Postpartum Depression in Primigravida Women

8/13/2019 Postpartum Depression in Primigravida Women

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Postpartum Depression inPrimigravida Women

In Rawalpindi, Northern Punjab,Pakistan

Naheed RazaMScN

Faculty in college of Nursing

AFPGMI Rawalpindi

razinaheed@gmailcom

!o Author"Ms #asmeen Saggu

Director Clinical Nursing

Shifa International

Hospital H-8/4, Islamabad

Adunct Assistant !rofessor

"Sc# Nursing !rogram

$ni%ersit& of Health Sciences

'ahore ( !a)istan
mailto:[email protected]:[email protected]


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A$S%RA!%

!ostpartum depression *!!D+, a maor health concern, produces insidious effects on ne

mothers, their infant, and famil his .uantitati%e descripti%e cross sectional stud& aimed to

determine the pre%alence, and describe the associated ris) factors of postpartum depression

among primiparas omen in 0aalpindi, Northern !unab, !a)istan# he Con%enient non-

probabilit& sample of 122 postnatal primiparas omen and data as collectedithin 42

da&s of their postpartum period# 3ec) Depression In%entor& *3DI+ $rdu %ersion a %alidated

research instrument to assess postpartum depression as used as stud& tool# Stud& as

conducted in public, pri%ate and arm& hospitals of 0aalpindi Northern !unab, !a)istan#

!articipants ere selected from ut !atient Department *!D+ and postnatal ards of these

Hospitals#

his stud& estimated the o%erall pre%alence for postpartum depression among

primiparas postnatal omen 567 of stud& participants ere falling in the categor& of maor

depression and 527 in mild depression# 0is) factors for postpartum depression among the

target group has significant association ith education status of participants, !referred Se of

3ab&, emplo&ment statuses of omen, present bab& se,mode of deli%er 9here as age,

marital status,emplo&ment status of husband& monthl& income of famil& *in !a) 0upees+,and

famil& S&stem ere not found contributing in de%eloping !!D among the participants# hisstud& informs a current situation of )noledge regarding ris) factors for postpartum

depression and has implications for clinical practice# Health care professionals should be

aare of that the fact is as pre%alent in !a)istan# 9omen should be screened for potential ris)

factors and depressi%e s&mptoms during pregnanc& and postpartum periods so that

appropriate inter%entions, can be initiated at suitable time# here is also a need to create

aareness in public order to minimi:e depressi%e s&mptoms in postnatal omen through

nursing practice, nursing administration and other health care professionals education#

'eywords" postpartum depression& ris( factors& primigra)ida


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IN%R*+,!%I*N

he earl& postpartum period is recogni:ed as the first fe ee)s after the child birth,

a time of reflecti%e change and one of the most demanding and stimulating transitions for

omen and their families *Affonso, and "a&berr&, ;


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retardation, signicant 9eight loss or eight gain, loss of energ&, feelings of orthlessness

and ecessi%e guilt, lo self-esteem and self- confidence, difficult& in concentration, and

suicidal ideation *A!A, 5222? and 9H, 522E+# he "arcF Societ&, an international

organi:ation for the stud& of ps&chiatric illness related to childbearing, recogni:es the time of

%ulnerabilit& for postpartum depression as one &ear after deli%er& *!arr&, and Ha&nes 5222+#

In Anglo-American literature the definition for postpartum depression is often used in a ider

concept including both maor and minor depressions? as a minor depression ma& be a

potentiall& se%ere disorder hen occur in the postpartum period# "ental disturbance

folloing childbirth as first mentioned b& Hippocrates *appro# 422 3C+ but the first good

description of postpartum mental illness as ritten b& a Grench ps&chiatrist, 'ouis "arcF,

in ;8@8 *illhagen, ;


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!rimpara omen in their postpartum period ithin 42 da&s, attending selected stud& setting

four public and militar& hospitals, outpatient clinics and postnatal ards#

his stud& attempted to determine the pre%alence of postpartum depression and to describe

the associated ris) factors of postpartum depression among !rimipara omen# he findings

of this stud& ma& pro%ide as a baseline data for health care planning and strengthen the

importance of care of the pregnant omen during and after deli%er It ill also help to

prepare nurses and other health care professionals in their practice# Gurthermore effect on

future and ongoing research on this issue#

-I%.RA%,R. R./I.0

Depression has been recogni:ed b& the orld Health rgani:ation *9H+ as one of the

greatest burdens of illnesses for indi%iduals, families and communities# Depression is

becoming a significant public health issue, ith a continuous rise in its pre%alence it ill be

ran)ed as the second maor cause of disease burden b& 5252 *'ope:, "athers, =::ati,

