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Prevalence of depression in women with preterm delivery in Jahrom city 2018

Masoomeh Najafi1, Sedigheh Najafipoor2, Farzad Poorgholami3 , Fatemeh Forouzan Jahromi 4*

1 MSc, Department of Nursing, Asadabaad Faculty of Medical Sciences, Asadabaad, Iran. 2 Assistant Professor at Department of  Medical Education, School of  Medicine, Jahrom University of Medical Sciences, Jahrom, Iran.  3 MSc of Medical-Surgical Nursing, Jahrom University of Medical Sciences, Jahrom, Iran. 4MSc of Critical Care Nursing, Jahrom University of Medical Sciences, Jahrom, Iran.


ABSTRACT

Background and Aim: The aim of this study was to investigate the prevalence of depression in women with preterm delivery in Jahrom city in 2017. Method: The research population of women with preterm labor, who had been at least 6 weeks to 1 year since their delivery, were deprived of the previous history of depression and referred to psychiatrists and drug users, and were covered by a health center in Jahrom city. A randomized-stratified random sample of 115 eligible people entered the study. The instrument used was demographic and depression questionnaires. Results: The results of the study showed that there is a significant relationship between the number of children and depression (p = 0.001). The results showed that mothers with one child had higher levels of depression than mothers with more children. Also, there is a significant relationship between the number of pregnancies, abortion history, type of delivery, child's gender, unintended pregnancy, child's unwanted gender from the father's and the mother's point of view and type of child feeding and depression. Mothers with first pregnancy had higher depression than other mothers. Mothers without a history of abortion had higher rates of depression than those with abortion history. Conclusion: The results of this study indicated a high prevalence of mild depression in women with preterm labor in Jahrom city in 2018‎.

Keywords:  Prevalence, Depression, preterm delivery, women


Introduction  

Pregnancy and labor are special events of the lives of women and their families. Pregnancy cause physiological and psychological changes and affects the functioning of different body organs. These changes cause symptoms and complaints in pregnant women and may occur naturally per pregnancy, but complications arise for mother and embryo if symptoms intensify [1]. If pregnant women do not adapt themselves with these changes, they are exposed to a high level of stress.

Bairami reported that the prevalence of psychiatric disorders in the first, second, and third trimester of pregnancy is 0.029, 0.028, and 0.039 respectively. [2] Today, the health of mother and child is the main goal for the social and economic development of every society [3]. According to the results of the studies conducted on preterm labor, various factors such as physical and psychological stress [4], depression [5], anxiety [3] social relationships and support and self-care [6] are related to the preterm labor. Preterm labor is referred to as delivery before thirty-seven weeks of pregnancy (259 days from the first day of the last menstruation) [6], which is the cause of about two-thirds of the neonate deaths [3]. The prevalence of preterm labor is reported by 5% in developed and 25% in developing countries. The costs of taking care of premature infants are estimated to be over $ 5 billion in the United States [7]. Preterm labor has been rising in Iran [8].

Short-term complications in premature infants include respiratory problems, persistent arterial duct, necrotizing enterocolitis, or intestinal gangrene, and intracranial hemorrhage and its long-term complications include congenital malformations, neurodevelopment disorders such as cerebral palsy, hydrocephalus, seizures, vision hearing, behavioral problems, and airway disorders [7]. Other maternal complications of preterm labor include concern and anxiety, complications of prolonged rest, complications of tocolytic, and sedative drug use. The embryonic complications include respiratory distress syndrome due to lack of lung evolution, premature body organs, the possibility of hypothermia due to low-fat tissue and damage to the skull and intracranial hemorrhage during labor and the probability of infection and anemia [9]. Premature infant birth is one of the major problems in society. In addition to causing economic and psychological problems in the family, it also causes the loss of financial and human resources. In research conducted in Boston, America (1997), it was reported that premature neonates had a more negative behavioral pattern than mature ones. Also in a study conducted in Dublin Hospital (1995) in a 3-years period, prematurity has been one of the major contributors to neonates' mortality [10].

The prevalence of postpartum depression has been reported 10-20% in recent studies conducted all around the world [11]. Also, postpartum depression has a high prevalence in Iran. It is reported 29% in the study of Salehi-Kasaei (1994) [12] and 27% in the study of Behboudi (2002) [13].

