Incidence of Post-Partum Depression among Female Patients Presenting in the Outpatient Clinic of Obstetrics & Gynecology Department in ACTH At Khartoum State, September - November 2017

Post-Partum Depression (PPD), also known as Post Natal Depression is a form of depression and/or anxiety that presents after childbirth. It usually presents about 4-6 weeks after delivery and may last up to a few years if left untreated. Patients with this mood disorder can present with low mood, irritability, feelings of anxiousness, low levels of energy, changes in sleeping and eating patterns, feelings of guilt and crying episodes. Patients may even present with suicidal thoughts. As with Major Depressive Disorder (MDD), these symptoms must be present for two consecutive weeks to confirm the diagnosis of PPD. This condition can affect both sexes, the father of the newborn may experience these symptoms too, but in this research, I will be focusing on the new mothers rather than their partners. In the past, many risk factors for PPD have been studied. The emphasis has historically been on psychosocial aspects, such as a personal history of psychiatric illness (previous PPD being a highly significant risk factor) [1] low socioeconomic status, low level of education, alcohol and drug abuse, and low levels of social or partner support [2,3].

After pregnancy, hormonal changes in a woman’s body may trigger symptoms of depression. During pregnancy, the amount of two female hormones, estrogen and progesterone, in a woman’s body increases greatly. In the first 24 hours after childbirth, the amount of these hormones rapidly drops back down to their normal non-pregnant levels. Researchers think the fast change in hormone levels may lead to depression, just as smaller changes in hormones can affect a woman’s moods before she gets her menstrual period.

Not surprisingly, women with fewer resources indicate a higher level of postpartum depression and stress than those women with more resources, such as financial. Rates of PPD have been shown to decrease as income increases [4]. Women with fewer resources may be more likely to have an unintended or unwanted pregnancy; increasing risk of PPD. Women with fewer resources may also include single mothers of low income. Single mothers of low income may have more limited access to resources while transitioning into motherhood.

Occasionally, levels of thyroid hormones may also drop after giving birth. Low thyroid levels can cause symptoms of depression including depressed mood, decreased interest in things, irritability, fatigue, difficulty concentrating, sleep problems, and weight gain. A simple blood test can tell if this condition is causing a woman’s depression. If so, thyroid medicine can be prescribed.

Once diagnosed, PPD is treated just like any other MDD through “Biopsychosocial” care which consists of anti-depressants/ hormone replacement if needed, appropriate psychotherapy and social support. However, making the diagnosis is not easy as most mothers do not seek help or pay attention to their symptoms; it’s usually ignored and assumed to just be a phase that will go away on its own. That is why the EPDS is a very important screening tool that helps many women face their problems and seek the appropriate care that they need for themselves and subsequently for their children.

A 2013 Cochrane review found evidence that psychosocial or psychological intervention after childbirth helped reduce the risk of postnatal depression [5,6]. These interventions included home visits, telephone-based peer support, and interpersonal psychotherapy [5] Support is an important aspect of prevention, as depressed mothers commonly state that their feelings of depression were brought on by “lack of support” and “feeling isolated” [7].

In couples, according to a systematic review and meta-analysis of 2015, emotional closeness and global support by the partner protect against both perinatal depression and anxiety. Further factors such as communication between the couple and relationship satisfaction have a protective effect against anxiety alone [8].

A major part of prevention is being informed about the risk factors. The medical community can play a key role in identifying and treating postpartum depression. Women should be screened by their physician to determine their risk for acquiring postpartum depression. Also, proper exercise and nutrition appear to play a role in preventing postpartum depression and depressed mood in general.

Descriptive Analytical hospital-based prospective study was conducted in Academy Charity Teaching Hospital (ACTH). The sample obtained was representative of the total coverage during September- November 2017, which equated to 40 cases. Data was collected through an interview-based questionnaire (an Arabic translated version of Edinburgh Post Natal Depression Scale).

Data analysis

Data was processed and analyzed using the Statistical Package of Social Sciences (SPSS version 20). Chi square test and independent T test were used to study the significance and associations of variables in the study. Data will be presented in forms of tables and charts for this study.

Ethical approval

Ethical clearance was obtained from the research technical and ethical committee at the faculty of Medicine in UMST and ACTH administration.

Verbal consent was taken from all patients participating in the study. The process was clearly explained to each patient. They were assured about their safety and confidentiality and that there was no harm in responding.

EPDS considered those who score equal to or more than 10 are positive for symptoms of PPD, and regarding this study 40 of women who interviewed only 3 had scored 10 or higher, making the incidence of PPD among the study group equaling approximately 7.5% (Figure 1).

Table 1: Shows the relationship between employment and EPDS scores suggestive of PPD.

Table 2: Chi square Tests for employment status vs. PPD.

Table 3: Chi square tests for socioeconomic status vs. EPDS score indicating PPD.

Table 4: Chi Square Tests of Marital Status vs. EPDS score indicating PPD.

Table 5: Shows association between Partner Support and EPDS score indicating PPD.

Table 6: Chi square tests for partner support vs PPD

Out of 24 unemployed women, 3 had positive symptoms of PPD (12.5%) while out of 16 employed women, none had positive symptoms (0%) (Table 1), but despite this fact which comprehended in this study the chi- square test showed there is no significant association between employment and PPD as p-value was greater than 0.05 (Table 2). Those of low socioeconomic status appear to have a higher incidence of depressive symptoms (8.6%) as oppose to those of moderate socioeconomic class who have no significant symptoms (Figure 2), and also there is no association between socioeconomic status and PPD ( Table 3). Women showing signs of depression(8.8%) were all married, with 0% depressed among single, widowed and divorced women (Figure 3), and there is no association between marital status and PPD (Table 4). In terms of ‘’partner support’’ the study showed that 3 women with “rarely supportive partners” have shown signs of depression (18.8%), while those with ‘’supportive, sometimes supportive, not supportive partners and those with no partners at all’’ show 0% of PPD (Table 5), and again there is no association between ‘’partner support’’ and PPD (Table 6).

This study revealed some expected and some greatly unexpected points when it came to the results obtained. Firstly, the incidence of women suffering from postpartum depression wasn’t very high, only 7.5% (3 out of 40 women) had positive symptoms of Post- Partum Depression. This result is comparable to another study that conducted in Mexico by Lara M, et al. [9] which found the incidence of PPD at six weeks to be 10% and to another one that conducted in India by Chandran M, et al. [10] in which the incidence was 11%.

These three women were all unemployed, poor, married women with a “rarely supportive” husband. 12.5% of unemployed women (that is 3 out of 24 unemployed women), 18.8% of women with “rarely supportive” husbands, 8.8% of married women and 8.6% of women of low socioeconomic status presented with symptoms of Post-Partum Depression and scored 10 or more on the Edinburgh Postnatal Depression Scale (EPDS).

Using Chi square testing, P values of all these associations were greater than 0.05. So, as it appears there is no significant association between these factors and Post-Partum Depression although these factors were proven in other researches to be significant. Such as Qatar’s prospective cross-sectional study , done by Bener A, et al. [11] which concluded that financial difficulties and poor marital relationships were major risk factors for developing Post-Partum Depression.

The incidence of Post-Partum Depression, using EPDS was found to be 7.5% which is comparable to findings in other developing countries. However; marital status, employment, partner support and socioeconomic status not significant associations with the incidence of PPD.

None.

Authors declare no conflict of interest.

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