Women's Health Nursing (여성건강간호학회지)

Korean Society of Women Health Nursing (한국여성건강간호학회)
권호 표지
DOI QR코드

DOI QR Code

Prevalence and factors associated with postpartum depression among Bhutanese mothers: a cross-sectional study

  • Received : 2024.04.22
  • Accepted : 2024.09.02
  • Published : 2024.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: This study investigated the prevalence of postpartum depression (PPD) and explored associated factors among mothers attending postnatal care in Bhutan. Methods: A cross-sectional study was conducted from August to November 2023 at a national referral hospital in Thimphu, the capital city of Bhutan. In total, 314 mothers were recruited. Sociodemographic, psychosocial, obstetric, and infant-related data were collected using questionnaires. The Edinburgh Postnatal Depression Scale, with a threshold of ≥11, was employed to screen for PPD, and logistic regression was used to test the potential factors. Results: The prevalence of PPD was 14.97%. Mothers with a perceived change in body image (adjusted odds ratio [AOR], 4.40; 95% confidence interval [CI], 1.91-10.17; p=.001), perceived heightened stress after delivery (AOR, 3.74; 95% CI, 1.45-9.67; p=.006), poor relationship with inlaws (AOR, 2.57; 95% CI, 1.24-5.30; p=. 011), and negative birth experience (AOR, 2.42; 95% CI, 1.17-5.00; p=.016) demonstrated significantly higher odds of developing PPD. However, mothers with a higher monthly family income (Bhutanese ngultrum [Nu.] 20,000 to <50,000; AOR, 0.35; 95% CI, 0.13-0.92; p=.033), ≥Nu. 50,000 (AOR, 0.37; 95% CI, 0.13-1.07, p=.067) compared to <Nu. 20,000, and advanced gestational age (37 to <41 weeks; AOR, 0.25; 95% CI, 0.09-0.71; p=.009) and ≥41 weeks (AOR, 0.08; 95% CI, 0.00-0.75; p=.028) compared to <37 weeks had significantly lower risks of PPD. Conclusion: To mitigate the prevalence and risk of PPD, prioritizing screening strategies and interventions may benefit mothers with perceived changes in body image and heightened perceived stress after delivery, poor relationships with in-laws, and those with negative birth experiences.

Keywords

Acknowledgement

Sherab Zangmo is a graduate student at Chiang Mai University (Faculty of Public Health) pursuing a master's degree program under a scholarship from the Thailand International Cooperation Agency (TICA). The authors express profound gratitude. We would like to acknowledge Dr. Thinley Yangzom, Head of the Department and the staff of at the Gyaltsuen Jetsun Pema Wangchuck Mother and Child Hospital (GJPWMCH) with a special mention to the postnatal care unit for their invaluable support during the data collection phase. We would also like to express our sincere appreciation to all the participants.

