INTRODUCTION:

Hypertension is one of the common complications met in pregnancy and it is one of the major causes of maternal morbidity and mortality leading to 10-15% of maternal deaths specially in developing world¹. World health organization estimate that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy².

PIH is defined as a sustained rise of blood pressure to 140/90 mm Hg or more on at least two occasions 4 or more hours apart beyond the 20^th week of pregnancy or during the first 24 hours after delivery in a previously normotensive woman³.Pregnancy Induced hypertension (PIH) affects about 5 % of Pregnant women and is a significantcause of maternal, fetal, and neonatal mortality and morbidity. In India the incidence of pre-eclampsia is reported to be 8-10% of the pregnancies⁴.

Pregnancy is a special time for a woman and her family. It is a time of many changes in a pregnant woman’s body, in her emotions, and in the life of her family. These changes often add new stresses to the lives of pregnant women. However, when stress builds up to uncomfortable levels, it can be harmful for the pregnant woman and can cause fatigue, sleeplessness, anxiety, headaches and backaches. When a high level of stress continues for a long period, it can contribute to potentially serious health problems, such as lowered resistance to infectious diseases, high blood pressure and heart disease⁶.

Statement of the problem:

Assess the effectiveness of Relaxation Therapy on Stress and Physiological parameters among Antenatal mothers with Pregnancy Induced Hypertension admitted at Pravara Rural Hospital, Loni (Bk).

Objectives:

1. To assess the level of stress and physiological parameters of antenatal mothers with pregnancy Induced Hypertension before implementation of Relaxation therapy.

2. To determine the effectiveness of relaxation therapy on stress and physiological parameters on antenatal mothers with Pregnancy Induced Hypertension.

3. To co-relate the post test stress and physiological parameters with their selected socio-demographic and clinical characteristics.

Hypotheses:

H₁– There is a significant difference in stress and physiological parameters in experimental and control group.

H0₁- There is no significant difference in Stress and physiological parameters in experimental and control group.

H₂- There is significant association between stress, physiological parameters with their selected demographic variables.

H0₂- There is no significant association between stress, physiological parameters with their selected demographic variables.

H₃- There is significant relationship between stress and physiological parameter.

H0₃- There is no significant relationship between stress and physiological parameter.

MATERIAL AND METHOD:

Quasi experimental study, where a pre and post test design with control group approach was used for assessing the effectiveness of Relaxation Therapy on Stress and Physiological parameters among Ante natal mothers with PIH. A sample for the present study was the ante natal mothers with PIH admitted in Pravara Rural Hospital and available during the period of data collection period. The sample size was comprised of 60 ante natal mothers with PIH, out of which 30 were in experimental group and 30 were in control group .Non probability method; purposive sampling technique was used for the selection of participants who meet the purpose of the study on the basis of inclusion and exclusion criteria

The data were collected from 60 ante natal mothers with PIH (30 in experimental and 30 in control group) admitted in maternity ward, who was selected through purposive sampling technique. The structured interview schedule was used to collect data, and the data were analyzed by using descriptive and inferential statistics. The result was presented in the form of tables, figures in chapter IV. This chapter presents a discussion of the findings

A self prepared and validated structured questionnaire was used to collect data, which comprised of Section A consisted of two parts, part-I deals with socio-demographic data and part-II Parital characteristics of ante natal mothers with PIH, Section-B consist of DASS Rating scale was used to assess the level of depression, anxiety and stress and Section C consist of observational checklist was used to assess the physiological parameters among ante natal mothers with PIH.

FINDINGS OF THE STUDY:

Section A: Socio demographic data:

Percentage wise distribution of ante natal mothers with PIHaccording their age show that in experimental group majority 57% were 19-23 years followed by 30% were 24-28 years whereas in control group 37% were 19-23 years one third (33%) were 24-28 years and significant percent (30%) were above 29 years. in both group one third (33%) had secondary school education followed by in experimental group 30% and 20% of them had higher secondary education. both group majority (83% and 73%) of them were home makers, and the remaining were doing agriculture and in the private / government service. (67% and 70%) of them were belongs to joint family, followed by significant proportion (30% and 20%) were belongs to nuclear family. (80% and 77% respectively) of them were Hindu religion and the remaining mothers were belongs to Muslim and Christian religion. in both group one fifth (20%) of them had previous history of PIH. (73% and 70%) of them were primipara mothers followed by significant proportion (23% and 20%) were second para. (67% and 70%) of them had less than one month of duration of illness of PIH, while a significant percent (27% and 20%) had duration of illness between 1-3 months. in both group majority (70% and 73%) of them had Tab. Depine (Nifedepine) as a treatment for PIH followed by (30% and 27%) underwent Tab. Labet. (Labetalol).

