Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
PLoS One. 2022 Aug 15;17(8):e0273176. doi: 10.1371/journal.pone.0273176. eCollection 2022.
Vulnerability for depression, anxiety and posttraumatic stress disorder symptoms due to perceived traumatic birth increase during the postpartum period. Traumatic birth has been defined as an event occurring during labour and birth that may be a serious threat to the life and safety of the mother and/or child. However, the comorbidity and multimorbidity of depression, anxiety and PTSD with their direct and indirect predictors is not well investigated in the postpartum period. In addition, the longitudinal directional association of depression, anxiety and PTSD with their comorbidities is not studied in Ethiopia.
The aim of this study was to assess prevalence of postnatal comorbid and multimorbid anxiety, depression and PTSD. It also aimed to determine the directional association of postnatal anxiety, depression and PTSD with the comorbidity and multimorbidity of these mental health problems over time and to explore the factors that are directly or indirectly associated with comorbidity and multimorbidity of anxiety, depression and PTSD.
A total of 775 women were included at the first, second and third follow-up of the study (6th, 12th and 18th week of postpartum period) during October, 2020 -March, 2021. A cross-lagged autoregressive path analysis was carried out using Stata 16.0 software in order to determine the autoregressive and cross-lagged effects of depression, anxiety and PTSD with their comorbidities. In addition, a linear structural equation modelling was also carried out to determine the direct and indirect effects of independent variables on the comorbidities of depression, anxiety and PTSD.
Comorbidity of anxiety with depression was the most common (14.5%, 12.1% and 8.1%) at the 6th, 12th and 18th week of postnatal period respectively. With regard to the direction of association, comorbidity of PTSD (due to perceived traumatic birth) with depression, PTSD with anxiety, depression with anxiety and triple comorbidity predicted depression and anxiety in subsequent waves of measurement. Direct and indirect maternal morbidity, fear of childbirth and perceived traumatic childbirth were found to have a direct and indirect positive association with comorbidities of depression, anxiety and PTSD. In contrast, higher parity, higher family size and higher social support had a direct and indirect negative association with these mental health disorders.
Postnatal mental health screening, early diagnosis and treatment of maternal morbidities, developing encouraging strategies for social support and providing adequate information about birth procedures and response to mothers' needs during childbirth are essential to avert comorbidity of anxiety, depression and PTSD in the postpartum period.
由于感知到创伤性分娩，产后期间抑郁、焦虑和创伤后应激障碍症状的脆弱性增加。创伤性分娩被定义为分娩过程中发生的事件，可能对母亲和/或儿童的生命和安全构成严重威胁。然而，在产后期间，抑郁、焦虑和创伤后应激障碍的共病和多种疾病及其直接和间接预测因素并没有得到很好的研究。此外，在埃塞俄比亚，抑郁、焦虑和创伤后应激障碍与其共病的纵向定向关联尚未研究。
本研究旨在评估产后共病和多种焦虑、抑郁和创伤后应激障碍的患病率。它还旨在确定产后焦虑、抑郁和创伤后应激障碍与这些心理健康问题随时间的共病和多种疾病的定向关联，并探讨与焦虑、抑郁和创伤后应激障碍的共病和多种疾病直接或间接相关的因素。
总共纳入了 775 名女性，她们在研究的第一、二和第三次随访（产后第 6、12 和 18 周）中参加了研究，时间为 2020 年 10 月至 2021 年 3 月。使用 Stata 16.0 软件进行交叉滞后自回归路径分析，以确定抑郁、焦虑和创伤后应激障碍与其共病的自回归和交叉滞后效应。此外，还进行了线性结构方程建模，以确定独立变量对抑郁、焦虑和创伤后应激障碍共病的直接和间接影响。
在产后第 6、12 和 18 周，焦虑与抑郁的共病最常见（分别为 14.5%、12.1%和 8.1%）。关于关联方向，创伤后应激障碍（由于感知到创伤性分娩）与抑郁、创伤后应激障碍与焦虑、抑郁与焦虑以及三重共病预测了随后测量波次中的抑郁和焦虑。直接和间接的产妇发病率、对分娩的恐惧和感知到的创伤性分娩被发现与抑郁、焦虑和创伤后应激障碍的共病有直接和间接的正相关。相反，较高的产次、较大的家庭规模和较高的社会支持与这些心理健康障碍有直接和间接的负相关。
产后心理健康筛查、早期诊断和治疗产妇发病率、制定鼓励社会支持的策略以及为分娩过程提供充足的信息以满足母亲的需求，对于避免产后焦虑、抑郁和创伤后应激障碍的共病至关重要。
