A Descriptive Study to assess Postpartum Depression among the Postnatal Mothers at Villianoor PHC, in Puducherry

 

Ms. M. Thamizhilakkiya, Prof. Manjubala Dash

¹Assistant Professor, Indirani College of Nursing, Puducherry

²Research Guide HOD, MTPG & RIHS, Puducherry

 

ABSTRACT:

Objective: The main objective of the study is to assess the prevalence of postpartum depression among the postnatal mothers, to associate the level of depression with the selected demographic variables of postnatal mothers. Methodology: Qualitative research design was selected and convenient sampling technique was used to select 30 samples from Villianur PHC who attended well baby clinic for the study and conducted the study with the questionnaire, consisting of 10 questions (EPDS Tool) for assessing the postnatal depression. Result: The data was analyzed by descriptive statistics. The findings of the study shown that 7 postnatal mothers are normal with the score (0-9), 12 postnatal mothers are having mild depression with the score (10-13), 10 postnatal mothers are having moderate depression with the score of (14-20) and 1 postnatal mothers affected with severe depression with the score of (21-27) The demographic variables like age, education, occupation, income, religion, total number of pregnancy shows association with postpartum depression. Conclusion: Primi mothers with young age, low educational status, unemployment low income are more affected with postnatal depression. Recomendation: Counselling during pregnancy itself is effective to prevent postnatal depression during postpartum period.

 

 

 

 

INTRODUCTION:

“Down came the Rain –My journey through Post Partum Depression”

                                                                  Brooke Shields

 

Postpartum period (or postnatal period) is the period beginning immediately after the birth of a child and extending for about six weeks. Pregnancy and Puerperium are highly stressful periods in a women’s life. Symptoms may include hopelessness, guilt, difficulty concentrating, poor appetite, and thoughts of suicide. Among a wide range of reasons a unique one is hormonal changes during the postpartum period that increase the incidence of depression in this period.¹ The birth of a child can be joyous and exiting time, but following childbirth, some women may experience postpartum disorders that can adversely affect a women s mental health. The person is threatened by various changes such as psychological changes and endocrine changes occurring in one body, as she is in reorganization of psyche in accordance with the new mother role especially in the first pregnancy.² (Logsdon 2004).

 

Psychological disorders during the post partum period are common and poorly understood in terms of pathophysiology. The major forms of these disorders are postpartum psychosis and postpartum depression. The postnatal depression is a more severe, lasting depression is experienced by up to 12%of women after delivery. The consequences of untreated postpartum depression can be serious due to the associated risk of suicide and infanticide. It is common among women with young children, and is strongly associated with financial diversity (Wong S 2007).³

 

According to The National Institutes of Mental Health, studies show that the childbearing years are when a woman is most likely to experience depression in her lifetime. Approximately 15% of all women will experience postpartum depression following the birth of a child. When the mental health of the mother is compromised, it affects the entire family (Lappon-Gracon S 2004)⁴

 

The postpartum depression affects many women globally. In the weeks and months that follow the birth of a child, between 10 and 20 percent of mothers experience serious or moderate symptoms of depression Today, the postpartum depression is affecting 13% women from diverse cultures.10-15% women depends postnatal depressive illness. In India, studies have shown that depression among young women (20-30years) is most common and illiterate (80%) house wives with (95%) from rural areas highly religious (60%) poor (90%) primipara (80%) and with a live baby born (70%). The postnatal depression affects 10-20% of women in United States. Despite the well documented risk factors and health conscious of postpartum depression if often remains undetected and untreated. The prevalence rates varying from 4.4%to 73%. The most frequent psychiatric disorder seen after childbirth, with a prevalence rate of 10% to 15%. The setting up of relevant and efficient prevention and promotion programs requires a better understanding of the effect of stress and social support on the mental health of mothers (Born L 2003)⁵.

 

OBJECTIVES OF THE STUDY:

·       To assess the prevalence rate of postpartum depression among the postnatal mothers.

·       To evaluate the effectiveness of EPDS tool among the postnatal mothers.

·       To associate the level of postpartum depression with the selected demographic and obstetrical variables of postnatal mothers.

CONCEPTUAL FRAMEWORK:

The conceptual framework of this study was based on the modified Donabedian’s process and outcome quality care model (1998) for conceptual framework. Donabedian, (1987) whose pioneering efforts created a framework for outcome research, (as cited by Julia B George, 1995). It provides a way to understand the many influences on the three interacting factors, the structure, process and the outcome.

 

The structure:

According to Donabedian’s model, structure refers to the physical, human and financial resources available in the settings in which care occurs. In this study the investigator was studying five demographic variables like age, education, occupation, income, religion, type of gravid.

 

The process:

Process describes the specific behaviors. It include the health care providers activities in diagnosing and treating problems, as well as the patient’s efforts in accessing care, adhering to the treatment plan and implementing self-care measures. In this study, the investigator assessed the level of depression level among the postnatal mothers under study. 

 

The outcome:

The outcome refers to any consequences of care. More specifically outcome refers to the health related conditions of individuals that are attributable to prior health care. In this study outcome is the final result of the level of depression level among postnatal mothers which was measured by using EPDS depression screening tool.

