Department of Public Health, Asian College for Advance Studies, Purbanchal University, Satdobato, Lalitpur, Nepal.
Research and Innovation Section, Southeast Asia Development Actions Network (SADAN), Lalitpur, Nepal.
PLoS One. 2021 Jan 22;16(1):e0245199. doi: 10.1371/journal.pone.0245199. eCollection 2021.
Postpartum depression is the most common mental health problem among women of childbearing age in resource-poor countries. Poor maternal mental health is linked with both acute and chronic negative effects on the growth and development of the child. This study aimed to assess the prevalence and factors associated with depressive symptoms among postpartum mothers in the lowland region in southern Nepal.
A hospital-based analytical cross-sectional study was conducted from 1st July to 25th August 2019 among 415 randomly selected postpartum mothers attending the child immunization clinic at Narayani hospital. The postpartum depressive symptoms were measured using the validated Nepalese version of the Edinburg Postnatal Depression Scale (EPDS). The data were entered into EpiData software 3.1v and transferred into Stata version 14.1 (StataCorp LP, College Station, Texas) for statistical analyses. To identify the correlates, backward stepwise binary logistic regression models were performed separately for the dichotomized outcomes: the presence of postpartum depressive symptoms. The statistical significance was considered at p-value <0.05 with 95% confidence intervals (CIs).
Among the total 415 study participants, 33.7% (95% CI: 29.2-38.5%) of postpartum mothers had depressive symptoms. Study participant's whose family monthly income <150 USD compared to ≥150 USD (aOR = 13.76, 95% CI: 6.54-28.95), the husband had migrated for employment compared to not migrated (aOR = 8.19, 95% CI:4.11-15.87), nearest health facility located at more than 60 minutes of walking distance (aOR = 4.52, 95% CI: 2.26-9.03), delivered their last child by cesarean section compared to normal (vaginal) delivery (aOR = 2.02, 95% CI: 1.12-3.59) and received less than four recommended antenatal care (ANC) visits (aOR = 2.28, 95% CI:1.25-4.15) had higher odds of depressive symptoms. Participants who had planned pregnancy (aOR = 0.44, 95% CI: 0.25-0.77) were associated with 56% lower odds of depressive symptoms.
One-third of the mothers suffered from postpartum depressive symptoms. The participant's husband migrated for employment, family income, distance to reach a health facility, delivery by cesarean section, not receiving recommended ANC visits, and plan of pregnancy were independent predictors for postpartum depressive symptoms. The study results warranted the urgency for clinical diagnosis of PPD and implementation of preventive package in study settings. Mental health education to pregnant women during ANC visits and proper counseling during the antepartum and postpartum period can also play a positive role in preventing postpartum depression.
产后抑郁症是资源匮乏国家育龄妇女中最常见的心理健康问题。产妇心理健康状况不佳与儿童生长发育的急性和慢性负面影响都有关联。本研究旨在评估尼泊尔南部低地地区产后母亲中抑郁症状的流行情况及其相关因素。
2019 年 7 月 1 日至 8 月 25 日，我们在纳拉扬尼医院的儿童免疫诊所对 415 名随机选择的产后母亲进行了一项基于医院的分析性横断面研究。使用经过验证的尼泊尔版爱丁堡产后抑郁量表（EPDS）来测量产后抑郁症状。数据被输入 EpiData 软件 3.1v 并转移到 Stata 版本 14.1（StataCorp LP，德克萨斯州大学城）进行统计分析。为了确定相关因素，我们分别对二分类结果进行了向后逐步二元逻辑回归模型：存在产后抑郁症状。统计显著性水平设为 p 值<0.05，置信区间（CI）为 95%。
在总共 415 名研究参与者中，33.7%（95%CI：29.2-38.5%）的产后母亲患有抑郁症状。与家庭月收入≥150 美元的参与者相比，家庭月收入<150 美元的参与者（aOR=13.76，95%CI：6.54-28.95），丈夫外出打工的参与者（aOR=8.19，95%CI：4.11-15.87），最近的卫生机构距离步行超过 60 分钟的参与者（aOR=4.52，95%CI：2.26-9.03），最后一次分娩为剖宫产的参与者（aOR=2.02，95%CI：1.12-3.59），以及接受的推荐产前护理（ANC）次数少于 4 次的参与者（aOR=2.28，95%CI：1.25-4.15），这些参与者更有可能出现抑郁症状。计划妊娠的参与者（aOR=0.44，95%CI：0.25-0.77）与抑郁症状的发生几率降低 56%有关。
三分之一的母亲患有产后抑郁症状。参与者的丈夫外出打工、家庭收入、到达卫生机构的距离、剖宫产分娩、未接受推荐的 ANC 就诊次数以及妊娠计划是产后抑郁症状的独立预测因素。研究结果表明，迫切需要在研究环境中对 PPD 进行临床诊断并实施预防方案。在 ANC 就诊期间对孕妇进行心理健康教育，并在产前和产后期间进行适当的咨询，也可以在预防产后抑郁症方面发挥积极作用。
