Institut Universitari d'Investigació en Ciències de la Salut (IUNICS). Palma de Majorca. Spain. INTRODUCTION. Design: longitudinal cohort study with follow-up ...
PSYCHOSOCIAL FACTORS OF POSTNATAL DEPRESSION. A longitudinal study Serrano MJ, Gili M, Bauzá N, Vives M, Monzón S, Roca M. University of Balearic Islands. Institut Universitari d Investigació en Ciències de la Salut (IUNICS). Palma de Majorca. Spain.
INTRODUCTION Postnatal depression has a prevalence of approximately 13%. There is no agreement on whether postpartum depression has differential characteristics from major depressive disorder (Riesch-Rosslerand and Hofecker Fallahpou, 2003). It is well known that after delivery women usually present changes in both emotional and cognitive functions. The etiology of postnatal depression remains unknown. There has been suggested various risk factors both psychosocial (degree of perceived social support) and biological. There are few studies linking depression and quality of life in postpartum (Canaval et al, 2000; Rojas et al 2006; Tychey et al, 2007; Da Costa et al 2006). The main objective of the present research is to study the relationship between the presence of an stressful life event (delivery) and the degree of perceived social support and the quality of life in the onset of postnatal depression. Another objective is to estimate the prevalence of postnatal depression in the population of puerperal women treated in our hospital.
METHODS Design: longitudinal cohort study with follow-up to 2-3 days, 8 and 32 weeks postpartum (3 stages). Sample: 276 puerperal women in the maternity hospital in Palma de Mallorca, over 18 years. We studied all consecutive Caucasian women who came to motherhood. Instruments: sociodemographic and obstetric data, a validated Spanish version of the Questionnaire of the Edinburgh Postpartum Depression, Nottingham Health Profile, Questionnaire Duke-UNC of social support. Method: 2-3 days, 8 and 32 weeks postpartum were assessed: presence of depression, health related quality of life and social support.
RESULTS - At the outset we found statistically significant differences in all variables (social support, energy, pain, physical mobility, emotional responses and social isolation), with the exception of the sleep dimension, which is not influenced by the level of depression. - At week 8, levels of statistical significance appear in 5 of 7 variables (social support, energy, emotional responses, sleep and social isolation), with which the pain and physical mobility dimensions don t seem to be related to the level of depression. - At week 32, the same results appear at 8 weeks, where the variables social support, energy, emotional responses, sleep and social isolation are significantly affected by the level of depression. - Obtained prevalence figures of postpartum depression around the 18% in the 3 evaluated moments EPDS Duke Energy Pain Mobility Emotional response Sleep Social Isolation
no yes no yes no yes no yes no yes no yes no yes
N initial 221 50 213 49 211 46 213 49 209 49 213 49 210 49
8 weeks 148 33 130 28 128 28 128 28 126 26 130 27 129 26
32 weeks 107 24 95 21 95 20 95 20 94 20 95 21 95 21
Mean
initial
42.26 (30.65) 71.78 (46.92) 16.90 (26.03) 31.29 (34.3) 19.08 (24.1) 27.17 (26.26) 26.65 (23.32) 34.69 (27.75) 8.88 (12.36) 26.98 (24) 27.39 (29.83) 31.29 (27.14) 3.10 (9.6) 10.20 (21)
8 weeks
32 weeks
54.16 (35.28) 88.91 (52.48) 10 (22.98) 25 (34.69) 6.15 (12.35) 10.27 (18.65) 30.96 (25.24) 26.79 (5.61) 10.23 (15.69) 33.33 (27.22) 12.18 (19.11) 33.33 (31.01) 4.84 (13.29) 26.92 (31.56)
67.36 (48.18) 108.92 (60.36) 5.61 (14.3) 41.27 (43.34) 4.47 (10.3) 13.75 (21.8) 4.21 (9.23) 10.62 (14.78) 8.98 (12.55) 38.89 (21.17) 9.65 (15.49) 33.33 (30.28) 4.74 (11.7) 32.14 (38.03)
P initial 0.000
8 weeks 0.001
32 weeks 0.000
0.008
0.036
0.001
0.043
0.273
0.077
0.009
0.387
0.075
0.000
0.000
0.000
0.402
0.002
0.002
0.025
0.002
0.004
Table 1. Mean comparison: EPDS (depressive vs non depressive) with the other variables
CONCLUSIONS We found statistically significant differences indicating us that as time goes on there is less perceived social support and low perceived quality of life that will increase the level of depression in women. The lack of perceived social support and to have a poor perception in the different dimensions of quality of life, especially in areas like energy, emotional responses, sleep and social isolation are clearly related to postpartum depression in more vulnerable women. The prevalence figures in our sample coincide with the numerous papers published. ACKOWLEDGEMENTS
All women who participated in the study.
REFERENCES 1. Canaval, G.E., González, M.C., Martínez, L., Tovar, M.C. & Valencia, C. (2000). Depresión postparto, apoyo social y calidad de vida en mujeres de Cali, Colombia. Revista Colombiana Médica, 31(1), 4-10. 2. Rojas, G., Fritsch, R., Solís, J., González, M., Guajardo, V., & Araya, R. (2006). Calidad de vida de mujeres deprimidas en el postparto. Revista Médica de Chile, 134, 713-720.
This study was funded by Instituto de Salud Carlos III (PI041779)
3. Tychey, C., Briançon, S., Lighezzolo, J., Spitz, E., Kabuth, B., Luigi, V., Messembourg, C., Girvan, F., Rosati, A., Thockler, A. & Vincent, S. (2007). Quality of life, postnatal depression and baby gender. Journal of Clinical Nursing, 17, 312-322. 4. Da Costa, D., Dritsa, M., Rippen, N., Lowensteyn, I. & Khalifé, S. (2006). Health-related quality of life in postpartum depressed women. Archives of Womens Mental Health, 9, 95-102.