References

  1. Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. Br J Psychiatry. 1987;150:782-786. https://doi.org/10.1192/bjp.150.6.782 
  2. Carlson K, Mughal S, Azhar Y, et al. Postpartum depression. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited Apr 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519070/
  3. Agrawal I, Mehendale AM, Malhotra R. Risk factors of postpartum depression. Cureus. 2022;14(10):e30898. https://doi.org/10.7759/cureus.30898 
  4. Stewart DE, Vigod SN. Postpartum depression: pathophysiology, treatment, and emerging therapeutics. Annu Rev Med. 2019;70:183-196. https://doi.org/10.1146/annurev-med041217-011106 
  5. Saharoy R, Potdukhe A, Wanjari M, Taksande AB. Postpartum depression and maternal care: exploring the complex effects on mothers and infants. Cureus. 2023;15(7):e41381. https://doi.org/10.7759/cureus.41381 
  6. Rai S, Pathak A, Sharma I. Postpartum psychiatric disorders: early diagnosis and management. Indian J Psychiatry. 2015;57(Suppl 2):S216-S221. https://doi.org/10.4103/0019-5545.161481 
  7. Mousa O, Yahya S, Al-Khars FM. Postpartum depression: neglected issue in maternal health. Int J Nur Educ. 2023;15:72-77. https://doi.org/10.37506/ijone.v15i1.18995 
  8. World Health Organization (WHO). World Health Day 2017: time to speak up about post-partum depression [Internet]. Geneva: WHO; 2017 [cited 2022 Apr 20]. Available from: https://www.mentalhealtheurope.org/news-22-worldhealth-day-2017-time-to-speak-up-about-post-partum-depression/ 
  9. Wang Z, Liu J, Shuai H, Cai Z, Fu X, Liu Y, et al. Mapping global prevalence of depression among postpartum women. Transl Psychiatry. 2021;11(1):543. https://doi.org/10.1038/s41398-021-01663-6 
  10. Valdes V, Berens AE, Nelson CA 3rd. Socioeconomic and psychological correlates of postpartum depression at 6 months in Dhaka, Bangladesh. Int J Psychol. 2021;56(5):729-738. https://doi.org/10.1002/ijop.12735 
  11. Upadhyay RP, Chowdhury R, Aslyeh Salehi, Sarkar K, Singh SK, Sinha B, et al. Postpartum depression in India: a systematic review and meta-analysis. Bull World Health Organ. 2017;95(10):706-717C. https://doi.org/10.2471/BLT.17.192237 
  12. Yadav T, Shams R, Khan AF, Azam H, Anwar M, Anwar T, et al. Postpartum depression: prevalence and associated risk factors among women in Sindh, Pakistan. Cureus. 2020;12(12):e12216. https://doi.org/10.7759/cureus.12216 
  13. Pradhananga P, Mali P, Poudel L, Gurung M. Prevalence of postpartum depression in a tertiary health care. JNMA J Nepal Med Assoc. 2020;58(223):137-140. https://doi.org/10.31729/jnma.4805 
  14. Pelzang R. Mental health care in Bhutan: policy and issues. WHO South East Asia J Public Health. 2012;1(3):339-346. https://doi.org/10.4103/2224-3151.207030 
  15. Policy and Planning Division, Ministry of Health, Bhutan. Annual health bulletin [Internet]. Ministry of Health; Bhutan: 2023 [cited 2024 Mar 26]. Available from: https://www.moh.gov.bt/wp-content/uploads/Annual-Health-Bulleti-2023.pdf 
  16. Bhutan Broadcasting Service (BBS). Postpartum depression is like any other disease and women should seek support, says medical experts [Internet]. BBS; 2023 May 1. [cited 2024 Apr 22]. Available from: https://www.bbs.bt/news/?p=185211 
  17. Regional Office for South-East Asia; World Health Organization (WHO). Addressing mental health in Bhutan: prepared for the ministerial roundtable of the 75th session of the WHO Regional Committee for South-East Asia [Internet]. WHO Team; 2022 [cited 2024 Mar 12]. Available from https://www.who.int/publications/i/item/9789290210153 
