INTRODUCTION:

Depression is an illness that involves the body, mood and thoughts that affects the way a person eats and sleeps, that the way one feels about oneself, and the way one thinks about things. (Medicine Net.com).

Depression and during pregnancy affect neonatal outcome. In particular, attention has focused on the increased risk of spontaneous preterm delivery, low birth weight, operative delivery. (Anderson; AM J Epidemiol, vol-159, 2004).

Postpartum depression has been described as a dangerous thief that robs women of precious time together with their infants that they had been dreaming of throughout pregnancy (Beck, 1999).

Post partum depression is a common and potentially serious health problem, with adverse consequences not only for the mothers mental health and functioning but also for the psychological health of partner and, significantly for the cognitive and social development of the infant. (Murray and Copper, 1997).

The causative factor for the antenatal and post-natal depression are-history of previous depression, stressful life events, stress related to child care, postnatal blues, presence of relationship conflict, absence of supportive person, higher levels of obstetric stressors and unemployment (Appleby et al 1994, O Hara et al 1991).

Early signs of antenatal and post-natal depression may include-anxiety, worries about baby, feelings of inability to cope, sleep disturbances, depressed mood, lack of pleasure or interest, weight loss, loss of energy agitation or retardation, frequent thoughts of death or suicide, feeling of worthlessness (Maureen D, Margaret R. Myles, 2005).

Preventive measure, early identification and treatment can alleviate months of suffering from postpartum depression. In order to prevent mothers who are at risk for developing this mood disorder need to be identified early, preferably during pregnancy. (Beck, 2001).

About 10 % of pregnancies are affected by postpartum and antepartum depression approximately 1 in 679 or 0.15% or 4,00,000 people in USA.(C. Neill, Epperson ,Connecticut, 2001).

SIGNIFICANCE OF THE STUDY:

Epidemiologic data from around the world show that depression is approximately twice as common in women than men and its first onset peaks during the childbearing years. The pregnancy and postpartum period may especially challenge women health. Approximately 10-15% of women suffer from depressive illness during pregnancy or the first year postpartum.

Although most studies of depression during pregnancy and child birth have focused on post-natal depression, depression during pregnancy itself is of public health importance for two reasons. First, a number of co-hort studies have shown that the strongest risk factor for postnatal depression is antenatal psychiatric morbidity (Chandran et al, 2002, Rahman et al, 2003; Heron et al, 2004).

Thus interventions for postnatal depression may need to begin before childbirth. Second, new evidence from developing countries shows that depression during pregnancy is also associated with adverse child outcomes, including low birth weight and poor infant growth. Studies in Westen societies generally show that depressive episodes occur in 10-20% of pregnant women; depression is the most prevalent psychiatric disorder during pregnancy. Few studies have been carried out on depression during pregnancy in low economic countries. (Frietas and Botega, 2002, Felve et al, 2004).

Approximately 21% of women experience a mood disorder and 30% an anxiety disorder at some point in their lives. Although historically it was believed that pregnant women were at lower risk of mood and anxiety disorder, recent studies do not support this belief. Rather between 10 and 27% of women experience depressive symptoms during pregnancy, including 2-11% who experience major depressive disorder. Rates of depression in women are higher during the childbearing years than at any other time. Estimated rates of depression during pregnancy vary from 7-15% in economically developed countries to 19-25% in poorer countries. (OKeane, 2007).

Postpartum depression affects approximately 13% of women, from diverse cultures, within the first 12 weeks after childbirth, appears to occur twice as often for women living in poverty, with rates ranging from 22% to 34%, and has a rate as high as 26% in adolescents. (Driscoll, 2006).

STATEMENT OF THE PROBLEM:

A study to assess the depression during pregnancy and postpartum period among adolescent and adult mothers in Civil hospital Belgaum, Karnataka.

OBJECTIVES OF THE STUDY:

1. To assess the depression among antenatal mother as measured by Edinburg Postnatal Depression Scale

2. To assess the depression among postnatal mothers as measured by Edinburg Postnatal Depression Scale

3. To compare the antenatal and postnatal depression among antenatal and postnatal mothers

4. To find out the association between the antenatal depression and selected demographic variables of antenatal mother.

5. To find out the association between the postnatal depression and selected demographic variables of postnatal mother.

OPERATIONAL DEFINITIONS:

1. Depression:

In this study it refers to a state of mood in which the individual is worried, hopeless, helpless, worthless and sad.

2. Pregnancy:

In this study it refers to the period from 34 weeks to 40 weeks of conception

3. Post Partum Period:

In this study it refers to the period after the delivery to the 6 weeks

4. Adolescent mothers:

In this study it refers to the woman who is carrying the pregnancy between puberty and maturity (12-21 Years)

5. Adult Mothers:

In this study it refers to the woman who is carrying the pregnancy in the age group of 21-40 Years

ASSUMPTIONS:

1. Depression is less common in postnatal mothers who have delivered normally and given birth to normal baby.

2. Depression rate is more in adolescent pregnant mothers

DELIMITATION:

This study is limited to

1. 50 antenatal mothers who attended OPD and delivered in the same hospital.