Section B

Table 1. Assessment of Depression, anxiety and stress among ante natal mothers with PIH before implementation of relaxation therapy.

S. N	Area	Experimental Group		Control Group
S. N	Area	Mean	SD	Mean	SD
1	Depression	3.96	1.86	5.56	2.06
2	Anxiety	7.03	2.15	5.9	1.24
3	Stress	9.06	2.98	8.56	2.72

Distribution of mean, SD of pre testscores on depression and anxiety shows that, in both group the mean scores was less than 7 for depression i.e (3.96±1.86) and (5.56±2.06) respectively indicates ante natal mothers with PIH had ‘mild’ depression, similarly in relation to anxiety the ante natal mothers had mean less than 7 i.e (7.03±2.15) and (5.9±1.24) respectively indicates mild anxiety.

Table 2. Assessment of physiological parameters among ante natal mothers with PIH before implementation of relaxation therapy.

Physiological Parameter	Experimental Group	Control Group
	Day 1	Day 1
	10 AM	10 AM
	No. (%)	No. (%)
BLOOD PRESSURE (mmHg)
120-130/ 80-90	13 (43%)	9 (30%)
130-140/ 90-100	15(50%)	18 (60%)
140-150/ 100-110	2 (7%)	3(10%)
PULSE (Beats/ Min)
80-100	25 (83%)	22(73%)
>100	5(17%)	8 (27%)
RESPIRATION (Breath/ Min)
20-22	24(80%)	26 (87%)
>22	6 (20%)	4 (13%)

Above mentioned table-2 depicts that in both group the ante natal mothers with PIH,on day one at 10.00 am higher percentage (50% and 60%) of them had blood pressure 130-140/90-100 mmHg followed by majority 83% and 73% had pulse rate between 80-100 beats/ min and the remaining had more than 100 beats/ min.

Section C:

Assessment of effectiveness of relaxation therapy on Depression, anxiety and stress among ante natal mothers with PIH.

Table 3. Area wise comparison of mean, SD and mean percentage of post test Depression, anxiety and stress among ante natal mothers with PIH.

SN	Area	Experimental Group		Control Group		Difference in mean
SN	Area	Mean	SD	Mean	SD	Difference in mean
1	Depression	1.33	0.79	4.7	1.41	3.37
2	Anxiety	3.13	1.26	4.8	0.84	1.67
3	Stress	6.2	2.15	7.16	2.14	0.96

Distribution of mean, SD and mean percentage of post test scores on depression and anxiety shows that, in both group the mean scores was less than 7 for depression i.e (1.33±0.79) and (4.7±1.41) respectively indicates ante natal mothers with PIH had ‘mild’ depression, similarly in relation to anxiety the ante natal mothers had mean less than 7 i.e (3.13±1.26) and (4.8±0.84) respectively indicates ‘mild’ anxiety. However in relation to stress, the participants in both group had mean score between 6-8 i.e. (6.2±2.15) and (7.16±2.14) respectively indicates the ‘mild level’ of stress. It interprets that the ante natal mothers with PIH in both group had mild level of depression, anxiety and stress after the implementation of relaxation therapy.

Table 4. Area wise comparison of frequency and percentage of post test physiological parameters among antenatal mothers with PIH.

Physiological parameter	Experimental Group		Control Group
	Day 1	Day 7	Day 1	Day 7
	10 AM	10 AM	10 AM	10 AM
	No. (%)	No. (%)	No. (%)	No. (%)
BLOOD PRESSURE (mmHg)
120-130/ 80-90	26 (87%)	27 (90%)	11(37%)	19 (64%)
130-140/ 90-100	4 (13%)	3 (10%)	17(57%)	10 (33%)
140-150/ 100-110	0 (0)	0 (0)	2 (7%)	1 (3%)
PULSE (Beats/ Min)
<80	5 (17%)	12 (40%)	2 (7%)	4 (13%)
80-100	25 (83%)	18 (60%)	22 (73%)	19 (64%)
>100	0 (0)	0 (0)	6 (20%)	7(23%)
RESPIRATION (Breath/ Min)
<20	2 (7%)	8 (27%)	3 (10%)	2 (7%)
20-22	28 (93%)	22 (73%)	22 (73%)	24 (80%)
>22	0 (0)	0 (0)	5 (17%)	4 (13%)

Above mentioned table-4 depicts that in experimental group the ante natal mothers with PIH, on day one and day seven at 10.00 am higher percentage (87% and 90%) of them had blood pressure 120-130/80-90 mmHg followed by majority (83% and 60%) had pulse rate between 80-100 beats/ min. The difference for Blood pressure was (50%) and (26%) respectively, and for Heart rate the difference was (10%) and (4%) respectively. It interprets that the relaxation therapy was effective to reduce the Blood pressure and Heart rate.

