Prevalence and Factors Associated with Postpartum Depression Among Mothers Attending Public Health Centers of Addis Ababa, Ethiopia, 2016

1. INTRODUCTION

Postpartum Depression (PPD) involves various groups of depressive symptoms and syndromes that take place during the first year following birth [1]. It is recognized as risk period for severe mood disorder that comprises provisional blue, major depression and debilitating psychotic depression [2]. Several sign and symptoms that define PPD are low self-worth and interest, tiredness, sadness, disturbed sleep and appetite [3], problem in concentrating and making decision, feeling of unworthy to live, having negative thought about the baby, feeling of guilt and shame [4].

Worldwide, statistics shows that 450 million people are seriously affected by neurological and mental illness ranking depression as the fourth principal cause for disability and premature deaths and by the year 2020, depression is predicted to be the second leading cause of disability [5]. Irrespective of economic status, race or ethnic groups’ depression tends to occur twice more in women than men [2].

Globally, about 10% of pregnant women and 13% of women who just gave birth are suffering from mental health problems. It is higher in developing countries where 15.5% develop mental illness during pregnancy and 19.8% after childbirth [3] continuing to affect the welfare of mothers, their babies, partners and family members [6].

A number of researches have been done in developed countries while limited facts from developing countries including Ethiopia are found [7, 8]. PPD has been studied in more than 90% of high income countries (HICs) compared with just 10% of low and middle-income countries (9). According to the Ethiopian national mental health strategy in the year 2012/13 - 2015/16 by Federal Democratic Republic of Ethiopia Ministry of Health (FMOH) mental illness was the leading non-communicable disorder in terms of burden. Indeed, in a predominantly rural area of Ethiopia, mental illness comprised 11% of the total burden of disease including schizophrenia and depression among the top ten of the most burdensome illness. The prevalence for general depression was 5.0% and more than one in ten pregnant women and one in 20 postnatal women in Ethiopia suffer from undetected depression [10].

As provision of care will vary depending on the socio-demographic and cultural factors, it is difficult to establish conclusion on prevalence and associated risk factors of PPD. Despite its massive effects especially in low and lower income countries, women and clinicians inadequately understand it. Even though multiple studies have been conducted in Ethiopia concerning postpartum cares, the focus has always been on PNC or family planning services whereas the prevalence and associated factors of PPD gained little attention. As a result, it is important to get an insight and plan for the implementation strategies to prevent and identify PPD early at the postpartum period. Therefore, the present study aims at assessing the prevalence and associated factors of postpartum depression among mothers attending public health centers in Addis Ababa, Ethiopia.

2. MATERIALS AND METHODS

3. RESULTS

3.5. Prevalence of Postpartum Depression

From all the respondents, 144 (23.3%) had postpartum depression (Fig. 1) and 69 (11.2%) reported they were not “able to laugh and see funny side of things”. For forty-eight (7.8%) of the participants it was “difficult to look forward with enjoyment to things” and 58 (9.4%) were frequently blaming themselves unnecessarily. As nearly one sixth of the study participants were anxious or worried for no good reason, 30 (4.9%) reported worrying about scaring or panicking for no good reason and 25 (4.0%) stated they were not able to cope up with things at all. Twenty-six (4.2%) of the study participants had difficultly to sleep and 21 (3.4%) respondents reported that mostly they “felt sad or miserable”. In addition, 18 (2.9%) were unhappy and have been crying most of the time whereas two (0.35%) had a thought of harming themselves (Table 4).

Table 4.

Characteristics	Frequency	Percent
Experienced laugh and see funny side of things
As much as always I could	394	63.8
Not quite so much now	102	16.5
Definitely not so much now	53	8.6
Not at all	69	11.2
Look forward with enjoyment to things
As much as I ever did	385	62.3
Rather less than I used to	125	20.2
Definitely less than I used to	60	9.7
Hardly at all	48	7.8
Blamed yourself unnecessarily
No never	309	50.0
Not very often	119	19.3
Yes some of the time	132	21.4
Yes most of the time	58	9.4
Been anxious or worried for no good reason
No not at all	319	51.6
Hardly ever	70	11.2
Yes sometimes	175	28.3
Yes very often	54	8.7
Felt scared or panic for no good reason
No not at all	375	60.7
No, not much	102	16.5
Yes, sometimes	111	18.0
Yes, quite a lot	30	4.9
Things have been on top of you
No I have been coping	388	62.8
No most of the time	166	18.8
Yes sometimes I haven’t been coping as well as usual	89	14.4
Yes most of the time I haven’t been able to cope at all	25	4.0
Difficult to sleep
No, not at all	375	60.7
Not, very often	144	23.3
Yes sometimes	73	11.8
Yes most of the time	26	4.2
Felt sad or miserable
No, not at all	386	62.5
Not, very often	149	24.1
Yes, quite often	62	10.0
Yes, most of the time	21	3.4
So unhappy you have been crying
No, never	410	63.3
Only occasionally	149	24.1
Yes quite often	41	6.6
Yes, most of the time	18	2.9
Thought of harming your self
Never	544	88.0
Hardly ever	41	6.6
Sometimes	31	5.0
Yes, quite often	2	0.3

