A STUDY OF POSTPARTUM DEPRESSION IN A FAST DEVELOPING COUNTRY:

PREVALENCE AND RELATED FACTORSAbdulbari Bener*1,2,3 ,F.Tuna Burgut4

Suhaila Ghuloum5, Javaid Sheikh4

1Dept. of Medical Statistics & Epidemiology, Hamad General Hospital, Hamad Medical

Corporation, Dept. Of Public Health, Weill Cornell Medical College, Doha, Qatar2 Dept. Evidence for Population Health Unit, School of Epidemiology and Health Sciences,

The University of Manchester, Manchester, UK3Dept. of Public Health & Medical Education, Weill Cornell Medical College, Qatar

4Dept. of Psychiatry, Weill Cornell medical College, Qatar5Dept. of Psychiatry, Hamad Medical Corporation, Doha, Qatar.

INTRODUCTION

Mental diseases are one of the most common complications associated with pregnancies and childbirth.

It was reported that postpartum depression (PPD) is one of the important public health problems affecting maternal and child health.

INTRODUCTION

Postpartum psychological disorders lead to maternal disability and disturbed mother-infant relationship.

Postpartum depression is a serious

disorder which has been estimated to

affect 13-20% of women in industrialised

nations.

INTRODUCTION (Contd…)

It was identified that past history of psychopathology, psychological disturbance during pregnancy, poor marital relationship, poor social support and stressful life events are the primary risk factors for developing postpartum depression.

This is the first study examining the prevalence of postpartum depression and associated risk factors among Arab women in Qatar.

INTRODUCTION (Contd…)

OBJECTIVES

The aim of this study was to determine the

prevalence and identify the risk factors of

postpartum depression among Arab

women in Qatar using Edinburgh

Postnatal Depression Scale (EPDS).

SUBJECTS &

METHODS

Design: This is a prospective cross-sectional study.

Setting: The study was conducted at Primary Health Care Centers in Qatar.

Period of Study: January 2010 to May 2011.

Subjects: A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study.

SUBJECTS & METHODS

Data Collection:

The survey instrument was initially

tested on 100 patients who visited the

health centres and thus validated the

questionnaire.

The study excluded mothers whose

postnatal period was over 6 months

and who refused to give consent to

take part in the study.

SUBJECTS & METHODS (Contd…)

A validated structured questionnaire

was used to collect the socio-

demographic variables, psychiatric

history, interpersonal relationship, life

events and obstetric risks with the help

of qualified nurses.

Data Collection (Contd…):

SUBJECTS & METHODS (Contd…)

The Edinburgh postpartum depression

scale (EPDS) was used to identify the

risk cases.

The EPDS is a 10-item self-report scale,

specifically designed to screen for

postpartum depression in primary

care.

SUBJECTS & METHODS (Contd…)

The EPDS is a reliable and valid

instrument, it has been used in a

number of international settings

The EPDS is a reliable and valid instrument, it has been used in a number of international settings

SUBJECTS & METHODS (Contd…)

The EPDS questionnaire has items such as:

1. Having been able to laugh.

2. Having looked forward with enjoyment

to things.

3. Having blamed oneself unnecessarily.

4. having been anxious or worried for no

good reason.

5. Having felt scared or panicky for no

good reason.

6. Experiencing overload.

7. Having been so unhappy that it has

caused sleeping problems.

8. Having felt miserable or sad.

9. Having been so unhappy as to have

cried.

10.Thoughts of harming oneself.

The EPDS questionnaire has items (contd..)

Each item is scored on a 4-point scale

(0–3), the minimum and maximum total

score ranging from 0 to 30, respectively.

A score of ≥12, the most commonly

used cut off, is used to distinguish

women suffering from depression from

those who are not.

The EPDS questionnaire has items (contd..)

EDINBURG POSTNATAL DEPRESSION SCALE: SCORING SAMPLE

STATISTICAL ANALYSIS

Student-t test was used to ascertain the

significance of differences between

mean values of two continuous

variables.

Chi-square analysis was performed to

test for differences in proportions of

categorical variables between two or

more groups.

STATISTICAL ANALYSIS

Multivariate logistic regression analysis using the forward inclusion and backward deletion method was used to assess the relationship between dependent and independent variables and to adjust for potential confounders and orders the importance of risk factors (determinant) for postpartum depression.

The level p<0.05 was considered as the cut-off value for significance.

STATISTICAL ANALYSIS (Contd…)

STUDY FINDINGS

STUDY FINDINGS

The prevalence of postpartum

depression among the study

sample was 17.6%.

