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Risk factor ppt

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  • 1. A STUDY OF POSTPARTUM DEPRESSION IN A FAST DEVELOPING COUNTRY: PREVALENCE AND RELATED FACTORS Abdulbari Bener*1,2,3 ,F.Tuna Burgut4 Suhaila Ghuloum5, Javaid Sheikh4 1Dept. of Medical Statistics & Epidemiology, Hamad General Hospital, Hamad Medical Corporation, Dept. Of Public Health, Weill Cornell Medical College, Doha, Qatar 2 Dept. Evidence for Population Health Unit, School of Epidemiology and Health Sciences, The University of Manchester, Manchester, UK 3Dept. of Public Health & Medical Education, Weill Cornell Medical College, Qatar 4Dept. of Psychiatry, Weill Cornell medical College, Qatar 5Dept. of Psychiatry, Hamad Medical Corporation, Doha, Qatar.
  • 2. INTRODUCTION
  • 3. INTRODUCTION Mental diseases are one of the most common complications associated with pregnancies and childbirth. It was reported that postpartum depression (PPD) is one of the important public health problems affecting maternal and child health.
  • 4. INTRODUCTION (Contd…) Postpartum psychological disorders lead to maternal disability and disturbed mother-infant relationship. Postpartum depression is a serious disorder which has been estimated to affect 13-20% of women in industrialised nations.
  • 5. INTRODUCTION (Contd…) It was identified that past history of psychopathology, psychological disturbance during pregnancy, poor marital relationship, poor social support and stressful life events are the primary risk factors for developing postpartum depression. This is the first study examining the prevalence of postpartum depression and associated risk factors among Arab women in Qatar.
  • 6. OBJECTIVESThe aim of this study was to determine the prevalence and identify the risk factors of postpartum depression among Arab women in Qatar using Edinburgh Postnatal Depression Scale (EPDS).
  • 7. SUBJECTS &METHODS
  • 8. SUBJECTS & METHODS Design: This is a prospective cross-sectional study. Setting: The study was conducted at Primary Health Care Centers in Qatar. Period of Study: January 2010 to May 2011. Subjects: A representative sample of 1669 mothers within 6 months after delivery were approached and 1379 (82.6%) mothers participated in this study.
  • 9. SUBJECTS & METHODS (Contd…) Data Collection:  The survey instrument was initially tested on 100 patients who visited the health centres and thus validated the questionnaire.  The study excluded mothers whose postnatal period was over 6 months and who refused to give consent to take part in the study.
  • 10. SUBJECTS & METHODS (Contd…)Data Collection (Contd…):  A validated structured questionnaire was used to collect the socio- demographic variables, psychiatric history, interpersonal relationship, life events and obstetric risks with the help of qualified nurses.
  • 11. SUBJECTS & METHODS (Contd…)  The Edinburgh postpartum depression scale (EPDS) was used to identify the risk cases.  The EPDS is a 10-item self-report scale, specifically designed to screen for postpartum depression in primary care.
  • 12. SUBJECTS & METHODS (Contd…)  The EPDS is a reliable and valid instrument, it has been used in a number of international settings  The EPDS is a reliable and valid instrument, it has been used in a number of international settings
  • 13. The EPDS questionnaire has items such as: 1. Having been able to laugh. 2. Having looked forward with enjoyment to things. 3. Having blamed oneself unnecessarily. 4. having been anxious or worried for no good reason. 5. Having felt scared or panicky for no good reason.
  • 14. The EPDS questionnaire has items (contd..) 6. Experiencing overload. 7. Having been so unhappy that it has caused sleeping problems. 8. Having felt miserable or sad. 9. Having been so unhappy as to have cried. 10.Thoughts of harming oneself.
  • 15. The EPDS questionnaire has items (contd..)  Each item is scored on a 4-point scale (0–3), the minimum and maximum total score ranging from 0 to 30, respectively.  A score of ≥12, the most commonly used cut off, is used to distinguish women suffering from depression from those who are not.
  • 16. EDINBURG POSTNATAL DEPRESSION SCALE: SCORING SAMPLE
  • 17. STATISTICAL ANALYSIS
  • 18. STATISTICAL ANALYSIS Student-t test was used to ascertain the significance of differences between mean values of two continuous variables. Chi-square analysis was performed to test for differences in proportions of categorical variables between two or more groups.
  • 19. STATISTICAL ANALYSIS (Contd…) Multivariate logistic regression analysis using the forward inclusion and backward deletion method was used to assess the relationship between dependent and independent variables and to adjust for potential confounders and orders the importance of risk factors (determinant) for postpartum depression. The level p<0.05 was considered as the cut-off value for significance.
  • 20. STUDY FINDINGS
  • 21. STUDY FINDINGSThe prevalence of postpartumdepression among the studysample was 17.6%.
