Abstract
Depression around childbirth is common in low income countries. The aim of this study was to examine the factors associated with persistence of depression from the antenatal to the postnatal period in urban Pakistan. A total of 1,357 pregnant women in their third trimester attending the antenatal clinic were included in the study. From these, 763 mothers who delivered at the study maternity home were reassessed after 3 months of childbirth. Edinburgh Postnatal Depression Scale (EPDS) was administered to measure depression in both the antenatal and the postnatal periods. Psychological distress, disability and life events experienced by mothers were also measured by using the Self-Reporting Questionnaire (SRQ-20), Brief Disability Questionnaire (BDQ), and Life Events Checklist, respectively. We found 25.8% prevalence rate of antenatal depression and 38.3% persistent depression in a private clinic. Persistently depressed mothers had significantly high psychological distress, more disability, and experienced more stressful life events than the resolved group. Our findings confirm the high rates of depression during pregnancy but we found low rates of persistent depression in this urban population as compared to the previous report. There is a need for further investigation of factors associated with persistent depression in order to develop appropriate interventions.
Similar content being viewed by others
References
Ali NS, Ali BS, Azam IS (2009) Post partum anxiety and depression in peri-urban communities of Karachi, Pakistan: a quasi-experimental study. BMC Publ Health 9:384
Appleby L, Gregoire A, Platz C, Prince M, Kumar R (1994) Screening women for high risk of postnatal depression. J Psychosom Res 38:539–545
Bennett HA, Einarson A, Taddio A, Koren G, Einarson TR (2004) Prevalence of depression during pregnancy: systematic review. Obstet Gynecol 103:698–709
Boath EH, Pryce AJ, Cox JL (1998) Postnatal depression: the impact on the family. J Reprod Infant Psychol 16:199–213
Bunevicius R, Kusminskas L, Bunevicius A, Nadisauskiene RJ, Jureniene K, Pop VJM (2009) Psychosocial risk factors for depression during pregnancy. Acta Obstet Gynecol Scand 88:599–605
Burke L (2003) The impact of maternal depression on familial relationships. Int Rev Psychiatry 15:243–255
Chandran M, Tharyan P, Muliyil J, Abraham S (2002) Post-partum depression in a cohort of women from a rural area of Tamil Nadu, India. Br J Psychiatry 181:499–504
Civic D, Holt VL (2000) Maternal depressive symptoms and child behavior problems in a nationally representative normal birthweight sample. Matern Child Health J 4:215–221
Cogill SR, Caplan HL, Alexandra H, Robson KM, Kumar R (1986) Impact of maternal postnatal depression on cognitive development of young children. Br Med J (Clin Res Ed) 292:1165. doi:10.1136/bmj.292.6529.1165
Cox J, Holden L (1994) Perinatal psychiatry: use and misuse of the Edinburgh Postnatal Depression Scale. Gaskell, London
Edwards B, Galletly C, Semmler-Booth T, Dekker G (2008) Does antenatal screening for psychosocial risk factors predict postnatal depression? A follow-up study of 154 women in Adelaide, South Australia. Aust N Z J Psychiatry 42:51–55
Evans J, Heron J, Francomb H, Oke S, Golding J (2001) Cohort study of depressed mood during pregnancy and after childbirth. BMJ 323:257–260
Faisal-Cury A, Rossi Menezes P (2007) Prevalence of anxiety and depression during pregnancy in a private setting sample. Arch Womens Ment Health 10(1):25–32
Gotlib IH, Whiffen VE, Mount JH, Milne K, Cordy NI (1989) Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 57:269–274
Husain N, Creed F, Tomenson B (2000) Depression and social stress in Pakistan. Psychol Med 30:395–402
Husain N, Bevc I, Husain M, Chaudhry IB, Atif N, Rahman A (2006) Prevalence and social correlates of postnatal depression in a low income country. Arch Womens Ment Health 9:197–202
Husain N, Chaudhry IB, Afridi MA, Tomenson B, Creed F (2007) Life stress and depression in a tribal area of Pakistan. Br J Psychiatry 190:36–41
Husain N, Humail SM, Chaudhry IB, Rahman R, Tomenson B, Creed F (2010) Psychological distress among patients of an orthopaedic outpatient clinic: study from a low income country. Ann Gen Psychiatr 9:1–7
Josefsson A, Berg G, Nordin C, Sydsjo G (2001) Prevalence of depressive symptoms in late pregnancy and postpartum. Acta Obstet Gynecol Scand 80:251–255