>amison, and "urra&, 5226+# he rate of postnatal depression in de%eloping countries ranges

from ;67 to 1@7 *!atel, 0odrigues, DeSou:a, 5225? A&din et al#, 522@? Cooper et al#, ;


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on the pre%alence of depression among postpartum omen# It has been documented that the

rate of depression in omen is higher during their childbearing &ears *Co, "urra&, and

Chapman, ;


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;


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o achie%e the primar& obecti%e, hich as to determine the pre%alence of post partum

depression, calculated sample si:e as a minimum 122 postpartum !rimipara omen#

+ata !ollection Instruments

Gor detecting depression during postpartum period the %alidated $rdu %ersion of the

3ec) Depression In%entor& *3DI+ as used to screen and label stud& participants ha%ing

depression#

+ata Analysis

All the anal&sis as done using the Statistical !ac)age for Social Sciences *S!SS+ %ersion

;E#Data entr& as through codes, and as prepared for statistical anal&sis b& using

descripti%e statistics mean, percentages, and fre.uenc& tables# "oreo%er, the multiple logistic

regression techni.ue as applied to eamine hether socio-demographic and ps&cho-social

factors ere significant predictors of depression during postpartum period#

Inclusion criteria"

!articipants from !D / postnatal ards in stud& settings#

!rimipara omen ithin postpartum period ithin 42 da&s#

!rimipara omen not ha%ing an& )non medical illness *ante partum hemorrhage,

chronic or pregnanc& induced h&pertension, diabetes, gestational diabetes and )non

ps&chotic illness#

3eteen the age of ;6 to 42 &ears#

!ostnatal omen ho are able to understand and spea) $rdu and local language#

!ostnatal omen ho gi%e their consent to participate in the stud

.2clusion criteriaB

"ultipara

!ostnatal primigra%ida omen ha%ing pre%ious histor& of depression or other )non

ps&chiatric illness#

!ostnatal primigra%ida omen ha%ing an& medical or pregnanc& related

complications#

!ostnatal primigra%ida omen ho ill not consent to participate in the stud& ere

ecluded from the stud

FIN+INGS AN+ +IS!,SSI*N *F R.S,-%S

hree hundred !rimigra%ida omen ere approached for the recruitment in the stud

he o%erall pre%alence of depression in !rimigra%ida omen ranged from 527 to 56 7# Data


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as collected from target population i#e# primigra%ida omen on the basis of predetermined

selection criteria#

+.S!RIP%I*N RANG. FR.3,.N!# P.R!.N%AG.

Age

;6-52 @; ;E#27

5;-5@ ;@1 @;#27

56-12 84 58#27

1;-1@ ;2 1#17

16-42 5 2#E7

"arital status "arried 5


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Gamil& *!a) 0upees+ @,222 to ;2,222 rupees ;;< 1


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"atric 5


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he uni%ariate of this sample shoed that age is not significant *pK 2#264+ association

for depression during postpartum period# Hoe%er, the current stud& indicated the teenage

and older age of omen had contributed in se%ere depression hich is contrar& to the studies

conducted in de%eloping countries# he age of the mother as found as one of se%eral

independent %ariables associated ith !!D *"an:ano, arcia, and "oreno, 5225+#

Gurthermore, researches carried out in other regions of !a)istan ha%e found older age to be

one of the ris) factors for depression in the general population and for depression during

pregnanc& *Ali, 0ahbar, Naeem, areen, Samad, 5225? Hamirani et al#,5226?

