Zejnullahu Vjosa A, Ukella-Lleshi Dardane, Zejnullahu Valon A, Miftari Ermira, Govori Valbona
Department of Obstetrics and Gynecology, University Clinical Center of Kosovo, Pristina, Kosovo, Albania.
Department of Abdominal Surgery, University Clinical Center of Kosovo, Pristina, Kosovo, Albania.
Eur J Obstet Gynecol Reprod Biol. 2021 Jan;256:215-220. doi: 10.1016/j.ejogrb.2020.11.025. Epub 2020 Nov 11.
Postpartum depression affects 10 up to 15 % of women of childbearing age in industrialized countries and presents significant public health problem which leads to short and long-term consequences for mother, child and her family. However, social determinants, including poverty, gender stereotypes, domestic violence, gender discrimination and cultural differences make this medical issue more problematic in less developed countries. The aim of this study was to examine the prevalence and risk factors of postpartum depression at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo (a tertiary referral center).
A prospective observational cohort study was conducted from June 2019 to October 2019 at the Clinic for Obstetrics and Gynecology in Pristina, Kosovo. A total of 247 delivery women were screened for postpartum depression at 6 weeks following delivery using the Edinburg Postnatal Depression Scale (EPDS). Socio-demographic, obstetric and psychologic factors were tested as predictors of PPD using bivariate or multivariate logistic regression analysis (Logit model). Odds ratio (OR) with 95 % confidence intervals were calculated for each risk factor. The p values < 0.05 were considered statistically significant.
The prevalence of PPD at the Clinic for Obstetrics and Gynecology in Kosovo teaching hospital was 21 % at 6 weeks following childbirth. The bivariate and multivariate logistic regression analysis identified four predictor variables for postpartum depression: pregnancy complications (OR 1.057; 95 % CI; 1.002-1.114 and P = 0.040); fear of childbirth (OR 1.121; 95 % CI; 1.057-1.190 and P = 0.00016); prenatal depression or anxiety (OR 1.088; 95 % CI; 1.032-1.147 and P = 0.0018); poor marital relation (OR 1.085, 95 % CI; 1.002-1.174 and P = 0.044). No statistically significant association was found between the postpartum depression (PPD) and maternal age, education, employment, family type, smoking, previous abortion, parity, household income, social support, child gender, birthweight, and breast feeding.
The high prevalence of postpartum depression in our setting and its known adverse effects on woman, infant and her family implies an urgent need for evidence-based interventions. Such interventions are needed to promote knowledge of perinatal mental illness and improve maternal mental health in particular in less developed countries. Future efforts should address early identification of high-risk women, assessment of risk factor during the antenatal period, early postpartum depression screening and timely therapeutic approaches, to improve social and psychological functioning of the woman.
在工业化国家，产后抑郁症影响着10%至15%的育龄妇女，这是一个重大的公共卫生问题，会给母亲、孩子及其家庭带来短期和长期的后果。然而，包括贫困、性别刻板印象、家庭暴力、性别歧视和文化差异在内的社会决定因素，使得这个医学问题在欠发达国家更加棘手。本研究的目的是在科索沃普里什蒂纳的妇产科诊所（一个三级转诊中心）调查产后抑郁症的患病率及危险因素。
2019年6月至2019年10月在科索沃普里什蒂纳的妇产科诊所进行了一项前瞻性观察队列研究。总共247名分娩妇女在产后6周使用爱丁堡产后抑郁量表（EPDS）进行产后抑郁症筛查。使用二元或多元逻辑回归分析（Logit模型）将社会人口统计学、产科和心理因素作为产后抑郁症的预测因素进行测试。计算每个危险因素的比值比（OR）及其95%置信区间。p值<0.05被认为具有统计学意义。
科索沃教学医院妇产科产后6周时产后抑郁症的患病率为21%。二元和多元逻辑回归分析确定了产后抑郁症的四个预测变量：妊娠并发症（OR 1.057；95%CI：1.002 - 1.114，P = 0.040）；害怕分娩（OR 1.121；95%CI：1.057 - 1.190，P = 0.00016）；产前抑郁或焦虑（OR 1.088；95%CI：1.032 - 1.147，P = 0.0018）；婚姻关系不佳（OR 1.085，95%CI：1.002 - 1.174，P = 0.044）。未发现产后抑郁症（PPD）与产妇年龄、教育程度、就业情况、家庭类型、吸烟、既往流产史、产次、家庭收入、社会支持、孩子性别、出生体重和母乳喂养之间存在统计学上的显著关联。
我们所研究环境中产后抑郁症的高患病率及其对女性、婴儿及其家庭已知的不利影响意味着迫切需要基于证据进行干预。需要这样的干预措施来促进围产期精神疾病的知识普及，尤其在欠发达国家改善孕产妇心理健康。未来的努力应致力于高危女性的早期识别、孕期危险因素的评估、产后抑郁症的早期筛查以及及时的治疗方法，以改善女性的社会和心理功能。