Section D:

Comparison of the effectiveness of relaxation therapy on depression, anxiety and stress with selected socio-demographic variable of ante natal mothers with PIH .

Comparison of mean, SD of post test scores of depression, anxiety and stress with their age shows that, irrespective of age group all the ante natal mothers with PIH of experimental group had mean less than 7 indicates ‘mild level’ of depression, anxiety and stress. However in control group the mothers of 19-23 years of age had higher mean score (8.18±1.16) indicate ‘moderate level’ of stress. It interprets that the ante natal mothers with PIH who had relaxation therapy had less severity of manifestation than the control group. (Table-5).

Comparison of mean, SD of post test scores of depression, anxiety and stress with their age shows that, irrespective of parity all the ante natal mothers with PIH of experimental group had mean less than 7 indicates ‘mild level’ of depression, anxiety and stress. However in control group the primipara mothers of had higher mean score (7.71±2.07) indicate ‘moderate level’ of stress. It interprets that the ante natal mothers with PIH who had relaxation therapy had less severity of manifestation than the control group. (Table-6).

Comparison of mean, SD of post test scores of depression, anxiety and stress with their gestational age shows that, irrespective of gestational age all the ante natal mothers with PIH of both group had mean less than 7 indicates ‘mild level’ of depression, anxiety and stress. It interprets that the ante natal mothers with PIH who had relaxation therapy had less severity of manifestation than the control group.

(Table-7).

Table 5. Comparison of mean and SD of post test scores of depression, anxiety and stress of experimental and control group to their Age

Age (in years).	No. of Patient	Experimental Group							No. of Patient	Control Group
		Depression			Anxiety		Stress			Depression		Anxiety		Stress
		Mean	SD	Mean		SD	Mean	SD		Mean	SD	Mean	SD	Mean	SD
19-23 Yrs	17	1.11	0.6	2.82		0.80	6.29	1.89	11	4.54	17.10	4.63	0.92	8.18	1.16
24-28 Yrs	9	1.22	0.83	3.55		1.66	6.22	2.68	10	4.3	1.49	4.9	0.73	7.8	2.20
29-33 Yrs	4	1	1.15	3.5		1.73	5.75	2.5	6	5.16	1.72	5.16	0.98	5.66	2.15
>33 Yrs	-	-	-	-		-	-	-	3	5.66	0.57	4.33	0.57	4.33	0.57

Table 6. Comparison of mean and SD of post test scores of depression, anxiety and stress of experimental and control group to their Parity

Parity	No. of Patient	Experimental Group						No. of Patient	Control Group
		Depression		Anxiety		Stress			Depression		Anxiety		Stress
		Mean	SD	Mean	SD	Mean	SD		Mean	SD	Mean	SD	Mean	SD
Primipara	22	1.13	0.66	3.09	1.26	6.09	2.16	21	4.57	1.32	4.61	0.65	7.71	2.07
2^ndpara	7	0.85	0.89	3.57	0.97	6.14	2.47	6	4.66	1.50	5.66	1.03	6.66	1.74
Multi para	1	2	0	1	0	9	0	9	5.66	0.57	4.33	0.57	4.33	0.57

Table 7. Comparison of mean and SD of post test scores of depression, anxiety and stress of experimental and control group to their Gestational Age

Gestational Age	No. of Patient	Experimental Group						No. of Patient	Control Group
		Depression		Anxiety		Stress			Depression		Anxiety		Stress
		Mean	SD	Mean	SD	Mean	SD		Mean	SD	Mean	SD	Mean	SD
21-28 Wks	13	0.84	0.68	3.38	1.12	6.30	2.32	10	4.7	1.24	5	1.15	7.2	5.06
29-36 Wks	16	1.31	0.7	3	1.36	6.56	2.10	18	4.66	1.41	4.72	0.60	7.27	1.99
>37 Wks	1	2	0	2	0	4	0	2	5	1.41	4.5	0.70	6	4.24