  • 22. STUDY FINDINGSThere were statistically significantdifferences observed betweendepressed and non-depressedmothers in their socio-demographiccharacteristics;
  • 23. STUDY FINDINGSMothers of age above 35 years (49.9% vs39.2%; p<0.001),Low education below intermediate level (51%vs 35.8%; p<0.001),Housewives (38.7% vs 29%; p=0.03),Low monthly income (QR 5000-9999) (43.2% vs32.2%;p<0.001)
  • 24. STUDY FINDINGSMaternal complications (38.7% vs 26.1%;p<0.001) and caesarean section (36.2% vs28.8%; p=0.022) were significantly higheramong depressed mothers compared to non-depressed women.
  • 25. STUDY FINDINGSFinancial difficulties (OR=2.04; p<0.001),prematurity (OR=1.64; p=0.025),poor family support (OR=1.52; p=0.016),dissatisfaction in marital life (OR=1.26;p=0.005),poor marital relationship (OR=1.13; p=0.05)were the main predictors of postpartumdepression.
  • 26. Table 1: Socio-demographic characteristics of the studied women according to PPD Status (N=1379) Post partum Depression Total Yes No Variable N=1379 EPDS≥12 EPDS<12 p-value n(%) N=243 N=1136 n(%) n(%)Age(Mean±SD) 33.5±6.5 33.3±7.1 33.5±6.4 0.560Age in Years <25 Years 204(14.8) 48(19.8) 156(13.7) 25-34 Years 633(45.9) 74(30.3) 535(47.1) <0.001 >35 Years 542(39.3) 121(49.9) 445(39.2)Education Level Illiterate 104(7.5) 27(11.1) 77(6.8) Primary 200(14.5) 50(20.6) 150(13.2) Intermediate 276(20.0) 47(19.3) 180(15.8) <0.001 Secondary 440(31.9) 64(26.4) 405(35.7) University 359(26.0) 55(22.6) 324(28.5)Occupation House Wife 424(30.7) 94(38.7) 330(29.0) Professional 573(41.6) 90(37.0) 483(42.5) Manual 126(9.1) 24(9.9) 102(9.0) 0.030 Business Women 180(13.1) 23(9.5) 157(13.8) Army/police 76(5.5) 12(4.9) 64(5.6)
  • 27. Table 1: Socio-demographic characteristics of the studied women according to PPD Status. (Contd…) Post partum Depression Total Yes No Variable N=1379 EPDS≥12 EPDS<12 p-value n(%) N=243 N=1136 n(%) n(%)Family income*QR Less 5000 141(10.2) 66(27.2) 75(6.6) 5000-9999 471(34.2) 105(43.2) 366(32.2) <0.001 10,000-14,999 326(23.6) 40(16.5) 286(25.2) >15,000 441(32.0) 32(13.2) 409(36.0)Consanguinity Yes 518(37.6) 108(44.4) 410(36.1) 0.015 No 861(62.4) 135(53.6) 726(63.9)Baby’s Gender Boys 692(50.2) 119(49.0) 573(50.4) 0.678 Girls 687(49.8) 124(51.0) 563(49.6)Transportation Access Yes 1172(85.0) 188(77.4) 984(86.6) <0.001 No 207(15.0) 55(22.6) 152(13.4)How many Bedrooms at your home 5.0±2.3 5.3±2.5 5.0±2.1 0.043How many people living at your home 6.0±3.1 6.5±3.3 6.0±3.0 0.020
  • 28. Table 2. Association between stressful life events and postpartum depression in studied women according to the PPD Status (N=1379) Post partum Depression Life Events Yes(EPDS≥12) No (EPDS<12) P-Value N=243 N=1136Relationship Problem n(%) n(%)Relationship with your husband Good 68(28.0) 405(35.7) 0.022 Bad 172(72.0) 731(64.3)Relationship with mother in law Good 72(29.6) 489(43.0) <0.001 Bad 171(70.4) 647(57.0)Strong family support Good 182(74.9) 984(86.5) <0.001 Bad 61(25.1) 152(13.4)Nanny to take of your child Yes 97(39.9) 472(41.5) 0.639 No 146(60.1) 664(58.5)No Of Children’s (Mean±SD) Boys 2.0±1.2 2.0±1.2 0.945 Girls 1.6±1.0 1.5±1.0 0.691Difficult to Manage with Income Yes 186(76.5) 789(69.5) 0.028 No 57(23.5) 347(30.5)Satisfaction in your married life Good 154(63.5) 895(78.8) <0.001 Bad 89(36.5) 241(25.7)History of Depression Yes 28(11.5) 142(12.5) 0.674 No 215(88.5) 994(87.5)Family history of depression Yes 42(17.3) 181(15.9) 0.604 No 201(82.7) 955(84.1)
