postpartum depression amongst women admitted to a kangaroo ... · urban population •it was...
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Postpartum Depression in Women Admitted to a Kangaroo Mother Care
Ward
Elzet Venter
Kalafong Hospital
Department of Paediatrics
University of Pretoria
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Introduction
• Postpartum depression (PPD) incidence in developed countries is ± 10-15 % (1)
• Known associated factors:
– Years of education
– Social stressors and absence of support
• Limited data available in developing countries
• Study in Cape Town at a well baby clinic - PPD was found to be 35 %(2)
(1)Tomlinson et al. 2006 (2) Cooper et al. 1999
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Effects of PPD on Infants
• PPD can have numerous effects on the infant
– Decreased visual and verbal interaction (3)
– Difficulty in breastfeeding and disturbed sleeping patterns
• Long term:
– Difficulty in forming attachments
– Adverse influence on social, verbal, cognitive and emotional development (4)
(3) Field et al. 2010 (4) Brand et al. 2009
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Research question
• How many mothers with LBW and/or premature infants admitted to a KMC ward screen positive for PPD?
• What factors are associated with an increased risk to develop PPD?
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Setting
• Kalafong Provincial Tertiary hospital
• Mainly low income patients from an urban setting
• Referral hospital for high risk pregnancies
• KMC ward consisting of 20 beds
• Step down unit
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Edinburgh Postpartum Depression Scale(5)
• The EPDS was developed and validated for use in the UK
• It is a I0-item self-report scale, designed specifically as a screening instrument for the postnatal period
• The 10 questions with choice of 3 answers where each answer carries a certain value
• Scores of 12 or more out of 30 predicted PPD
(5) Cox et al.
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Modified EPDS (6)
• The language of the EPDS was simplified and validated for use in a South African multilingual, urban population
• It was administered verbally to participants
• A threshold of 12 on the EPDS identified:
– 100% of women with major depression and
– 71% of women with minor depression
• Positive predictive value 53% and negative predictive value 92%
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Inclusion criteria
1. Mothers who voluntarily agreed to participate
2. Mothers with infants born less that 37 weeks gestational age
3. Infants with birth weights less than 2500 grams
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Exclusion criteria
1. Caregivers other than mothers
2. Mothers with language barriers
3. Mothers whose babies have congenital abnormalities
4. Teenage mothers < 16 years
5. Mothers previously diagnosed with a mood disorder or who are on mood stabilising therapy
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Methodology
• Permission obtained from Ethics committee at UP
• Short pilot study (December 2014)
• Data collection: 01/01/15-31/12/15
• Experienced research assistant interviewed mothers individually: – Informed consent obtained
– Completed modified EPDS
– Demographic questionnaire
• All women with scores ≥12/30 was referred for psychological evaluation and/or counselling
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Demographic information
Mother
• Age
• Citizenship
• Gravity and parity
• Pregnancy planned
• Delivery method
• HIV status
• Social (education, employment, support)
Infant
• Birth weight
• Gestation age
• Gender
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Results
• Total number of mothers interviewed: n = 457
• EPDS Score > 12: n = 166 (37%)
• Demographics
– Mean age of mothers – 28 years
– Mean weight of infants – 1670 grams
– Mean gestational age – 34 weeks
– Mean age at interview – 14 days
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Residential Area – Socio Economic
218 53 24%
139 59 42%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All Depressed %
Informalsettlements
Establishedsuburbs
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Education
5 101 311 40
20% 37% 38% 28%
0%10%20%30%40%50%60%70%80%90%
100%
Noschooling
0-10 11+12 After school
%
Depressed
All
p value: 0,555
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Relationship
182 134 80 57
41% 37% 31% 28%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Single Co-habitting Married Traditional
Depressed
All
p value:0,352
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Miscarriages
35%
41%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All Depressed %
Miscarriages
None
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HIV status
112 45 40%
345 12 35%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
All Depressed
Negative
Positive
p value :0,668
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EPDS≥ 12/30 (n=166)
Variables p-values
Citizenship RSA citizen (140) Non- RSA citizen( 26) 0,383
Pregnancy
planned
Planned (75) Unplanned (89) 0,232
Employment
father
0,578
Maternal grand
parent support
0,558
Gender Female (93) Male (73) 0,035
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Limitations
• Observational descriptive study
• Mothers in a tertiary referral hospital
• High risk pregnancies and deliveries
• Language barrier to interviewing non- RSA citizens
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In Summary
• PPD was found to be very prevalent in mothers with preterm and / or LBW infants
• 1 in 3 mothers were screened as having PPD
• Gender was the only associated factor found to be statistically significant
• More single mothers suffered from PPD compared to married ones
• Socio economic factors may influence why mothers from informal settlements had more PPD
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Conclusion
• Screening for postpartum depression should be considered as part of routine post natal care
• From these findings it is important to have counselling and psychological support for mothers in the post partum period, especially those with preterm and / or LBW infants
• Appropriate treatment and follow-up for affected mothers to prevent long term complications for the infants
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Acknowledgements
• Dr van E Rooyen and Dr A Bergh
• Mrs. Elsie Etsane
• MRC statistical analysis:
– Prof Samuel Manda
– ms. Tshifiwa Nkwenika
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Bibliography
1.Tomlinson M, Cooper PJ, Stein A, Swartz, Molteno C. Post-partum depression and infant growth in a South African peri-urban settlement. Child: Care, Health & Development. 2006; 32(1):81-86.
2. Cooper PJ, Tomlinson M, Swartz L, Woolgar M, Murray L, Molteno C. Post-partum depression and the mother-infant relationship in a South African peri-urban settlement. B J of Psychiatry.1999 Dec; 175:554-558
3.Field T. Postpartum depression effects on early interactions, parenting and safety practices. Infant Behav Develop. 2010; 33:
1-6
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Bibliography
4. Brand SR, Brennan PA. Impact of antenatal and postpartum maternal mental illness: how are the Children? Clin Obstet Gynecol. 2009; 53: 441–55.
5.Cox JL, Holden JM, Sagovsky R. Detection of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression scale.
British J of Psychiatry. 1987; 150:782-786.
6.Lawrie TA, Hofmeyer GJ, de Jager M, Berk M. Validation of the Edinburgh Postnatal depression scale on a cohort of South African women. SAMJ [Internet]. 1998 [cited 2014 Aug 23]; 88:1340-1344. Available from http://www.samj.org.za