Table 8. Comparison of mean and SD of post test scores of depression, anxiety and stress of experimental and control group to their Duration of Illness

Duration of illness	No. of Patient	Experimental Group						No. of Patient	Control Group
		Depression		Anxiety		Stress			Depression		Anxiety		Stress
		Mean	SD	Mean	SD	Mean	SD		Mean	SD	Mean	SD	Mean	SD
≤ 1 Month	20	1.1	0.71	3.25	1.25	6	2.26	21	4.61	1.32	4.76	0.88	7.76	2.07
1-3 Month	8	1.12	0.83	2.87	1.35	6.32	2.04	6	4.33	1.21	4.83	0.74	5.83	1.72
3-6 Month	1	1	0	4	0	8	0	2	6.5	0.70	5.5	0.70	6.5	2.12
≥ 6 Month	1	2	0	2	0	5	0	1	5	0	4	0	4	0

Comparison of mean, SD of post test scores of depression, anxiety and stress with their duration of illness shows that, irrespective of month all the ante natal mothers with PIH of experimental group had mean less than 7 indicates ‘mild level’ of depression, anxiety and stress. However in control group the mothers less than one month had higher mean score (7.76±2.07) indicate ‘moderate level’ of stress.It interprets that the ante natal mothers with PIH who had relaxation therapy had less severity of manifestation than the control group. (Table-8).

Section E:

Testing of hypotheses

H0₁- There is no significant difference in Stress anxiety and Depression and physiological parameters in experimental and control group.

Table 9. Paired ‘t’ value of post test on depression, anxiety and stress in experimental group and control group

SN	Area	‘t’ value	Level of significant
1	Depression	15.09	Significant
2	Anxiety	7.76	Significant
3	Stress	7.51	Significant

(df-29, Table value-3.86, P<0.05 level)

Paired ‘t’test was calculated to analyze the difference in depression, anxiety and stress among the experimental group (i.e after implementation of relaxation therapy) and control group (i.e without intervention). A significant difference was found between the depression, anxiety and stress between the two groups at P< 0.05 level. (Table-9).

Hence the stated null hypothesis (H01) rejected and the alternative hypothesis (H1) was accepted, as it was interpreted that there was highly significant difference existed between post test level of depression, anxiety and stress. Thus the difference observed in the study variables in experimental and control group were true difference and not by chance.

H0₂- There is no significant association between Depression, anxiety and stress with their selected demographic variables.

Table 10. Association between the depression, anxiety and stress of experimental group of ante natal mothers with PIH with their selected socio-demographic variables. n=30

S. N	Variables	Depression	Anxiety	Stress
1	Age	3.70	1.02	4.79*
2	Educational Qualification	7.5*	4.41*	2.06
3	Type of family	3.69	1.19	10.75*
4	Parity	1.31	13.92*	8.82*
5	Gestational age	10.35*	5.9*	2.45
6	Duration of illness	0.29	2.80	7.5*
7	Co-morbid illness	1.95	14.28*	10.07*

(df-1) Table value 3.84 P<0.05 Level *Significant

Chi-square values were calculated to find out association between depression, anxiety and stress with their selected socio demographic variables of the experimental group of PIH ante natal mothers. Finding reveled that there was a significant association between the depression and the demographic variables like educational qualification, gestational age of PIH. Alongside the anxiety had statistically significant association with educational qualification, parity, gestational age and co-morbid illness of PIH. However, there was significant association between the stress with their demographic variables like age, type of family, parity, duration of illness and co-morbid illness of PIH. Hence, the stated null hypothesis (H02) was rejected and the alternative hypothesis (H2) was accepted. (Table-10).

H0₃- There is no significant relationship between stress anxiety and Depression with their selected demographic variables.

The coefficient of co-relation test values reveled that among the selected study variables like depression and anxiety had moderately positive correlation (r= + 63) which indicates that depression has influence on anxiety. In anxiety and stress, these two variables had strong positive (r= + 0.66), which interprets that anxiety has influence on stress. Alongside between the depression and stress, a strong positive correlation (r= +72) was noted which indicates the depression has influence on stress. It was found that there was positive relationship between the study variables like depression, anxiety and stress. Hence, that the stated null hypothesis (H03) was rejected and the alternative hypothesis (H3) was accepted.

