Postpartum depression in the Occupied Palestinian Territory:a longitudinal study in Bethlehem

BACKGROUND: Postpartum depression (PPD) affects women from different cultures around the world. No previous studies have investigated PPD among women in Palestine. Fertility rates in Palestine are among the highest in the world, hence even low rates of PPD could have considerable national impact. The aim of this study was to determine the prevalence of, and risk factors for, PPD among Palestinian mothers. METHODS: 101 mothers were recruited during the registration of their child’s birth (within 1 week) at the Bethlehem branch of the Ministry of Interior. Participants were assessed via a face to face interview, and were followed up 1 week, 2 weeks, 6 weeks, 3 months, and 6 months later by telephone interview. Interviews included the Arabic Edinburgh Postnatal Depression Scale (EPDS), with PPD indicated by depressive symptoms (EPDS score ≥11) at ≥2 follow-up time points. Pearson’s correlation was calculated between repeated EPDS scores, and multivariable logistic regression was used to investigate risk factors for PPD. RESULTS: The prevalence of depressive symptoms was fairly constant (14–19%) over the follow-up period. Most depressive symptoms developed within 1 month of delivery; mothers with depressive symptoms at 3 months postpartum were highly likely to still have symptoms at 6 months. 27.7% (28/101) of women met our criteria for PPD. High parity (odds ratio (OR) 4.52 (95% CI 0.90, 22.8) parity 3+ versus primiparous), unplanned pregnancy (OR 2.44 (0.99, 6.01)) and sex of child not being the one desired (OR 5.07 (1.12, 22.9)) were associated with PPD, but these associations were attenuated in multivariable analysis. CONCLUSIONS: The prevalence of PPD in Palestine appears to be higher than in high income countries, but similar to the prevalence in other Middle Eastern countries. High parity and unplanned pregnancy were identified as risk factors for PPD, suggesting that fully meeting the need for family planning could reduce the incidence of PPD in the Palestinian population

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

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

Psychometric properties and longitudinal validation of the self-reporting questionnaire (SRQ-20) in a Rwandan community setting: a validation study

Background: This study took place to enable the measurement of the effects on mental health of a psychosocial intervention in Rwanda. It aimed to establish the capacities of the Self-Reporting Questionnaire (SRQ-20) to screen for mental disorder and to assess symptom change over time in a Rwandan community setting. Methods. The SRQ-20 was translated into Kinyarwanda in a process of forward and back-translation. SRQ-20 data were collected in a Rwandan setting on 418 respondents; a random subsample of 230 respondents was assessed a second time with a three month time interval. Internal reliability was tested using Cronbach's alpha. The optimal cut-off point was determined by calculating Receiver Operating Curves, using semi-structured clinical interviews as standard in a random subsample of 99 respondents. Subsequently, predictive value, likelihood ratio, and interrater agreement were calculated. The factor structure of the SRQ-20 was determined through exploratory factor analysis. Factorial invariance over time was tested in a multigroup confirmatory factor analysis. Results: The reliability of the SRQ-20 in women ( = 0.85) and men ( = 0.81) could be considered good. The instrument performed moderately well in detecting common mental disorders, with an area

Perceptions of postnatal depression across countries and cultures: from a TransCultural Study of PostNatal Depression (TCS-PND)

Objectives The qualitative study was conducted within the international “Transcultural study of postnatal depression (PND)” in 17 centres located in 13 different countries. The aim was to explore perceptions of PND by lay and professional key informants, specifically regarding description of symptoms, awareness of this pathology and of possible care. Methods Broad areas of inquiry and open-ended probes were developed by the TCS-PND research group during international workshops to obtain data comparable between countries on perceptions of PND. A non-random convenience sampling method was used to recruit postpartum mothers for focus groups, and fathers and grandmothers for interviews. Influential healthcare planners and clinicians were interviewed as professional key informants in each centre. Within sites, transcripts of focus groups and interviews underwent a process of text analysis in the original language until exhaustive theme extraction was achieved. Themes (in English) from all the centres were combined into broader categories and after consensus discussions these categories were revalidated. Results and discussion Qualitative data were supplemented in each centre with sociodemographic data to address the issues of: (i) whether perceptions of PND are related to some specific cultural perception of mental heath and/or of status of parenthood and (ii) how high or low levels of general care and specificity of health policy relate to differences in perception of needs for care. Data collected using the same probes and methodology in different countries and cultures has enabled a comparative analysis of perceptions of PND. In addition it has shown that, although not described with the same words, PND is a well-recognised condition by recent mothers in all countries in this study. Data on focus groups and interviews from selected countries are given in the following abstracts to illustrate some similarities and differences in perceptions between countries

A Study of Postpartum Depression in a Fast Developing Country: Prevalence and Related Factors

Background: Depression is a common and disabling complication of postpartum women. There is a paucity of research on postpartum depressive disorders and their predictors in women from Arab countries. Aim: The aim of this study was to determine the prevalence and identify risk factors of postpartum depression among Arab women in Qatar using Edinburgh Postnatal Depression Scale Score (EPDS). Design: This is a prospective cross-sectional study conducted during the period from January 2010 to May 2011. Setting: Primary healthcare centers of the Supreme Council of Health, State of Qatar. Subjects: A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study. Methods: The study was based on a face-to-face interview with a designed diagnostic screening questionnaire. Occurrence of postpartum depressive symptoms was assessed by the EPDS. Also, socio-demographic characteristics, medical and family history, and obstetric variables of patients were collected through a designed questionnaire. The diagnostic screening questionnaire was reviewed and calculated the final score which identified the risk cases. Results: The prevalence of postpartum depression among the study sample was 17.6%. 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), with low monthly income (QR 5000-9999) (43.2% vs. 32.2%; p < 0.001) were significantly at high risk for postpartum depression. 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. 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. Conclusion: This prevalence of postpartum depression in women living in Qatar was comparable to previous epidemiological research done in developing countries. Financial difficulties, prematurity, lack of family support, and poor marital relationships have been identified as main risk factors for developing postpartum depression. (Int'l. J. Psychiatry in Medicine 2012;43:325-337