| Abstract|| |
Background: Postnatal depression is a serious psychiatric condition that occurs in puerperium. It is associated with increased morbidity and can overwhelm new mothers and interfere with the care of their babies. This study aimed to determine the prevalence rate of postnatal depression and assess factors that are associated with its development among northeastern Nigerian women. Materials and Methods: Edinburgh Postnatal Depression Scale (EPDS) questionnaire was administered to four hundred and eighty-three women who delivered at the maternity unit of a tertiary health institution in northeastern Nigeria. Their sociodemographic and clinical variables were also obtained using pro forma questionnaire designed by the researchers. Results: One hundred and eight respondents scored 13 or more points on EPNDS, making the prevalence rate of postnatal depression 22.4%. Factors that are associated with the development of postnatal depression are unemployment [odds ratio (OR) = 0.49, 95% (CI) = 0.27-0.86, P value = 0.018), lack of support from the husband (OR = 0.34, 95% CI = 0.19-0.60, P value = 0.000), and primiparity (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013); others are unplanned pregnancy (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013) and physical illness in the mother (OR = 1.81, 95% CI = 1.77-2.79, P value = 0.007). Conclusion: The study showed that a significant proportion of new mothers have postnatal depression. This may negatively affect their parenting skills and may have adverse effects on them and their children. Early detection and effective management, together with an efficient collaboration among psychiatrists, obstetricians, and other health workers who are involved in the care of new mothers, will go a long way in reducing the negative consequences that may result from this condition.
Keywords: Nigeria, postnatal depression, puerperium
|How to cite this article:|
Sulyman D, Ayanda KA, Dattijo LM, Aminu BM. Postnatal depression and its associated factors among Northeastern Nigerian women. Ann Trop Med Public Health 2016;9:184-90
|How to cite this URL:|
Sulyman D, Ayanda KA, Dattijo LM, Aminu BM. Postnatal depression and its associated factors among Northeastern Nigerian women. Ann Trop Med Public Health [serial online] 2016 [cited 2020 Jul 11];9:184-90. Available from: http://www.atmph.org/text.asp?2016/9/3/184/179099
| Introduction|| |
Postnatal depression, also known as postpartum depression, is a depressive illness occurring after childbirth. It is characterized by a feeling of sadness, loss of interest, easy fatigability, sleep problem, inability to cope with daily activities, and poor appetite. There could also be problems with the care of the new born baby, and in severe cases the patient may pose danger to the baby by physically harming the baby. Cases of mothers murdering their newborn babies have been documented and reported widely.
Postnatal depression is a common disorder in most societies with a slight variation in its presentation. The prevalence rates of postnatal depression varies across the globe with values ranging 1.9-82.1%. Hormonal changes during pregnancy and after delivery have been implicated in some studies, as having an etiological influence in postpartum depression.
Studies have identified different sociodemographic and clinical variables as risk factors for the development of depressive disorder in puerperium. Factors such as illnesses in the baby as well as physical deformities and congenital abnormalities were identified. The presence of physical illness in the new mother is also a recognized factor. The baby born from an unwanted/unplanned pregnancy also predisposes the mother to depression after delivery. Failure of the mother to get a baby of the desired gender may also be a factor in the development of postnatal depression.
Marital discord, lack of support from the husband, and single motherhood were other factors that have been identified as risk factors in this disorder., Some studies have reported postnatal depression to be more common among women with multiparity. The reason adduced for this was that the presence of other young children at home to be catered for inadvertently increases the stress of the new mother. However, other studies reported a higher prevalence rate among the primiparous women.
There is a need to detect and manage mothers with postnatal depression because of the associated risk to their babies viz-a-viz lack of proper care of the babies, physical injuries to the babies, and sometimes death. There is also an enormous burden on the mother and other caregivers. It is also important to identify the associated risk factors for the development of postnatal depression so as to prevent this illness, which is known for its high morbidity and mortality. However, there is dearth of studies in this part of the country and hence, the need for this present study.
