postpartum depression in primigravida women
TRANSCRIPT
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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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