STUDY FINDINGS

There were statistically significant

differences observed between

depressed and non-depressed

mothers in their socio-demographic

characteristics;

STUDY FINDINGS

Mothers of age above 35 years (49.9% vs

39.2%; p<0.001),

Low education below intermediate level (51%

vs 35.8%; p<0.001),

Housewives (38.7% vs 29%; p=0.03),

Low monthly income (QR 5000-9999) (43.2% vs

32.2%;p<0.001)

Maternal complications (38.7% vs 26.1%;

p<0.001) and caesarean section (36.2% vs

28.8%; p=0.022) were significantly higher

among depressed mothers compared to non-

depressed women.

STUDY FINDINGS

Financial difficulties (OR=2.04; p<0.001),

prematurity (OR=1.64; p=0.025),

poor family support (OR=1.52; p=0.016),

dissatisfaction in marital life (OR=1.26;

p=0.005),

poor marital relationship (OR=1.13; p=0.05)

were the main predictors of postpartum

depression.

STUDY FINDINGS

Table 1: Socio-demographic characteristics of the studied women according to PPD Status (N=1379)

Variable

Total

N=1379

n(%)

Post partum Depression

p-valueYes

EPDS≥12

N=243

n(%)

No

EPDS<12

N=1136

n(%)

Age(Mean±SD) 33.5±6.5 33.3±7.1 33.5±6.4 0.560

Age in Years

<25 Years 204(14.8) 48(19.8) 156(13.7)

<0.00125-34 Years 633(45.9) 74(30.3) 535(47.1)

>35 Years 542(39.3) 121(49.9) 445(39.2)

Education Level

Illiterate 104(7.5) 27(11.1) 77(6.8)

<0.001

Primary 200(14.5) 50(20.6) 150(13.2)

Intermediate 276(20.0) 47(19.3) 180(15.8)

Secondary 440(31.9) 64(26.4) 405(35.7)

University 359(26.0) 55(22.6) 324(28.5)

Occupation

House Wife 424(30.7) 94(38.7) 330(29.0)

0.030

Professional 573(41.6) 90(37.0) 483(42.5)

Manual 126(9.1) 24(9.9) 102(9.0)

Business Women 180(13.1) 23(9.5) 157(13.8)

Army/police 76(5.5) 12(4.9) 64(5.6)

Variable

Total

N=1379

n(%)

Post partum Depression

p-valueYes

EPDS≥12

N=243

n(%)

No

EPDS<12

N=1136

n(%)

Family income*QR

Less 5000 141(10.2) 66(27.2) 75(6.6)

<0.0015000-9999 471(34.2) 105(43.2) 366(32.2)

10,000-14,999 326(23.6) 40(16.5) 286(25.2)

>15,000 441(32.0) 32(13.2) 409(36.0)

Consanguinity

Yes 518(37.6) 108(44.4) 410(36.1)0.015

No 861(62.4) 135(53.6) 726(63.9)

Baby’s Gender

Boys 692(50.2) 119(49.0) 573(50.4)0.678

Girls 687(49.8) 124(51.0) 563(49.6)

Transportation Access

Yes 1172(85.0) 188(77.4) 984(86.6)<0.001

No 207(15.0) 55(22.6) 152(13.4)

How many Bedrooms at your home 5.0±2.3 5.3±2.5 5.0±2.1 0.043

How many people living at your home 6.0±3.1 6.5±3.3 6.0±3.0 0.020

Table 1: Socio-demographic characteristics of the studied women according to PPD Status. (Contd…)

Life Events

Post partum Depression

P-ValueYes(EPDS≥12)

N=243

No (EPDS<12)

N=1136

Relationship Problem n(%) n(%)

Relationship with your husband Good 68(28.0) 405(35.7)0.022

Bad 172(72.0) 731(64.3)

Relationship with mother in law Good 72(29.6) 489(43.0)<0.001

Bad 171(70.4) 647(57.0)

Strong family support Good 182(74.9) 984(86.5)<0.001

Bad 61(25.1) 152(13.4)

Nanny to take of your child Yes 97(39.9) 472(41.5)0.639

No 146(60.1) 664(58.5)

No Of Children’s (Mean±SD) Boys 2.0±1.2 2.0±1.2 0.945

Girls 1.6±1.0 1.5±1.0 0.691

Difficult to Manage with Income Yes 186(76.5) 789(69.5)0.028

No 57(23.5) 347(30.5)

Satisfaction in your married life Good 154(63.5) 895(78.8)<0.001

Bad 89(36.5) 241(25.7)

History of Depression Yes 28(11.5) 142(12.5)0.674

No 215(88.5) 994(87.5)

Family history of depression Yes 42(17.3) 181(15.9)0.604

No 201(82.7) 955(84.1)

Table 2. Association between stressful life events and postpartum depression in studied women according to the PPD Status (N=1379)