The current study examined the mental health of new mothers with the aim of determining the prevalence rate of postnatal depression among them. It also identified factors that are associated with the development of postnatal depression among new mothers that delivered in a Nigerian teaching hospital.
| Matarials and Methods|| |
The study is a cross-sectional study among women who newly delivered at a federal tertiary health institution in northeastern Nigeria.
All the women who delivered in the hospital and were subsequently transferred to the postnatal ward constituted the study population.
- Patients with prior history of psychiatric illness
- Patients who are too ill to participate.
The sample size was calculated using Fisher's formula.
n = z 2 pq/d 2
Where n = the desired sample size
z = the standard normal deviate set at 1.96 [95% confidence level (CI)]
P = the proportion in the target population estimated to have the disorder (27.2%)
q = 1-p (1.0-0.272 = 0.728)
d = desired level of accuracy, set at 0.05
n = 1.962 × 0.272 × 0.728/0.052
n = 304
The estimated sample size was 304 but the number was increased to 483 to improve the power of the study.
- Pro Forma Questionnaire: This was developed by the researchers to record sociodemographic and clinical variables
- Edinburgh Postnatal Depression Scale (EPDS): This is a 10-item screening instrument, which was developed to detect depression among postnatal women. Assessment is done by adding the total score for each of the 10 items. The higher the score, the more the depressive symptoms. This instrument has been used and validated in Nigeria. A cutoff point of 10 is used for milder cases while a cutoff point of 13 is suggested for severe cases. A cutoff of 13 is used in this study.
Ethical approval for the study was obtained from the Ethics and Research Committee (ERC) of the institution. Informed consent of each respondent was sought and only those whose consent was obtained were recruited for this study.
All eligible participants at the postnatal ward were included until the sample size was achieved. The women were given the information about the purpose of the study. Those who gave their informed consent were interviewed by trained research assistants using EPDS and pro forma questionnaire after they had spent a minimum of 24 h in the ward and before they were discharged.
The data were analyzed using EPI-INFO version 6.04d (Center for Disease Control and Prevention (CDC) Atlanta, Georgia, USA). The frequency table was generated together with other relevant tables. The level of statistical significant was set at 5% confidence limit for two-tailed test. A second-stage analysis was conducted using logistic regression using only variables that were statistically significant at the first analysis. This was done to determine the variables that predicted psychiatric morbidity among the studied population.
| Results|| |
Four hundred and eighty-three respondents participated in this study. The age range was 17-46 years. A majority (78.2%) of the participants were below the age of 30 years. Almost all the respondents (97.5%) were married. Among the married respondents, 58% were in monogamous marriages and the remaining 42% were in polygamous marriages. Almost one-fifth of the married respondents had previous marriages.
The predominant religion among the participants was Islam, which constituted 87% of the studied sample while the remaining 13% were Christians. Sixty-four percent of the respondents had no formal education. Barely 20% of the participants were employed at the time of this study [Table 1].
The result of this study further revealed that more than 40% were primiparous women, 38.5% were multiparous women, and 20.5% were grand multiparous women. One hundred and nine participants believed that the pregnancy were unplanned. Also, barely more than 10% of the respondents had premature deliveries.
The analysis of the genders of the babies showed that male babies were slightly more than female babies. However, 11.8% of the respondents desired another gender as against their baby's gender. Further analysis showed that 12.8% of the participants with female babies would have preferred male babies. This was against 8.8% of the respondents with male babies who would have preferred female babies.
The outcomes of the pregnancy were classified as whether the baby was alive and well, alive and sick, or dead. Three hundred and forty-five babies were alive and well, 103 babies were sick, and 35 babies died during or following deliveries. Considering the health of the mothers, 213 respondents, who represented 44.1% of the sample, reported one form of physical illness or the other during or following deliveries [Table 2].