  18. Fan Q, Long Q, De Silva V, Gunarathna N, Jayathilaka U, Dabrera T, et al. Prevalence and risk factors for postpartum depression in Sri Lanka: a population-based study. Asian J Psychiatr. 2020;47:101855. https://doi.org/10.1016/j.ajp.2019.101855 
  19. Xiong R, Deng A. Prevalence and associated factors of postpartum depression among immigrant women in Guangzhou, China. BMC Pregnancy Childbirth. 2020;20(1):247. https://doi.org/10.1186/s12884-020-02946-4 
  20. Dingana TN, Ngasa SN, Ngasa NC, Tchouda LAS, Abanda C, Sanji EW, et al. Prevalence and factors associated with post-partum depression in a rural area of Cameroon: a cross-sectional study. Pan Afr Med J. 2022;42:138. https://doi.org/10.11604/pamj.2022.42.138.32347 
  21. Rahmadhani W, Kusumastuti K, Chamroen P. Prevalence and determinants of postpartum depression among adolescent mothers: a cross-sectional study. Int J Health Sci. 2022;6(2):533-544. https://doi.org/10.53730/ijhs.v6n2.6422 
  22. Chapman SL, Wu LT. Postpartum substance use and depressive symptoms: a review. Women Health. 2013;53(5):479-503. https://doi.org/10.1080/03630242.2013.804025 
  23. van der Zee-van den Berg AI, Boere-Boonekamp MM, Groothuis-Oudshoorn CGM, Reijneveld SA. Postpartum depression and anxiety: a community-based study on risk factors before, during and after pregnancy. J Affect Disord. 2021;286:158-165. https://doi.org/10.1016/j.jad.2021.02.062 
  24. Cho H, Lee K, Choi E, Cho HN, Park B, Suh M, et al. Association between social support and postpartum depression. Sci Rep. 2022;12(1):3128. https://doi.org/10.1038/s41598-022-07248-7 
  25. Bradshaw H, Riddle JN, Salimgaraev R, Zhaunova L, Payne JL. Risk factors associated with postpartum depressive symptoms: a multinational study. J Affect Disord. 2022;301:345-351. https://doi.org/10.1016/j.jad.2021.12.121 
  26. Asaye MM, Muche HA, Zelalem ED. Prevalence and predictors of postpartum depression: Northwest Ethiopia. Psychiatry J. 2020;2020:9565678. https://doi.org/10.1155/2020/9565678 
  27. Yokoyama M, Tanaka K, Sugiyama T, Arakawa M, Miyake Y. Cesarean section is associated with increased risk of postpartum depressive symptoms in Japan: the Kyushu Okinawa Maternal and Child Health Study. J Affect Disord. 2021;278:497-501. https://doi.org/10.1016/j.jad.2020.09.106 
  28. Laohachaiaroon P, Pongsuthirak P, Nakariyakul B, Kayanki T. Prevalence and factors affecting postpartum depression in Buddhachinaraj Phitsanulok Hospital. J Med Assoc Thai. 2022;105(7):589. https://doi.org/10.35755/jmedassocthai.2022.07.13332 
  29. Myo T, Hong SA, Thepthien BO, Hongkrailert N. Prevalence and factors associated with postpartum depression in primary healthcare centres in Yangon, Myanmar. Malays J Med Sci. 2021;28(4):71-86. https://doi.org/10.21315/mjms2021.28.4.8 
  30. Policy and Planning Division, Ministry of Health, Bhutan. Annual health bulletin [Internet]. Ministry of Health; (Bhutan). 2020; [cited 2024 Jan 18]. Available from: https://www.moh.gov.bt/wp-content/uploads/ict-files/2017/06/health-bulletin-Website_Final.pdf 
  31. Department of Public Health, Ministry of Health, Bhutan. National policy for midwifery trained personnel for safe motherhood practice [Internet]. Ministry of Health, Bhutan; c2018 [cited 2023 Oct 10]. Available from: https://www.moh.gov.bt/wp-content/uploads/afd-files/2014/11/Final-Version-Midwifery-standard_2018.pdf 
  32. Levis B, Negeri Z, Sun Y, Benedetti A, Thombs BD; DEPRES-sion Screening Data (DEPRESSD) EPDS Group. Accuracy of the Edinburgh Postnatal Depression Scale (EPDS) for screening to detect major depression among pregnant and postpartum women: systematic review and meta-analysis of individual participant data. BMJ. 2020;371:m4022. https://doi.org/10.1136/bmj.m4022 