Karmaliani R, Asad N, Bann CM et al (2009) Prevalence of anxiety, depression and associated factors among pregnant women of Hyderabad, Pakistan. Int J Soc Psychiatry 55:414–424
Kazi A, Fatmi Z, Hatcher J, Kadir MM, Niaz U, Wasserman GA (2006) Social environment and depression among pregnant women in urban areas of Pakistan: importance of social relations. Soc Sci Med 63:1466–1476
Leigh B, Milgrom J (2008) Risk factors for antenatal depression, postnatal depression and parenting stress. BMC Psychiatry 8:24
Lovestone S, Kumar R (1993) Postnatal psychiatric illness: the impact on partners. Br J Psychiatry 163:210–216
Milgrom J, Gemmill AW, Bilszta JL, Hayes B, Barnett B, Brooks J, Ericksen J, Ellwood D, Buist A (2008) Antenatal risk factors for postnatal depression: a large prospective study. J Affect Disord 108(1–2):147–157
Mirza I, Jenkins R (2004) Risk factors, prevalence, and treatment of anxiety and depressive disorders in Pakistan: systematic review. BMJ 328:794–797
O’Brien LM, Heycock EG, Hanna M, Jones PW, Cox L (2004) Postnatal depression and faltering growth: a community study. Pediatrics 113:1242–1247
O’Hara MW, Swain AM (1996) Rates and risk of postpartum depression: a metaanalysis. Int Rev Psychiatry 8:37–54
Patel V, Rodrigues M, DeSouza N (2002) Gender, poverty, and postnatal depression: a study of mothers in Goa, India. Am J Psychiatry 159:43–47
Patel V, Rahman A, Jacob KS, Hughes M (2004) Effect of maternal mental health on infant growth in low-income countries: new evidence from South Asia. BMJ 328:820–823
Rahman A, Creed F (2007) Outcome of prenatal depression and risk factors associated with persistence in the first postnatal year: prospective study from Rawalpindi, Pakistan. J Affect Disord 100:115–121
Rahman A, Iqbal Z, Harrington R (2003) Life events, social support and depression in childbirth: perspectives from a rural community in the developing world. Psychol Med 33:1161–1167
Rahman A, Iqbal Z, Bunn J, Lovel H, Harrington R (2004) Impact of maternal depression on infant nutritional status and illness. Arch Gen Psychiatry 61:946–952
Rahman A, Iqbal Z, Lovel H, Shah MA (2005) Screening for postnatal depression in the developing world: a comparison of the WHO Self-Reporting Questionnaire (SRQ-20) and the Edinburgh Postnatal Depression Screen (EPDS). J Pak Psych Soc 2:69–72
Rahman A, Bunn J, Lovel H et al (2007) Maternal depression increases infant risk of diarrhoeal illness—a cohort study. Arch Dis Child 92:24–28
Rubertsson C, Wickberg B, Gustavsson P et al (2005) Depressive symptoms in early pregnancy, two months and one year postpartum-prevalence and psychosocial risk factors in a national Swedish sample. Arch Wom Ment Health 8:97–104
Shah SM, Bowen A, Afridi I, Nowshad G, Muhajarine N (2011) Prevalence of antenatal depression: comparison between Pakistani and Canadian women. J Pak Med Assoc 61(3):242–246
Stein A, Gath DH, Bucher J, Bond A, Day A, Cooper PJ (1991) The relationship between post-natal depression and mother–child interaction. Br J Psychiatry 158:46–52
VonKorff M, Ustun TB, Ormel J et al (1996) Self-report disability in an international primary care study of psychological illness. J Clin Epidemiol 49:297–303
World Health Organization (1994) A user’s guide to the Self Reporting Questionnaire (SRQ). WHO/MNH/PSF/94.8. Geneva: World Health Organization
Yoshida K, Yamashita H, Ueda M et al (2001) Postnatal depression in Japanese mothers and the reconsideration of ‘Satogaeri bunben’. Pediatr Int 43:189–193
Acknowledgements
We would like to thank: the Pakistan Institute of Learning & Living for funding this study, Mr. Mian Muhammad Anees, Senior Trustee of the Chiniot Maternity Centre, for his support, all the staff at the Chiniot Maternity Centre, all the participants in the study, Miss Rubina Ameen for helping in data collection and Mr. Sami Ansari for undertaking data entry.
Conflict of interest
N. Husain and I.B. Chaudhry have received support for educational programs and/or travel support and/or speaker fees from Astra Zeneca, Eli Lilly, Lundbeck, Sanofi-Aventis, Bristol, Myers Squibb, Janssen Cilag and Wyeth.
All other authors declare that they have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Husain, N., Parveen, A., Husain, M. et al. Prevalence and psychosocial correlates of perinatal depression: a cohort study from urban Pakistan. Arch Womens Ment Health 14, 395–403 (2011). https://doi.org/10.1007/s00737-011-0233-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00737-011-0233-3