Maternal Characteristics

Post partum Depression

P-ValueYes

EPDS≥12

N=243

n(%)

No

EPDS<12

N=1136

n(%)

Planned Pregnancy Yes 117(48.1) 617(54.3)0.530

No 126(51.9) 517(45.7)

History of Fertility Yes 32(13.2) 116(10.2)0.176

No 211(86.8) 1020(89.8)

Complication during pregnancy Yes 94(38.7) 295(26.1)<0.001

No 149(61.3) 841(73.9)

Maternal Complications*

Anaemia 23(9.4) 48(4.2) 0.001

Bleeding 65(26.7) 170(15.0) <0.001

Blood Pressure 25(10.2) 27(2.4) <0.001

GDM 24(9.9) 70(6.2) 0.051

Miscarriage 8(3.2) 25(2.2) 0.435

Threatened abortion 3(0.9) 4(0.4) 0.109

Urinary infection 9(3.7) 5(0.5) 0.001

Mode of last Delivery

Vaginal delivery 155(63.8) 809(71.2)0.022

C-Section 88(36.2) 327(28.8)

Table 3: Maternal and Infant characteristics of the studied women according to the PPD Status. (N= 1379)

Infant Characteristics

Post partum Depression

P-ValueYes

EPDS≥12

N=243

n(%)

No

EPDS<12

N=1136

n(%)

Normal weight and height

Yes Yes 205(84.4) 986(86.8)0.367

No No 38(15.6) 150(13.2)

Premature baby in ICU

Yes Yes 41(16.9) 135(11.9)0.034

No No 202(83.1) 1001(88.1)

Mode of Feeding

Solely breast fed 74(30.5) 424(37.3)

<0.001Breast fed and formula 114(46.9) 590(51.9)

Formula 55(22.6) 122(10.7)

Strong preference for the baby gender

Yes 88(36.2) 360(31.7)0.172

No 155(63.8) 776(68.3)

Table 3: Maternal and Infant characteristics of the studied women according to the PPD Status. ( Contd…)

Independent Variables

Odd

ratio

95%

Confidence

Interval

P Value

Difficulty to manage with income. 2.37 1.56 – 3.58 <0.001

Prematurity 1.64 1.06 – 2.54 0.025

Poor Family Support 1.52 1.0 – 2.14 0.016

Dissatisfaction in their married life. 1.26 1.0 – 1.47 0.005

Poor marital relationship 1.13 1.0 – 1.29 0.048

Table 4: Results of logistic Regression analysis

for predictors of Post partum Depression.

Table 5. Prevalence rate for postpartum depression according to the country

Country Age GroupSample

SizePrevalence rate (%) Year Reference

Australia 16-35 Years 4366 17.4% 2010 Yelland et al

Australia 18-44 Years 80 24.7% 2006 Miller et al

Australia 17-36 Years 52 25.1% 2007 Phillips et al

Brazil 14-47 Years 271 20.7% 2008 Tannous et al

Brazil 13-31 Years 410 19.0% 2000 Inacia et al

India Goa 18-37 Years 59 23% 2001 Patel et al

Pakistan 17-40 Years 149 36% 2006 Hussain et al

Morrocco 18-44 Years 144 18.7% 2005 Agoub et al

Oklahoma 18-35 Years 5586 26% 2005-2006 Crutcher et al

Turkey 15-44 Years 1447

29.0% at 0-2 Months

36.6% at 3-6 months

36.0 % a t 7-12 Months

42.7% at >13 Months

2004 Bugnayci et al

Dubai 25-34 Years 90 18.0% 1997 Abou Saleh and Ghubash

Bangladesh 17-41 Years 361 33% 2009 Gausia et al

USA 17-47 Years 192 23.4 1995 Hobfoll et al

Qatar 18-45 years 1379 17.6% 2010-2011 Bener et al

CONCLUSION

The present study revealed the following:

The prevalence of postpartum depression was higher than the rates observed in developed countries.

The prevalence of postpartum depression was greatest among mothers with lower socio-economic level such as advanced age, low education and illiteracy, housewives, low family income.

CONCLUSION

Among the psychosocial factors, lack of

family support, marital disharmony,

stressful life events were significantly

associated with postpartum depression.

Financial difficulties, prematurity, lack of

family support and poor marital

relationships have been reported as main

risk factors for developing postpartum

depression.

CONCLUSION (Contd…)

ACKNOWLEDGEMENTThis study was generously supported and funded

by the Qatar National Research Fund- QNRF NPRP 30-6-7-44 and Weill Cornell IRB Ethical Approval (WCMC-Q#2011-0008). The authors

would like to thank the Hamad Medical Corporation for their support and ethical

approval (HMC MRC #10119/10)

THANK YOU!