  • 29. Table 3: Maternal and Infant characteristics of the studied women according to the PPD Status. (N= 1379) Post partum Depression Yes No Maternal Characteristics EPDS≥12 EPDS<12 P-Value N=243 N=1136 n(%) n(%)Planned Pregnancy Yes 117(48.1) 617(54.3) 0.530 No 126(51.9) 517(45.7)History of Fertility Yes 32(13.2) 116(10.2) 0.176 No 211(86.8) 1020(89.8)Complication during pregnancy Yes 94(38.7) 295(26.1) <0.001 No 149(61.3) 841(73.9)Maternal Complications* Anaemia 23(9.4) 48(4.2) 0.001 Bleeding 65(26.7) 170(15.0) <0.001 Blood Pressure 25(10.2) 27(2.4) <0.001 GDM 24(9.9) 70(6.2) 0.051 Miscarriage 8(3.2) 25(2.2) 0.435 Threatened abortion 3(0.9) 4(0.4) 0.109 Urinary infection 9(3.7) 5(0.5) 0.001Mode of last Delivery Vaginal delivery 155(63.8) 809(71.2) 0.022 C-Section 88(36.2) 327(28.8)
  • 30. Table 3: Maternal and Infant characteristics of the studied women according to the PPD Status. ( Contd…) Post partum Depression Infant Characteristics Yes No EPDS≥12 EPDS<12 P-Value N=243 N=1136 n(%) n(%)Normal weight and height Yes Yes 205(84.4) 986(86.8) 0.367 No No 38(15.6) 150(13.2)Premature baby in ICU Yes Yes 41(16.9) 135(11.9) 0.034 No No 202(83.1) 1001(88.1)Mode of Feeding Solely breast fed 74(30.5) 424(37.3) Breast fed and formula 114(46.9) 590(51.9) <0.001 Formula 55(22.6) 122(10.7)Strong preference for the baby gender Yes 88(36.2) 360(31.7) 0.172 No 155(63.8) 776(68.3)
  • 31. Table 4: Results of logistic Regression analysis for predictors of Post partum Depression. Odd 95% P Value Independent Variables ratio Confidence IntervalDifficulty to manage with income. 2.37 1.56 – 3.58 <0.001Prematurity 1.64 1.06 – 2.54 0.025Poor Family Support 1.52 1.0 – 2.14 0.016Dissatisfaction in their married life. 1.26 1.0 – 1.47 0.005Poor marital relationship 1.13 1.0 – 1.29 0.048
  • 32. Table 5. Prevalence rate for postpartum depression according to the country SampleCountry Age Group Prevalence rate (%) Year Reference SizeAustralia 16-35 Years 4366 17.4% 2010 Yelland et alAustralia 18-44 Years 80 24.7% 2006 Miller et alAustralia 17-36 Years 52 25.1% 2007 Phillips et alBrazil 14-47 Years 271 20.7% 2008 Tannous et alBrazil 13-31 Years 410 19.0% 2000 Inacia et alIndia Goa 18-37 Years 59 23% 2001 Patel et alPakistan 17-40 Years 149 36% 2006 Hussain et alMorrocco 18-44 Years 144 18.7% 2005 Agoub et alOklahoma 18-35 Years 5586 26% 2005-2006 Crutcher et al 29.0% at 0-2 Months 36.6% at 3-6 monthsTurkey 15-44 Years 1447 2004 Bugnayci et al 36.0 % a t 7-12 Months 42.7% at >13 MonthsDubai 25-34 Years 90 18.0% 1997 Abou Saleh and GhubashBangladesh 17-41 Years 361 33% 2009 Gausia et alUSA 17-47 Years 192 23.4 1995 Hobfoll et alQatar 18-45 years 1379 17.6% 2010-2011 Bener et al
  • 33. CONCLUSION
  • 34. CONCLUSIONThe present study revealed the following: The prevalence of postpartum depression was higher than the rates observed in developed countries. The prevalence of postpartum depression was greatest among mothers with lower socio-economic level such as advanced age, low education and illiteracy, housewives, low family income.
  • 35. CONCLUSION (Contd…) Among the psychosocial factors, lack of family support, marital disharmony, stressful life events were significantly associated with postpartum depression. Financial difficulties, prematurity, lack of family support and poor marital relationships have been reported as main risk factors for developing postpartum depression.
  • 36. ACKNOWLEDGEMENTThis study was generously supported and funded by the Qatar National Research Fund- QNRF NPRP 30-6-7-44 and Weill Cornell IRB Ethical Approval (WCMC-Q#2011-0008). The authors would like to thank the Hamad Medical Corporation for their support and ethical approval (HMC MRC #10119/10)
  • 37. THANK YOU!

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