 

Modified Donabedian’s process and outcome quality care model (1998) - Conceptual Framework

STRUCTURE		PROCESS		OUTCOME
CHARACTERISTICS DEMOGRAPHIC VARIABLE   ŸAGE ŸEDUCATION ŸOCCUPATION ŸINCOME ŸTYPES OF GRAVIDA		ASSESMENT OF DEPRESSION LEVEL EPDS TOOL E- Edinburgh P-Postnatal D-Depression S -Scale		DEPRESSION LEVEL OF MOTHERS     Normal Mild Moderate Severe

 

MATERIAL AND METHODS:

The quantitative approach with non experimental – descriptive design was adapted for this study. The dependent variable in this study was depression level of postpartum mothers and independent variable is EPDS tool. The study was conducted in Villianoor PHC, Situated in Puducherry. Population of this study includes Post natal mothers who are attending well baby clinic at 6 to 8 weeks, Villianoor PHC, Situated in Puducherry. The inclusion criteria for the study was postnatal mothers who were present at the time of data collection, willing to participate in the study, Postnatal mothers whose infant age under 6 to 8 weeks. An exclusion criterion for the study was who were not present at the time of data collection, Permission was obtained from the concerned authorities. The purpose of the study was explained to the mothers and an informed oral consent was taken from all the participants of the study.

 

The EPDS standardized tool was used for the study. It consists of two sections. Section I: Demographic variables. It includes Name, Age, Sex, Religion, education, occupation, income, type of gravida of the postnatal mothers participating in study. Section II: EPDS tool to assess the depression level of postnatal mothers. EPDS tool is the mnemonic for Edinburgh, Postnatal, Depression, Scale. It consists of total 10 Multiple choice questions. Answer for each question carries scores. These scores were calculated in total and the mothers were segregated into four levels of depression i.e. normal, mild, moderate, severe. Scoring System of EPDS Depression screening tool is 0-9= Normal, 10-13 = Mild, 14-20 = Moderate, 21-27=Severe.

 

The EPDS depression screening questionnaires were given to the mothers. The depression level of the mothers was assessed by scoring the responses of the mothers by using the standard scoring system of EPDS tool. The mothers were categorized to normal, mild, moderate, severe, according to the scores obtained for their responses.

 

Data collection method:

Permission obtained from the concerned authorities. The purpose of the study will be explained to the subjects, an informed consent will be taken and questionnaires will be given to subjects to fill it. The depression level of postnatal mothers will be assessed by scoring the responses by using the standard scoring system of EPDS tool. The Postnatal mothers will be categorized to low, medium and high risk according to the scores obtained for them. The high risk will be informed to concerned authorities and will be send for counseling for the further improvement of their Psychological health.

 

SECTION-A:

Distribution of demographic variables:

Table 1: Distribution of age in years        n=30

SL. No	Age in years	Frequency	Percentage
1	18-20	6	20%
2	21-25	17	57%
3	26-32	7	23.33%
4	Total	30	100%

 

Inference:

Table-1 shows that percentage distribution of age which consists of 20% belongs to 18-20 years of age, 57% belongs to the age of 21-25yrs, and 23.33% belongs to 26-32yrs of age. This indicates that most of the postnatal women were in the age of early adulthood.

 

 

Figure 2: Shows distribution of type of Gravida

 

Inference:

Figure 2 shows that 53% of postnatal mothers are Primigravida and 47% of postnatal mothers are Multigravida. This indicates that most of the mothers are Primi.

 

 

Figure 3: Shows distribution of EPDS score

 

Inference:

Figure 3: shows that 23.3% of postnatal mothers are normal, 40% of mothers are affected with mild depression, 33.33% of mothers are moderately affected, 3.33% of mothers are affected severely with depression. This shows that most of the postnatal mothers are mildly affected with depression.

 

SUMMARY:

Puerperium are highly stressful periods in a women’s life. Symptoms may include hopeless stress, guilt, difficulty concentrating, poor appetite, and thoughts of suicide. Among a wide range of reasons a unique one is hormonal changes during the postpartum period that increase the incidence of depression in this period. The birth of a child can be joyous and exiting time, but following childbirth, some women may experience postpartum disorders that can adversely affect a women s mental health. So every postnatal mothers should be screened for depression level. The routine depression level screening will help the authorities to identify the high risk mothers and to provide appropriate counseling to them for their behavioral development. 

 

 

RECOMMENDATIONS:

The following recommendation are made by using the findings.

A similar study should be,

·       Conducted with large samples

·       A comparative study between normal postnatal mother and abnormal postnatal mothers.

·       An educative Programme should be conducted on depression among postnatal mothers.

·       A similar study can be conducted by analyzing the various aspects of depression level.

 

CONCLUSION:

The conclusion drawn from the study is that most of the mothers 57% belongs to the age of 21-25yrs, 83.33%belongs to Hindu, 53% of postnatal mothers are Primigravida .The findings of present study reveals that 23.33% of post natal mothers are normal, 40% of post natal mothers are affected with mild depression, 33.33 % of  postnatal mothers are moderately affected and 3.33% of mothers are severely affected with depression.

 

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Received on 21.02.2019          Modified on 31.04.2019

Accepted on 23.05.2019     © A&V Publications all right reserved