One hundred and eight respondents scored 13 or more points on EPDS. Therefore, the prevalence rate of postnatal depression among respondents in this study was 22.4%.
The respondents with postnatal depression and those without postnatal depression were similar in many sociodemographic variables except for employment status and support provided by the husband. Lack of formal education or low level of education was found to be significant at the first stage of the analysis; this significance was lost during the second-stage analysis using logistic regression. Therefore, unemployed mothers were more represented among the depressed group (odds ratio (OR) = 0.49, 95% CI = 0.27-0.89, P value = 0.18] and so were the women who reported little or no support from their husbands (OR = 0.34, 95% CI = 0.19-0.60, P value = 000) [Table 3].
|Table 3: Sociodemographic variables of the respondents with psychiatric disorders compared with those without psychiatric disorders|
Click here to view
The various clinical variables also indicated that women with high EPNDS scores were similar to those with lower scores on many variables except for the following: Parity of the mother (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013), whether the pregnancy was planned or not (OR = 0.56, 95% CI = 0.35-0.88, P value = 0.013), and whether the mother has good physical health or not (OR = 1.81, 95% CI = 1.77-2.79, P value = 0.007) [Table 4].
|Table 4: Clinical characteristics of respondents with psychiatric disorders compared with those without psychiatric disorders|
Click here to view
| Discussion|| |
The prevalence rate of postnatal depression in this study was 22.4%. Postnatal depression has been studied in different societies and various results have been reported. Norhayati et al. (2015) reported in their review of the literature values between 5.2% and 74% for developing countries and 1.9% and 82.1% for developed countries. Differences in studied populations and methodologies might be responsible for this wide variation. The rate found in this study was comparable to many studies from Nigeria and other parts of the world with a similar methodology. Abiodun (2006), using EPDS followed by Present State Examination found a prevalence rate of 18.6% of postnatal depression in a primary care setting. Also, Adewuya (2005) found the prevalence rate of postnatal depression to be 19.9% among western Nigerian women. In another Nigerian study that used a methodology similar to the current study, Ebeigbe and Akhigbe found a prevalence rate of 27.2%. Similarly, Mohammad et al. reported a prevalence rate of 22% among Jordan women.
The prevalence rate reported here is higher than 7.5% reported in an Australian study among new mothers. This was also higher than a community-based study where the rate was found to be 5.5%.
Women who had postnatal depression and those without it were similar on many sociodemographic variables except for employment status and the presence of social support from husbands. Women who had postnatal depression were more likely to be unemployed and also more likely to lack adequate support from their husbands. Unemployment is a positive predictive index of low socioeconomic status, and this has invariably been associated with the increased rate of postpartum depression. This study is also comparable to that of Kheirabadi et al. (2010) who found unemployment to be significantly associated with the development of postnatal depression. Studies from developed countries have found similar results., Although Ozdemir et al. (2014) have independently found the low level of education as a predictive factor in the development of postpartum depression, this study failed to find the same.
Women who reported a lack of support from their husbands were also more likely to develop postnatal depression in this current study. The period of postpartum is regarded as stressful as the new mother needs to cope with the care of the new baby and home. Mothers at this critical period require support from their spouses. Where this support is lacking, there is a tendency for the development of psychological stress. Other studies where the lack of the husband's support has been found to be associated with development of postnatal depressive illness include those by Ege et al., (2008) and Yagmir and Ulocoka (2011).,
This study did not find any association between the maternal age and postnatal depression. This was unlike the study by Abiodun, (2006) which found younger mothers to have a greater risk of developing postpartum depression. It is also unlike the study by Kheirabadi et al. 2010 where the advanced age of mothers was found to be significantly associated with increased risk of postpartum depression. However, this study was comparable to studies which found no association between maternal age and postnatal depression.,
Considering the clinical variables of the respondents, they were found to be similar in many respects except for the following: Parity of the mother, unplanned pregnancy, and physical illness in mothers. Those mothers with unplanned pregnancy were more represented in the group with postnatal depression. Cases of postnatal depression were also more common among primiparous women and it was also so among mothers who had one form of physical illnesses or the other in the perinatal period.
