Postnatal depression among rural women in South India: do socio-demographic, obstetric and pregnancy outcome have a role to play?

Abstract

INTRODUCTION: Postnatal depression (PND) is one of the most common psychopathology and is considered as a serious public health issue because of its devastating effects on mother, family, and infant or the child. OBJECTIVE: To elicit socio-demographic, obstetric and pregnancy outcome predictors of Postnatal Depression (PND) among rural postnatal women in Karnataka state, India. DESIGN: Hospital based analytical cross sectional study. SETTING: A rural tertiary care hospital of Mandya District, Karnataka state, India. SAMPLE: PND prevalence based estimated sample of 102 women who came for postnatal follow up from 4th to 10th week of lactation. METHOD: Study participants were interviewed using validated kannada version of Edinburgh Postnatal Depression Scale (EPDS). Cut-off score of ≥ 13 was used as high risk of PND. The percentage of women at risk of PND was estimated, and differences according to socio-demographic, obstetric and pregnancy outcome were described. Logistic regression was applied to identify the independent predictors of PND risk. MAIN OUTCOME MEASURES: Prevalence, Odds ratio (OR) and adjusted (adj) OR of PND. RESULTS: Prevalence of PND was 31.4% (95% CI 22.7-41.4%). PND showed significant (P < 0.05) association with joint family, working women, non-farmer husbands, poverty, female baby and pregnancy complications or known medical illness. In binomial logistic regression poverty (adjOR: 11.95, 95% CI:1.36-105), birth of female baby (adjOR: 3.6, 95% CI:1.26-10.23) and pregnancy complications or known medical illness (adjOR: 17.4, 95% CI:2.5-121.2) remained as independent predictors of PND. CONCLUSION: Risk of PND among rural postnatal women was high (31.4%). Birth of female baby, poverty and complications in pregnancy or known medical illness could predict the high risk of PND. PND screening should be an integral part of postnatal care. Capacity building of grass root level workers and feasibility trials for screening PND by them are needed