DISCUSSION:

A) Description of socio demographic data of ante natal mothers with PIH:

In experimental and control group, (57% and 37%) of ante natal mothers were 19-23 years of age, which revealed that the reproductive age group were commonly affected populations with PIH .This finding was upheld by Deepti Damodarm who also observed that the majority (45%) and (37%) of ante natal mothers of experimental and control group over the age of 20-25 years.⁷Overall (83%) of mothers in experimental group and (73%) of mothers in control group were home makers. It was concurrent with the study done by Deepti around (43%) of ante natal mothers with PIH were Home makers⁸.Higher percent (67%) and (70%) of ante natal mothers in experimental and control group were belongs to joint family. The result supports the changes in family structure. experimental and control group one fifth (20%) of them had previous history of PIH. This findings was consistent with study carried out by Meenakshi Sharma who noticed that in both group (36% and 48%) mothers had previous history of PIH⁹.

B) Description of parital characteristics of ante natal mothers with PIH:

In experimental and control group according their parity shows that (73% and 70%) of them wereprimipara mothers. This findings was consistent with the study done by PratibhaKamathwho also observed that (73%) of ante natal mothers with PIH were primi para¹⁰.

In both group (53% and 60%) of them had 29-36 weeks of gestational age, however the significant percent (43% and 33%) had 21-28 weeks of gestational age respectively of ante natal mothers respectively .These findings were parallel with the study carried out by Neethu Mariam Philip who also reported that the occurrence of PIH was highest in 28-36 weeks of gestational age¹¹.

In both group significant percent (30% and 26% respectively) of them had anaemia whereas majority (60% and 57%) did not had any co-morbid illness. These findings were supported by Bajwa, S. K., &Ghuman, G. S who found that ante natal mothers with PIH had co-morbid illness¹². Level of depression, anxiety and stress among ante natal mothers with PIH before implementation of interventions in experimental and control group

The study finding noted that the ante natal mothers with PIH under study during pretest scores on depression and anxiety shows that, in both group the mean score was (3.96±1.86) and (5.56±2.06) respectively indicates ‘mild level’ of depression, similarly in relation to anxiety the ante natal mothers had mean (7.03±2.15) and (5.9±1.24) respectively indicates ‘mild’ anxiety. However the stress score was (9.06±2.98) and (8.56±2.72) indicate ‘moderate level’ of stress. The study findings was consistent with the studydone by Andrea Suzanne also found that before the nursing intervention (Relaxation therapy) on depression, anxiety and stress among ante natal mothers with PIH shows that mothers in the experimental group had significantly lower depression scores and higher anxiety and stress score when compared to the control group¹³.

C) Effectiveness of relaxation therapy on depression, anxiety and stress among ante natal mothers with PIH experimental and control group:

The study findings revealed that on depression, anxiety and stress shows that in both group had in posttest mean score for depression (1.33±0.79) and (4.7±1.41) respectively indicates ante natal mothers with PIH had ‘mild’ depression, similarly in relation to anxiety the ante natal mothers had mean scores was (3.13±1.26) and (4.8±0.84) respectively indicates ‘mild’ anxiety. However in relation to stress, the participants in both group had mean scores was (6.2±2.15) and (7.16±2.14) respectively indicates ‘mild level’ of stress. Its shows that the relaxation therapy had significant effect in reducing the level of depression, anxiety and stress.This study findings was consistent with the study was done by Paras Joshi also found that after the nursing intervention on depression, anxiety and stress among ante natal mothers with PIH shows that mothers in the experimental group had significantly lower depression, anxiety and stress scores when compared to the control group¹⁴.

D) Testing of hypotheses:

Significant difference in Depression, anxiety and stress and physiological parameters in experimental and control group:

The study finding analyze the difference in depression, anxiety and stress among the experimental group and control group. A significant difference was found between the depression and anxiety between two groups under study. It is consistent to the study conducted by Kalaivani G. who also found that relaxation therapy had significant difference in post test scores of depression and anxiety¹⁵. Alongside a significant difference was found between the stress in two groups under study. It is consistent to study conducted by Shruti Srivastava, Natash Dua also found that relaxation therapy had significant difference in post test scores of stress.¹⁶

CONCLUSION:

The conclusion drawn from the study was that the ante natal mothers suffer from PIH.The result highlights that the relaxation therapy was effective in reducing the stress and physiological parameters on ante natal mothers with PIH which was statistically significant. It was evident that there was a significant positive relationship was excited between the depression, anxiety and stress. It was emphasized that the compliance with intervention to reduce the level of stress and physiological parameters.

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Received on 15.10.2018 Modified on 16.11.2018

Int. J. Nur. Edu. and Research. 2019; 7(2):211-217.

DOI: 10.5958/2454-2660.2019.00046.2