Women with unplanned pregnancy are more likely to develop postnatal depression. This may be due to the fact that they are not psychologically prepared. Pregnancy and puerperium periods are known to be both physically and psychologically tasking; thus, mothers need to be ready for these periods for effective parenting. Several studies in different parts of the world have found similar results with the present one. Mohammad et al. (2011) found that unplanned pregnancy was an associated factor in the development of postpartum depression among Jordanian women. Similarly, Mercier et al. (2013) observed that unplanned pregnancy possesses almost four times higher risk of postnatal depression than planned or intended pregnancy. Other studies that found similar results were those of Iranfar et al. (2005) among Iranian women, Nakku et al. (2006) among Ugandan women, and Yagmur and Ulucoka (2011) among eastern Turkish women.,,
The study also found primiparity to be significantly associated with the development of postnatal depression when compared with their counterparts with higher parity. This might be due to inadequate prior knowledge and preparedness for parenting. There might also be a heightened anticipatory fear about labor and caring for the baby. This finding was also comparable to another Nigerian study where primiparity was found to be predictive of postpartum depression. This present study was however, different from the finding by Nielsen et al. (2000) where a higher parity was found to be associated with the development of postnatal depression. The reason given for this was that new mothers who need to care for more young children at home may experience more stress, thereby predisposing them to postnatal depression.
Another clinical variable that was significantly associated with the development of postnatal depression in this study was physical illness in the mother. The perinatal period itself is considered stressful; therefore, having to cope with additional stress of sickness during this period might be overwhelming for the new mother. This is also be compounded by the sociocultural expectation of caring for the baby and other members of the family. Eastwood et al. (2012) found that mothers with physical illnesses have more tendency to develop postnatal depression among Australian women. A similar result was found among the Chinese women population living in the USA by Cheng et al., (2013).
This study did not find an association between preterm baby and postnatal depression. While Abiodun (2006) also did not find an association, Ebeigbe and Akhigbe (2008), and Adewuya et al. (2005) found preterm delivery to be an associated factor with the development of postpartum depression.,,
| Conclusion|| |
There is increased risk of postnatal depression among the studied population and the factors associated with this risk have been highlighted. There is a need for proper screening of women in puerperium so as to detect postnatal depression early and for appropriate treatments to be instituted. There should be an improved collaboration between the obstetricians and psychiatrists in managing this group of patients so as to reduce morbidity and hence, increase the quality of lives in them and their new babies.
Limitation of the study
This was a cross-sectional study, which was conducted within a few days of delivery by the respondents; some participants might have developed postnatal depression later. A prospective study would have been more informative. However, there is poor postnatal follow-up attitude in this part of the country, which made that very difficult.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hatters Friedman S, Resnick PJ. Child murder by mothers: Patterns and prevention. World Psychiatry 2007;6:137-41.
Qotes MR, Cox JL, Neema S, Asten P, Glangeaud-Freudenthal N, Figueiredo B, et al
; TCS-PND Group. Postnatal depression across countries and cultures: A qualitative study. Br J Psychiatry Suppl 2004;46:s10-6.
Norhayati MN, Hazlina NH, Asrenee AR, Emilin WM. Magnitude and risk factors for postpartum symptoms: A literature review. J Affect Disord 2015;175:34-52.
Soares CN, Zitek B. Reproductive hormone sensitivity and risk for depression across the female life cycle: A continuum of vulnerability? J Psychiatry Neurosci 2008;33:331-43.
Pearlstein T, Howard M, Salisbury A, Zlotnick C. Postpartum depression. Am J Obstet Gynecol 2009;200:357-64.