2. Those who able to speak and understand Kannada or Marathi or Hindi or English.

REVIEW OF LITERATURE:

The review of the literature is an extensive systematic scrutanization of potential sources of previous study and work. This process helps in identification and selection of problems, backgrounds of the study, formation of tool, choosing methodology, formulating hypothesis.

Figueiredo, Pacheco and Costa (2007) done a study on depression during pregnancy and postpartum period in adolescent and adult Portuguese mothers. 108 samples (54 adult and 54 adolescent) women at 24-36 weeks of pregnancy and at 2-3 months of postpartum women were included in the study. The Edinburg Postnatal Depression Scale (EPDS) was administered among the samples. The result shows that 18.5% of mothers in 3^rd trimester of pregnancy scored EPDS >12 and 17.6% of women who was in postnatal also scored EPDS >12 before and after delivery. 25.9% of adolescent mothers presented depression 25.9% of adolescent mothers and 9.3% of adult mothers had depression while considering socio economic demographics adolescent mothers were still risk for depression symptoms during pregnancy as well as for post partum period.

Austin M. P. Tully L. Parker G. (2007) made an attempt to examine the relationship between antenatal anxiety and postnatal depression at Sydney, Australia. A sample of 748 women was included in the study during 3^rd trimester of pregnancy and at 8 weeks of postpartum. The samples have completed Brief Measure of Worry Severity (BMWS) and Speilberger State Trait Anxiety Inventory (STAC) during antenatal period and EPDS in postpartum for predicting postnatal depression. The result were women with high antenatal anxiety on the BMWS were 2-6 times more likely to have probably postnatal depression than those with low scores. Then compared to those who participated in the follow up at 8 weeks postnatally, those who didn’t participate appear to at greater risk of developing postnatal depression.

Anderson et al (2006) conducted follow up study to assess the depression and anxiety during pregnancy and 6 months of post partum in Sweden. A sample of 1555 women attending two obstetric clinics in Sweden has been selected for the study. The results shown that in few cases of depressive and / or anxiety disorder were prevalent in post partum while comparing with 2^nd trimester clinks. 16.5% of postpartum women and 29.5% of pregnant women was affected with depression and 100 anxiety.

METHODOLOGY:

Research Approach and Design:

Non experimental design and descriptive approach was used in this study.

Setting of the Study:

The study was conducted in Civil hospital Belgaum, Karnataka.

Variables:

· Independent Variables: Age, education, culture, previous experience and previous exposure to depression.

· Dependent Variables: Level of antenatal anxiety and postnatal depression of antenatal mothers and postnatal mothers.

Population:

The population of the study was adolescent and adult Antenatal and Postnatal mothers in Civil hospital Belgaum, Karnataka.

Sample Size:

The sample size consists of 50 mothers in Civil hospital Belgaum, Karnataka.

Sampling Technique:

Sampling is the process of selecting a portion of the population to represent the entire population, non-probability, convenient sampling technique is used for the investigation.

Criteria for Selection of Sample:

Inclusion criteria:

Pregnant adolescent and adult mothers, adolescent and adult postnatal mothers.

Exclusion Criteria:

Mothers admitted for the obstetrical and gynecological problems, I and II trimester pregnant women were excluded from the study.

Development and Description of the Tool:

The tool for the data collection was developed by using following tool Edinburg postnatal depression scale (EPDS)

Description of the Tool:

Edinburg postnatal depression scale (EPDS) is a standardized tool which consists of 10 statements.

Part:I: Comprised demographic data of adolescent and adult antenatal and postnatal mothers.

Part-II: Questionnaires to assess the severity of postnatal depression which comprised of so questions with multiple choices. This questionnaire is reliable to the severity of antenatal depression also.

RESULTS:

Major findings of the study:

Regarding their age 27(54%) mothers belong to age group of >21 Years and only 2(4%) belong to age group of 21 Years. (Fig.1)

With regard to education 19 (38%) of mothers had secondary education of 10^th std. and 6 (12%) were illiterate and 2 (4%) were elementary, collegiate and above. (Fig.2)

With regard to their economic status 25 (50%) mothers were having income of Rs.2001-3000 per month and only 2 (4%) mothers were having income of Rs.>4001 per month. (Fig.3)

While considering the type of family, 32(64%) were from joint family and 18(36%) were from nuclear family (Fig 4).

