much higher than that previously documented with a range of 6.8–27.3%. This review indicated that the widely cited prevalence of maternal PND of 10–15% underestimates rates of PND worldwide. The reasons for this variability may not be fully explained by review methods. Future studies should evaluate the nature of women's PND experiences across cultures to explain these wide variations.

Postpartum depression in India: a systematic review and meta-analysis

OBJECTIVE

To provide an estimate of the burden of postpartum depression in Indian mothers and investigate some risk factors for the condition.

METHODS

We searched PubMed®, Google Scholar and Embase® databases for articles published from year 2000 up to 31 March 2016 on the prevalence of postpartum depression in Indian mothers. The search used subject headings and keywords with no language restrictions. Quality was assessed via the Newcastle-Ottawa quality assessment scale. We performed the meta-analysis using a random effects model. Subgroup analysis and meta-regression was done for heterogeneity and the Egger test was used to assess publication bias.

FINDINGS

Thirty-eight studies involving 20 043 women were analysed. Studies had a high degree of heterogeneity (I2  = 96.8%) and there was evidence of publication bias (Egger bias = 2.58; 95% confidence interval, CI: 0.83-4.33). The overall pooled estimate of the prevalence of postpartum depression was 22% (95% CI: 19-25). The pooled prevalence was 19% (95% CI: 17-22) when excluding 8 studies reporting postpartum depression within 2 weeks of delivery. Small, but non-significant differences in pooled prevalence were found by mother's age, geographical location and study setting. Reported risk factors for postpartum depression included financial difficulties, presence of domestic violence, past history of psychiatric illness in mother, marital conflict, lack of support from husband and birth of a female baby.

CONCLUSION

The review shows a high prevalence of postpartum depression in Indian mothers. More resources need to be allocated for capacity-building in maternal mental health care in India.

Postpartum Depression in Women: A Risk Factor Analysis

INTRODUCTION

Postpartum Depression (PPD) is a known entity affecting not only the women but the whole family. It affects women more harshly and chronically due to their increased stress sensitivity, maladaptive coping strategies and multiple social roles in the community.

AIM

To estimate the commonly associated risk factors of PPD among the women coming to a tertiary hospital in New Delhi, India.

MATERIALS AND METHODS

It was a longitudinal study conducted at the antenatal clinic for a period of one year. Total 260 women were screened at > 36 weeks of gestation, of which 149 postnatal women completed the questionnaire for PPD at six weeks of their delivery. The inform consent, demographical data and obstetrical details from each participant was taken before commencing the screening. Various risk factors and their association were determined by odds-ratio and significant association was accepted at < 5% level of error. In order to identify the most important confounding variables, logistic regression analysis was used.

RESULTS

PPD is a common mental health problem seen among the postnatal women as it was found in 12.75% (19 out of 149) of subjects at six weeks of their delivery. Moreover, it has significant association with the young maternal age (p-value=0.040), birth of the female child (p-value=0.015), previous stressful life events (p-value= 0.003), low self-esteem and feeling of loneliness (p-value=0.007).

CONCLUSION

This study provides important information regarding the risk factors associated with development of PPD in this region of India. Female sex of the new born and the younger age play an important role in the development of PPD.

Intimate partner violence around the time of pregnancy and postpartum depression: The experience of women of Bangladesh

BACKGROUND AND OBJECTIVES

Intimate partner violence (IPV) around the time of pregnancy is a serious public health concern and is known to have an adverse effect on perinatal mental health. In order to craft appropriate and effective interventions, it is important to understand how the association between IPV and postpartum depression (PPD) may differ as a function of the type and timing of IPV victimization. Here we evaluate the influence of physical, sexual and psychological IPV before, during and after pregnancy on PPD.

METHODS

Cross-sectional survey data was collected between October 2015 and January 2016 in the Chandpur District of Bangladesh from 426 new mothers, aged 15-49 years, who were in the first six months postpartum. Multivariate logistic regression models were used to estimate the association between IPV and PPD, adjusted for socio-demographic, reproductive and psychosocial confounding factors.

RESULTS

Approximately 35.2% of women experienced PPD within the first six months following childbirth. Controlling for confounders, the odds of PPD was significantly greater among women who reported exposure to physical (AOR: 1.79, 95% CI [1.25, 3.43]), sexual (AOR: 2.25, 95% CI [1.14, 4.45]) or psychological (AOR: 6.92, 95% CI [1.71, 28.04]) IPV during pregnancy as opposed to those who did not. However, both before and after pregnancy, only physical IPV evidences a direct effect on PPD. Results highlight the mental health consequences of IPV for women of Bangladesh, as well as the influence of timing and type of IPV on PPD outcomes.

CONCLUSIONS AND IMPLICATIONS

The findings confirm that exposure to IPV significantly increases the odds of PPD. The association is particularly strong for physical IPV during all periods and psychological IPV during pregnancy. Results reinforce the need to conduct routine screening during pregnancy to identify women with a history of IPV who may at risk for PPD and to offer them necessary support.

Antenatal depression in coastal South India: Prevalence and risk factors in the community

BACKGROUND

Antenatal depression is a highly prevalent disorder with serious implications on maternal and child outcomes. There are few studies examining this in low-middle-income community settings.

AIMS

To determine the prevalence of antenatal depression in women from a coastal rural background in Kerala and Tamil Nadu and to determine its associated factors.

MATERIALS AND METHODS

In this cross-sectional community-based study, in 202 antenatal women, standard interview and diagnostic criteria (Clinical Interview Schedule-Revised (CIS-R)) were employed for identifying depression and examining a wide range of putative clinical and sociocultural risk factors including domestic violence.

RESULTS

There was a 16.3% prevalence of depression among the 202 women sampled. The possible risk factors after stepwise backward regression were pressure to have a male child, 11.48 (2.36-55.78); financial difficulties, 8.23 (2.49-27.22); non-arranged marriage, 6.05 (1.72-21.23); history of miscarriage-still birth, 5.77 (1.55-21.43) and marital conflict, 9.55 (2.34-38.98).

CONCLUSION

There is a need to develop strategies for recognition and appropriate intervention for antenatal depression, in the context of locally relevant risk factors, so as to improve both maternal and child outcomes.

The depression in women in pregnancy and postpartum period: A follow-up study

AIM

This was a follow-up study to determine postpartum depression (PPD) and its causes in a population previously evaluated in the first trimester of pregnancy.

METHODS

The study sample consisted of pregnant women who were evaluated in the first trimester and 360 women who were re-evaluated in the postpartum period. Detailed sociodemographic data were obtained from the women, and depression was assessed with the Edinburgh Postpartum Depression scale (EPDS) and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (DSM) Axis I Disorders (SCID-I).

RESULTS

In this follow-up study, the prevalence of PPD was 35% (n = 126). A depressive disorder in the first trimester of pregnancy, previous mental disorder, somatic disorder, exposure to domestic violence during pregnancy, baby's staying in the incubator and not breastfeeding were predictors of PPD. Exposure to violence and a history of previous depression predicted depression both in pregnancy and in the postpartum period.

CONCLUSION

Depression rates are high in Eastern Turkey. Exposure to violence during pregnancy and the existence of a previous mental disorder were risk factors for perinatal depression in this study. Performing screening tests can identify women at risk of pregnancy-related depression. Prevention programs should be established in areas where the prevalence of depression is high.