  33. Engda AS, Belete H, Tilahun FA, Demeke SM, Engidaw NA, Wubetu AD, et al. Prevalence of depression and associated factors among normal and overweight reproductive age women, Ethiopia: community-based comparative cross-sectional study. Int J Womens Health. 2021;13:337-347. https://doi.org/10.2147/IJWH.S301778 
  34. Riesco-Gonzalez FJ, Antunez-Calvente I, Vazquez-Lara JM, Rodriguez-Diaz L, Palomo-Gomez R, Gomez-Salgado J, et al. Body image dissatisfaction as a risk factor for postpartum depression. Medicina (Kaunas). 2022;58(6):752. https://doi.org/10.3390/medicina58060752 
  35. Afshari P, Tadayon M, Abedi P, Yazdizadeh S. Prevalence and related factors of postpartum depression among reproductive aged women in Ahvaz, Iran. Health Care Women Int. 2020;41(3):255-265. https://doi.org/10.1080/07399332.2019.1578779 
  36. Raghavan V, Khan HA, Seshu U, Rai SP, Durairaj J, Aarthi G, et al. Prevalence and risk factors of perinatal depression among women in rural Bihar: a community-based cross-sectional study. Asian J Psychiatr. 2021;56:102552. https://doi.org/10.1016/j.ajp.2021.102552 
  37. Aslam M, Nawab T, Ahmad A, Abedi AJ, Azmi SA. Postpartum depression and its clinico-social correlates - a community-based study in aligarh. Indian J Public Health. 2022;66(4):473-479. https://doi.org/10.4103/ijph.ijph_1694_21 
  38. Ayoub K, Shaheen A, Hajat S. Postpartum depression in the Arab region: a systematic literature review. Clin Pract Epidemiol Ment Health. 2020;16(Suppl 1):142-155. https://doi.org/10.2174/1745017902016010142 
  39. Qi W, Liu Y, Lv H, Ge J, Meng Y, Zhao N, et al. Effects of family relationship and social support on the mental health of Chinese postpartum women. BMC Pregnancy Childbirth. 2022;22(1):65. https://doi.org/10.1186/s12884-022-04392-w 
  40. Paiz JC, de Jezus Castro SM, Giugliani ER, Dos Santos Ahne SM, Aqua CB, Giugliani C. Association between mistreatment of women during childbirth and symptoms suggestive of postpartum depression. BMC Pregnancy Childbirth. 2022;22(1):664. https://doi.org/10.1186/s12884-022-04978-4 
  41. Urbanova E, Skodova Z, Baskova M. The association between birth satisfaction and the risk of postpartum depression. Int J Environ Res Public Health. 2021;18(19):10458. https://doi.org/10.3390/ijerph181910458 
  42. Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017;7(7):CD003766. https://doi.org/10.1002/14651858.CD003766.pub6 
  43. National Statistics Bureau of Bhutan. 2017 Population & housing cencus of Bhutan; national report [Internet]. National Statistics Bureau of Bhutan; c2018;[cited 2023 Apr 20]. Available from https://www.nsb.gov.bt/publications/census-report/ 
  44. Deki S, Wangmo K. Women's views and experience of respectful maternity care while delivering in three regional referral hospitals of Bhutan. Int J Nurs Educ. 2020;12(2):141-146. https://doi.org/10.37506/ijone.v12i2.4285 
  45. World Health Ornagnization Team; Department of Public Health, Ministry of Health (MoH) of Bhutan. Noncommunicable disease risk factors: Bhutan STEPS survey report, 2019 [Internet]. MoH of Bhutan; 2020 [cited 2023 Dec 14]. Available from: https://www.who.int/publications/m/item/2019-steps-country-report-bhutan 
  46. de Paula Eduardo JA, de Rezende MG, Menezes PR, Del-Ben CM. Preterm birth as a risk factor for postpartum depression: a systematic review and meta-analysis. J Affect Disord. 2019;259:392-403. https://doi.org/10.1016/j.jad.2019.08.069 
  47. Pradhan D, Nishizawa Y, Chhetri HP. Prevalence and outcome of preterm births in the national referral hospital in Bhutan: an observational study. J Trop Pediatr. 2020;66(2):163-170. https://doi.org/10.1093/tropej/fmz046