While considering the religion, 42 (84%) mothers were belongs to Hindu religion and 6 (12%) of mothers were belongs to Muslim religion. (Fig.5)

While considering the area to residence 29 (58%) mothers were living in rural are and about 21(42%) mothers were living in urban area. (Fig.6)

With regard to their obstetrical score 25 (50%) were primi-gravida mothers and remaining 25 (50%) were multigravida. (Fig.7)

While considering mode of delivery for postnatal mothers 32 (64%) delivered through normal vaginal delivery and 18 (36%) were delivered through caesarean section. (Fig.8)

Assessment of Level of Antenatal Depression of Adult and Adolescent Antenatal Mothers.

Table-1: Distribution of Level of Depression of Antenatal Mothers. n=50

Level of antenatal depression	Number	Percentage
No depression (<10)	13	26
Possible Depression (10 and above)	37	74

Table 2 describes that 13 (26%) were having no depression and 37 (74%) had possible depression. (Fig. 9)

Table-2: Mean and Standard Deviation of Depression of Antenatal Mothers. n=50

Statistics	Antenatal Depression Level
Mean	13.06
Standard Deviation	5.41

The above table explains that the antenatal mothers scored a mean antenatal depression level of 13.06 with a standard deviation of 5.41 (Fig. 10)

Assessment of Level of Postnatal Depression among Adult and Adolescent Postnatal Mothers.

Table-3: Distribution of Level of Depression of Postnatal Mothers. n=50

Level of Postnatal depression	Number	Percentage
No depression(<10)	24	48
Possible Depression (10 and above)	26	52

Table 4 describe that 24 (48%) were not having postnatal depression and 26 (52%) were had possible depression. (Fig. 11)

Table-4: Mean and Standard Deviation of Depression of Postnatal Mothers. n=50

Statistics	Postnatal Depression Level
Mean	9.96
Standard Deviation	5.54

The above table explains that postnatal mothers scored a mean postnatal depression level of 9.96 with a standard deviation of 5.54 (Fig. 12)

Correlation between antenatal depression and postnatal depression among mothers. n=50

r=0.330

The above ‘r’ value shows that there is a positive correlation between antenatal and postnatal depression among antenatal and postnatal mothers.

Association between Level of Antenatal Depression and Demographic Variables:

Findings suggests that there is no significant association between level of antenatal depression with demographic variables such as age, education, occupation, economic status, type of family, religion, area of residence. Obstetric score (gravida, parity, no. of living childrens) mode of delivery and past medical and surgical illness.

Association between Postnatal Depression and Demographic Variables:

Findings suggests that there is no significant association between level of postnatal depression with demographic variables such as age, education, occupation, type of family, religion, area of residence. Obstetric score ( gravida, parity, no. of living children ) mode of delivery and past medical and surgical illness. But the economic status and area of residence has significant association with postnatal depression.

IMPLICATIONS:

The investigator has drawn the following implications from the study which are vital concern to the field of nursing service, nursing administration, nursing education and nursing research.

Nursing Service:

The midwives must be tactful enough to detect the antenatal and postnatal depression at the earliest. So that she can avoid the major complications during present pregnancy and postnatal period and in future. So emphasis must be given about the prevention of depression during pregnancy and postnatal period.

Nursing Administration:

The nursing administrator should see that the health promotion aspect is included in care. The nursing administrator should teach about the signs and symptoms of depression and effects of depression on neonatal outcome. Apart from this nursing administrator should think of appointing community health nurse or educate their family which will enable to assess and prevent the depression during pregnancy and postnatal period.

Nursing Education:

Definite curriculum must emphasize on effective home visit and train the nursing staff to provide effective care during hospitalization. This will enable the nurse to get adequate knowledge and skills not only to treat the mothers at hospitals but also to educate the mothers and family in a better way.

Nursing Research:

Nursing research should focus on complications of pregnancy, delivery and postnatal period associated with psychiatric disorders such as depression, anxiety, mood disorders etc. and the effectiveness of educating and training mothers and family members in the prevention of antenatal and postnatal depression.

RECOMMENDATIONS:

The following studies can be undertaken to strengthen the accident and emergency care.

1. The same study can be repeated in different regions of the state or nation so as to compare the results.

2. The same study can be repeated on a large sample so as to generalize the results.

3. Similar kind of study can be conducted among different population such as nulliparous and multiparous mothers. A study can be done to assess the constraints depression through different population such as adult, elderly.

CONCLUSION:

On the basis of the findings, the investigator concluded that antenatal mothers had high level of possible depression during pregnancy when compared with the postnatal depression during postnatal period. These findings revealed that depression was more common in pregnancy period and psychological support of the family and their husbands may helps in reducing the depression.

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Received on 14.08.2014 Modified on 12.09.2014

Int. J. Nur. Edu. and Research 2(4): Oct.- Dec. 2014; Page 297-303