4. DISCUSSION

The current study assessed the magnitude and factors that has an association with post-partum depression in selected health centers of Addis Ababa. The prevalence of PPD among mothers who came for postnatal and vaccination services in sampled health centers was 23.3%. This result implied that a significant proportion of women were experiencing PPD, indicating that maternal mental health problem is a substantial concern for which services are urgently needed. This result was comparable to studies conducted in China, a city of Poland and Lahore, Pakistan, where PPD was presented among 27% [10], 23% [16] and 25% [19] of women given birth, respectively. On the other hand, this figure was substantially higher when compared to other similar studies done in Japan [20], Canada [21], Qatar [22], Turkey [23] and Sudan [24] where the corresponding proportion of women displaying PPD was 8%, 9%, 19%, 15% and 9%, respectively. However, this figure is less compared to other similar studies done in the Ethiopian regions, Amhara (33%) and Oromia, Bale zone (32%) [25, 26]. Likewise, studies from Iran [27], South Africa [14] and Uganda [28] also reported a high prevalence of PPD. The difference between the present study and previous reports might be due to usage of different investigation tools, different sample sizes various assessment periods, different methods in the assessment of PPD and economic status of the regions investigated.

PPD was significantly higher among unmarried than those who were married. This finding is in line with studies carried out in United States [11, 29], Uganda [30] Jamaica [31] and Amhara region in Ethiopia [25]. This might be due to the fact that, during the period of pregnancy and delivery unmarried women were handling the situation alone and did not have the support they needed from a partner.

Furthermore, PPD was significantly higher among participants who had low income compared to those who did not. This was similar to other studies conducted in Saudi Arabia [32], Qatar [22], Korea [33], western Iran [27], south India [34], and Japan [20]. This might be because of overstressing to provide their children with everything they feel they require despite financial constraints and may in turn be related to having experienced stressful life events related to money during pregnancy or previous in life. More likely so, another significant association found in this study was between depression and previous history of child death in which PPD was significantly higher among participants who lost a baby at least once than among those did not. This result is consistent with the 2012 Communicable Disease Control (CDC) report on “ depression among women of reproductive age” [15] and another study, which was Conducted Among reproductive age groups in South East Ethiopia, Oromia region, Goba and Robe town of Bale zone [26]. The association between a previous history of child death and PPD might be because serious negative life events are most influential on individuals’ mental status; it is also possible that the association could be explained by the pregnant women’s fear of losing their newborn as well.

An increased odd of PPD among women who did not have a planned pregnancy was also observed. Most, but not all previous studies, e.g. investigations carried out in Qatar [22], Turkey [23], Iran [35] and northwestern Brazil [36] identified unplanned pregnancy to be associated with PPD, whereas another report from Iran did not find evidence for this relationship [37]. The difference might be due to economical variation between the different regions investigated. A study which was conducted among pregnant mothers who follow antenatal service in Addis Ababa, Ethiopia also highlighted that unplanned pregnancy had a contribution for antenatal depression [38].This indicates that unplanned pregnancy is a factor for both antenatal depression and PPD. Although, the family planning service coverage in Ethiopia has increased, unplanned pregnancy is still common implying that there is still a gap in utilization of the service.

The other variable that was significantly associated with PPD was history of substance use (alcohols (‘tela’, ‘teji’, beer and Wayne), ‘chat’ (an evergreen plant which has sympathomimetic effect when gradually chewed); cigarettes and water pipe smoking (shisha). This might be because women have lack of awareness about the effect of drinking before and during pregnancy especially homemade drinks. This is indicative of the fact that women should receive adequate information regarding the effect of alcohol drinks on pregnancy whether commercial or homemade. The finding was similar to other studies where postpartum depression was assessed in women between 3 and 52 weeks postpartum [39]. In other cross sectional study, among 43,093 adult women, 12.4% of the respondents were exposed to major depression in which 35.4% were nicotine dependent [29].

In addition, PPD was significantly higher among women who gave birth without the presence of any relatives in the health institutions and who did not get social support during labor and delivery. This result was consistent with a study conducted in Bydgoszcz city of Poland [16]. The finding identified that the presence of any relatives, especially husbands during labor and delivery was helpful for emotional support other than giving social support.

CONCLUSION

This study found that 23.3% of respondents had PPD, which is significantly a high value. It also identifies the presumed risk factors; Socio-demographic factors like marital status and low economic status were associated with PPD. Similarly, women who had previous history of child death and substance use had a higher probability of being depressed at the postpartum period. Unplanned pregnancy and childbirth without the presence of any relatives were also among the factors which were identified. Incorporating mental health service with existing or present maternal health care service in addition with inter sector collaboration between women’s affair and health institutions is recommended to prevent PPD.

REFERENCES