Hussain,ater, omenson, Creed, 5224? 0abbani 0aa, 5222+#

he uni%ariate anal&sis of stud& shoed no significant association beteen

depression and marital status of participants *pK #115+#omen ho ere ido the& had no

depression because their children ere source of hope for them and also the& had social

support from their parents and parents in- las# Hoe%er, a stud& conducted b& Hara,

*;


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ell understood, but no depression hich is noticed among illiterates is another area to be

eplored in future research#

he findings of this stud& also eplored association beteen depression and emplo&ment

status of omen# he maorit& of the omen *


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nuclear families# he reasons might be the factors related to self dependence at home, less

emotional disturbance, lo interruption, lo or) load of famil& and less preference toards

cultural, tradional, and regional customs# his is the combination of people and their beha%ior

that is affecting this factor#

he preference for male child is deepl& rooted in South Asia here omen are often

blamed for the birth of girls# !reference for bo&s o%er girls is common in China, especiall& in

rural China, India as ell as in !a)istan and other Asian countries# here are se%eral possible

eplanations for this occurrence# "ostl& parents rel& on sons economicall& hen the&

become old# Gurthermore, famil& names are considered an important representation of the

famil& and are accepted through the male line# he stud& has also found significant

association beteen depressions and preferred se of the bab& among 11#17 -!rimipara

omen# Hoe%er, this stud& suggests that the effects of ha%ing a female child on the motherPs

mood ma& onl& be temporar his stud& also supported pre%ious findings from China that

deli%ering a female as significantl& associated ith postpartum depression ith a to-fold

greater than before ris) compared to omen ho deli%ered a male bab& *Co, Connor,

endell, ;


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pre%alent in families ith lo socio-economic status# he result of this stud& is congruent

ith earlier stud& and found the significant association as obser%ed beteen depression and

mode of deli%erhe percentageof births among participants deli%ered b& cesarean section

as @4#117 the highest le%el in researchers stud& hich pla&s a great role in de%eloping

depression in postpartum period#

*utcome 6 ,tilization of Study"

he stud& finding can be e.uall& implemented in nursing practice, nursing

administration and other health care professionals#

here are distinct feature hich ha%e come up during research hich ere not under

the scope of this stud Hoe%er, it has gi%en an insight that future research stud& can

etend the scope of those perspecti%es#

he findings needs to be shared at larger forum ith all the sta)eholders concerned so

as to plan care modalities for pregnant omen in general and !rimipara in particular

to support them in their ne role of motherhood#

Implication for nursing .ducation and practice

It is of great importance that health care professionals should be aare of this

phenomenon and its related concepts#

he finding of stud& ill bring a scientific and e%idence based truth to the health care

planners, nursing/ midifer& and medical educationist to pro%ide )een emphasis on

the postpartum care of omen into the curricula of all health care pro%iders#

As earl& identification of ris) factors, priorities and cost-effecti%e pre%enti%e health

measures at primar&, secondar& and tertiar& le%el could be applied#

Girst of all, famil& planning and counseling ser%ice ma& reduce unanted /unplanned

pregnanc Secondl&, secondar& pre%ention inter%entions encompass earl& detectionand treatment of disabling depressi%e s&mptoms# 0outine screening for !!D b& using

self reported .uestionnaire during postpartum period are strongl& encouraged# Ginall&,

tertiar& pre%ention inter%entions need pre%enting relapses of depressi%e s&mptoms#

0outine follo up and home health %isits during the pregnanc& and post partum

period are strongl& recommended#

Implications for Research

he ad%ancement that has been made in an& field is based on e%idence and data gathered

from research, and sharing of the findings ith sta)eholders# Similarl&, there is a need to


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conduct the stud& countr& ide and to eplore other cultural, religious aspects hich ma&

trigger the de%elopment of !!D in !rimipara so as to plan health facilities and communit&

access to at primar&, secondar& and tertiar& le%el of care#

Guture studies ill assist in de%eloping interdisciplinar& and intra-sectoral collaborationsto impro%e planning de%elopmental programs for the communit& to address illiterac& and

access to health care pro%ider# Conse.uentl&, omen ma& ha%e better economic

opportunities to get social and economic empoerment#

-imitation of the study"

here ere number of limitations in this stud&B

he use of con%enience sampling limits to 0aalpindi and the results can not be

generali:ed to other parts of the countr

'imited sample si:e as not enough to %alidate the finding#

'imited time of the stud& is a big limitation#

3udgetar& constraint#


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Reference

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eploring le%els of postpartum depressi%e s&mptomatolog >ournal of !s&chosomatic

Disorder, 4#, "a&berr&, '# *5222+# An international stud&

eploring le%els of postpartum depressi%e s&mptomatolog >ournal of !s&chosomatic

Disorder, 4ournal of !a)istan "edical Association,

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American !s&chiatric Association, *5222+# Diagnostic and Statistical "anual of "ental

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American !s&chiatric Association# *522@+# 'ets tal) facts about depression

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Postpartum Depression in Primigravida Women

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