Prevalence of Antenatal Depression among Antenatal Women

INTRODUCTION

Women are an integral part of the society from time immemorial. During their life span, they pass through many important milestones, most important being pregnancy and delivery. Each role is a new experience for every woman. Being the care takers, any health problems of women affects the entire rhythm of the family. This reveals the importance of maintaining high levels of wellness for women who are the cornerstones of every family.

Pregnancy is a period when both physiological and psychological changes occurs in a woman’s body. Many expectations are laid regarding a mother’s emotional status during pregnancy. Most often, they are expected to be happy and excited about the new role. At the same time, they may feel uncertain about their new role as a mother, fears about the pregnancy or coping with labor and delivery. It is estimated that depression affects about 20% of women during their lifetime, with pregnancy being a period of high vulnerability. Depression during pregnancy demands a greater attention mainly due to three main reasons. Firstly, rate of depression during pregnancy is high during antenatal period. Secondly, it is the strongest risk factor for post-natal depression and thirdly, it leads to adverse maternal and fetal outcomes.

Unaddressed depression during pregnancy, often due to a lack of identification or treatment, has been found to contribute to numerous negative health outcomes. Suicide, smoking, drinking and drug use, poor nutrition, increased discomfort during pregnancy (i.e., nausea, shortness of breath, abdominal pain, gastrointestinal issues, and dizziness), and overall poor maternal health are common among depressed pregnant women1,2,3. The common risk factors for depression among antenatal women according to a meta-analysis are maternal anxiety, life stress, life time depression history, poor social support, domestic violence, unplanned or unwanted pregnancy, lack of intimate relationships and noncohabitation status & socioeconomic status.^4,5 

Prevalence rates of depression among pregnant women range from approximately 12–24%, with approximately 13% of pregnant women taking antidepressant medication^6,7. In a survey conducted in US among women in reproductive age group (including pregnant women) between 2005 and 2009, the prevalence of past year major depressive episode was 10%. Among them 99.6% self-reported some functional impairment in home management, work, social life or personal relationships.⁸

The prevalence of depression was 33% among 365 women in their first trimester of pregnancy in a cross sectional study conducted in Karnataka. The depression was measured using Kessler Psychological Distress Scale (K-10). Presence of antenatal depressive symptoms in the first trimester were positively associated with vomiting, prevalence ratio (PR) = 1.54 (95 % CI 1.10, 2.16) and negatively with anemia, PR = 0.67 (95 % CI 0.47, 0.96)9.An unpublished most recent study reports 59% of the study participants experienced depressive symptomatology during pregnancy¹⁰. With this background information the researchers felt the need to assess the prevalence of antenatal depression among women attending the antenatal OPD of St. John’s Medical College HospitalBangalore” 

OBJECTIVES

1. To assess the prevalence of depression among antenatal women

2. To determine the association between prevalence of depression and demographic variables of antenatal women.

METHODOLOGY

A descriptive cross sectional design was selected for the study. Keeping in mind the objectives of the study and the setting in which the study was intended to conduct, the sample size was determined. The total sample size was calculated to be 200, with a power of 80%, alpha error of 0.5%. However, we acquired 135 participants only. All antenatal women attending antenatal OPD in their second and third trimester who did not have any known history of psychiatric or associated medical disorders were selected for the study. Convenient sampling method was used to select the antenatal women. After obtaining written consent, the proforma consisting of a questionnaire to fill the demographic variables and EPDS were administered. The data collection was done when the antenatal women were waiting to meet their obstetricians during their routine antenatal visit. Approximately ten to twenty minutes were taken to collect data from each sample. The obtained data were tabulated and entered in a master sheet for statistical analysis after data cleaning.

RESULTS

I. Description of demographic characteristics of antenatal women

Findings showed that out of 68 antenatal women,75% of the antenatal women participated in the present study were primigravida, 68% hadhigher secondary and above education. Majority (85.29%) were home makers and though 60.29% of the women were from nuclear family, 50 % of the women had support from either their parents or in-laws during pregnancy and 45.58% were supported by their husbands.

II. Prevalence of antenatal depression among Antenatal women

The prevalence of antenatal depression was  measured by using EPDS. Out of 135 women 131 antenatal women scored 14 and above on the scale. (Table 1) indicating 97.03% of them suffered from probable depression and the rest of them scored 13 to 14 which indicate high possibility of depression.

III. Association between depression and demographic variables

To find association of depression with demographic variables of antenatal women Fissure’s exact probability test was used. A significant association was found between depression and variables such as type of family and age of the women. Depression was not associated with any other demographic variables of the women. (Table 3)

DISCUSION

In the present study majority (75%) of antenatal women were primi, home makers, educated high school and above. Even though 60.29% of the women were living in nuclear family and 39.71% women were from joint family, 50 of them had support of either own parents or in-laws. Out of 135 antenatal women who participated in the study, 131 women scored 14 and above in the Edinburg Postpartum Depression Scale (EPDS) (97.03%) indicating an alarming increase in the number of antenatal women with probable signs of depression. Previous studies showed there was an increase in the number of antenatal women who scored 13 or higher on the EPDS but depressive episode went undiagnosed more often than in non-pregnant women.^8,11 Another similar study reported high numbers 51/109 (47% CI 37.2–56.3) of women met the criteria for a major depressive episode (MDE). Of these, 14/51 (28%) reported episodes lasting between two weeks and two months, while 34/51 (67%) reported the current episode had persisted for more than two months but less than 6 months. Eight of the 51 (16%) depressed women reported a previously diagnosed episode of MDE which resolved prior to the current pregnancy, two of which were reported to have occurred during the postnatal period of a previous pregnancy.¹² In another study, it was found that antenatal depressive disorders were present in 9.9% with 5.1 % (97) meeting the criteria for probable major depression and 4.8% (90) meeting criteria for probable minor depression.¹³

In the present study higher scores in the EPDS were independent of antenatal women’s demographic variables such as type of family, education, or occupation, but age showed a significant association. Findings of the present study is congruent with a previous study which also did not show any significant association between EPDS score and variables like education, annual household income, and social support¹¹. Whereas another study done among different ethnic groups reported ethnicity, recent adverse life event, a history of depression, and poor subjective health three months before conception and single parenthood were significantly associated with a higher score in EPDS during pregnancy. Living with in-laws though increased the risk but did not reach to a significant level. Living with own parents seemed a protective factor.¹³

LIMITATIONS

• The present study was done with a small sample size limiting its generalizability

• Data collection was done by three researchers therefore probable inclusion of personal bias  

CONCLUSION

The study revealed that 97.03% of the women participated in the study scored 14 and above the EPDS which is interpreted as probable depression which is consistent with the previous study findings indicating an increase in the prevalence of antenatal depression in the recent past which is a cause of concern. The prevalence of probable depression was significantly associated with age. The study findings emphasize the need for strong social and family support for women during pregnancy. Health care providers need to be sensitive to the social changes and offer their support in the form of parent craft classes and counseling sessions