Barbadoro P, Cotichelli G, Chiatti C, Simonetti ML, Marigliano A, Di Stanislao F, et al
. Socio-economic determinants and self-reported depressive symptoms during postpartum period. Women Health 2012;52:352-68.
Gaillard A, Le Strat Y, Mandelbrot L, Keïta H, Dubertret C. Predictors of postpartum depression: Prospective study of 264 women followed during pregnancy and postpartum. Psychiatry Res 2014;215:341-6.
Mohammad KI, Gamble J, Creedy DK. Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women. Midwifery 2011;27:e238-45.
Ege E, Timur S, Zincir H, Geçkil E, Sunar-Reeder B. Social support and symptoms of postpartum depression among new mothers in Eastern Turkey. J Obstet Gynaecol Res 2008;34:585-93.
Yağmur Y, Ulukoca N. Social support and postnatal depression in low-socioeconomic level postpartum women in Eastern Turkey. Int J Public Health 2011;55:543-9.
Nielsen Forman D, Videbech P, Hedegaard M, Dalby Salvig J, Secher NJ. Postpartum depression: Identification of women at risk. BJOG 2000;107:1210-7.
Abiodun OA. Postnatal depression in primary care populations in Nigeria. Gen Hosp Psychiatry 2006;28:133-6.
Spinelli MG. Maternal infanticide associated with mental illness: Prevention and of saved lives. Am J Psychiatry 2004;161:1548-57.
World Health Organization. The World Health Report 2001. Mental Health: New Understanding New Hope 2001. p. 30.
Ebeigbe PN, Akhigbe KO. Incidence and associated risk factors of postpartum depression in a tertiary hospital in Nigeria. Niger Postgrad Med J 2008;15:15-8.
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.
Adewuya AO, Eegunranti AB, Lawal AM. Prevalence of postnatal depression in western Nigerian women: A controlled study. Int J Psychiatry Clin Pract 2005;9:60-4.
Eastwood JG, Jalaludin BB, Kemp LA, Phung NH, Barnett BE. Relationship of postnatal depressive symptoms to infant temperament, maternal expectations, social support and other potential risk factors: Findings from a large Australian cross-sectional study. BMC Pregnancy Childbirth 2012;12:148.
Ahmed HM, Alalaf SK, Al-Tawil NG. Screening for postpartum depression using Kurdish version of Edinburgh Postnatal Depression Scale. Arch Gynecol Obstet 2012;285:1249-55.
Kheirabadi GR, Maracy MR. Perinatal depression in cohort study on Iranian women. J Res Med Sci 2010;15:41-9.
Rubertsson C, Wickberg B, Gustavsson P, Rådestad I. Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a National Swedish sample. Arch Womens Ment Health 2005;8:97-104.
Chien LY, Tai CJ, Huang CH, Sheu SJ. Adherence to 'doing-the-month' practices is associated with fewer physical and depressive symptoms among postpartum woman in Taiwan. Res Nurs Health 2006;29:374-83.
Ozdemir H, Ergin N, Selmoglu K, Bilgel N. Postnatal depressive mood in Turkish women. Psychol Health Med 2014;10:96-107.
Mercier RJ, Garrett J, Thorp J, Siega-Riz AM. Pregnancy intention and postpartum depression: Secondary data analysis from a prospective cohort. BJOG 2013;120:1116-22.
Iranfar S, Shakeri J, Ranjbar M, NazhadJafar P, Razaie M. Is unintended pregnancy a risk factor for depression in Iranian women? East Mediterr Health J 2005;11:618-24.
Nakku JE, Nakasi G, Mirembe F. Postpartum major depression at six week in primary health care, prevalence and associated factors. Afr Health Sci 2006;6:207-14.
Cheng CY, Walker LO, Chu TP. Physical conditions and depressive symptoms of Chinese postpartum mothers in the United States and Taiwan. Health Care Women Int 2013;34:539-55.
Department of Psychiatry, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]