Prevalence and factors associated with the development of antenatal and postnatal depression among Jordanian women

Abstract

Objectives

to investigate the prevalence of depression during pregnancy and postpartum period for Jordanian women and identify associated risk factors and maternity service delivery issues.

Design

a prospective cross-sectional study. Participants were recruited during the last trimester of pregnancy, provided personal, social and obstetric information, and completed the Edinburgh Postnatal Depression Scale (EPDS), Depression Anxiety and Stress Scale (DASS-21), the Maternity Social Support Scale (MSSS), the Cambridge Worry Scale (CWS), Perceived Self-Efficacy Scale (PSES) and Perceived Knowledge Scale (PKS). All participants were contacted again at six–eight weeks and six months post partum to complete a telephone or face-to-face interview. The postnatal questionnaire included the EPDS, MSSS, and DASS-21.

Setting

a teaching hospital and five health centres in Irbid city in northern Jordan.

Participants

Arabic speaking women (n=353) between the ages of 18 and 45 years, in their last trimester of pregnancy, at low risk for obstetric complications and receiving antenatal care between November 2005 and August 2006.

Findings

high rates of antenatal (19%) and postnatal depression (22%) were reported. A regression analysis revealed that stress, anxiety, financial problems, perceived lack of parenting knowledge, difficult relationship with the mother-in-law, unplanned pregnancy, and low self-efficacy were associated with antenatal depression. These seven factors accounted for 83% (r²=0.834) of variance in the development of probable antenatal depression. At six–eight weeks post partum, a regression analysis revealed that antenatal depression, unplanned pregnancy, difficult relationship with mother-in-law, dissatisfaction with overall care, stress, lack of social support, giving birth to a female baby, feeling pressured to birth the baby quickly, and perceived low parenting knowledge were associated with postnatal depression. These nine variables accounted for 82% (r²=0.819) of variance in the development of probable PND. Three intrapartum and postpartum variables associated with PND at six–eight weeks (postpartum haemorrhage, unhelpful doctors during labour and birth, and anxiety) were no longer associated with PND at six months.

Conclusions and implications for practice

Jordanian women need support to prepare for labour and birth. Postpartum emotional support and assessment of symptoms of depression needs to be incorporated into routine practice. The opportunity for open discussion along with increased awareness and clarification of common misconceptions about antenatal and postnatal depression are necessary. Quality assurance systems would help reduce the rate of invasive obstetric procedures, and give greater emphasis to emotional care provided to women during the perinatal period.

Introduction

Having a child is a time of biological, psychological and social change in a woman’s life. These changes can contribute to personal growth and happiness, but may also predispose women to emotional distress. Postnatal depression (PND) is an important public health problem which has negative effects on the mother, infant and the whole family (Dennis and Ross, 2006a, Husain et al., 2006). Study results consistently suggest that around 10% of mothers suffer from PND when assessed between three and six months post partum, with a higher prevalence in the early postnatal period (Stowe et al., 2005).

Some authors suggest that PND is a problem of industrialised countries. It has been argued that socio-cultural patterns, such as traditional postnatal family support, limit the likelihood of PND in populations of developing countries (Agoub et al., 2005, Felice et al., 2004). Although there is still relatively limited information, studies from non-industrialised countries have begun to emerge (Felice et al., 2004, Abiodun, 2006, Andajani-Sutjahjo et al., 2007). For example, Green et al. (2006) reported a 22% prevalence of PND in United Arab Emirates women, which is higher than rates for women in western developed countries.

The aetiology of PND is considered to be multifactorial (Ross et al., 2004). A history of marital discord, a poor parenting relationship experienced by women during their childhood, low self-esteem, low socio-economic status, unwanted pregnancy, dissatisfaction with labour and birth, medical interventions in labour, and stressful life events during pregnancy as well as antenatal depression have been associated with postpartum depression (Baker et al., 2005, Dennis and Ross, 2006a, Dennis and Ross, 2006b, Husain et al., 2006, McCoy et al., 2006). There are additional risk factors associated with the development of PND amongst women in developing countries. These factors relate to specific cultural norms and include birth of a daughter when a son was desired, and relationship difficulties with the mother-in-law (Lee et al., 2004, Green et al., 2006).