 

Methods:

This research was a descriptive cross-sectional study. The study population included pregnant women who had preterm labor at least 6 weeks to one year ago and did not have a history of depression, a history of referral to a psychiatrist, and taking psychiatric drugs and also were under surveillance of one of the health centers in Jahrom city. A stratified random sampling method was used to enter 115 eligible women to the study. The study data were collected using a two-part questionnaire. The first part included maternal demographic information such as age, level of education, spouse's level of education, job, number of pregnancies, number of children, the abortion history, the type of delivery, the child's gender, the unintended pregnancy, child's unwanted gender from the father's and the mother's point of view, type of child feeding, and baby's medical problems in the first week after birth. The second part consisted of questions about depression based on Beck's questionnaire. Beck's Depression test was introduced in 1961 by Beck and his colleagues for the first time. It was revised in 1971 and re-introduced in 1978. Since then, over 30 years after its introduction, more than 1,000 studies have been carried out about it or it was used in those researches. In Iran, this questionnaire has been standardized by Okhovvat and is widely used to measure depression in the normal and with mentally disordered people.

The Beck Depression questionnaire is known as a cross-cultural test that is applicable to all social classes. The respondents are required to rank the intensity of their symptoms on a scale from zero to three (0-3). Its questions are related to areas such as the feeling of failure and guilt, irritability, sleep disturbances, and lack of appetite. The validity and reliability of this questionnaire have been evaluated extensively since it was introduced about 30 years ago. Analysis to determine the internal consistency of the usual 21-items version of this test has shown that the coefficients range from 0.73 to 0.93 with an average of 0.76. In the present study, the 21-items version of this questionnaire was used. The total score of 0-14 is considered normal or individuals with depression at the normal level, 15-31 is representative of the mild depression level, 32-47 represents the moderate level, and 48-63 is considered as severe depression.

After obtaining permission from the vice-chancellor of research at Jahrom University of Medical Sciences, the researcher was referred to the health-care centers (a referral center for mothers in the postpartum period). All participants received information about the study objectives and provided written informed consent and then the questionnaires were delivered to them. Data were analyzed and summarized using descriptive statistics and tables consisting of frequencies and percentages and estimating the distribution of the frequencies of the variables in terms of depression.

 

Results:

A total number of 115 women with preterm labor participated in the study. Most of the participants (95.7%) were under 30 years old and their mean age was 29.2 ± 3.75. Almost half of the mothers (53.9%) and 63.5% of fathers had a diploma or lower than diploma degree. The majority of the mothers (73.9%) were housewives. Nearly half of the mothers (45.2%) had only one child, 29.6% had 2 children and the rest 25.2% had three children. 59.1% of the participants had a vaginal delivery and the rest 40.9% had cesarean deliveries. More than half of the newborn babies (65.2%) were girls. 10.4% of the mothers had an unintended pregnancy. The gender of 7.8% of the infants was unwanted from the point of view of the child's father, and also 7.8% from the mother's point of view. Half of the mothers (52.2%) fed their children with breast milk. 27.8% had a history of abortion. 71.3% of the infants had experienced a medical problem in the first week after birth (Table 1).

The mean depression score was 13.085 ± 14.33. A higher score indicates a more severe level of depression. 58.3% of the women did not have depression (0-14), 33% of them had mild depression (31- 15%) and only 8.7% had moderate depression (32-47%). A severe level of depression was not observed in participating women. The results of the study showed that there is a significant relationship between the number of children and depression (p-value = 0.001) so that single-child mothers suffered from depression more than the others. Also, there is a significant relationship between the number of pregnancies, the abortion history, the type of delivery, the child's gender, unintended pregnancy, child's unwanted gender from the father's and the mother's point of view, and type of child feeding and depression (p-value <0.05). Mothers with the first pregnancy had experienced depression more than the other ones. Women with a history of abortion had a lower incidence of depression than those without a history of abortion. Depression in women with a vaginal delivery was higher than women with cesarean delivery. Results also showed that mothers who had delivered a girl baby experienced a higher level of depression than mothers with a boy. Also, the results indicated that the incidence of depression was the highest in the mothers who used hybrid milk to feed their babies.

Depression was higher in mothers aged 20 to 25 years than in mothers aged 26 to 35 years. The average depression in mothers
with postgraduate education was higher than other groups. The rate of depression in mothers was not significantly different according to the education of the wife, the rate of depression was higher in working women than housewives. Depression was also higher in women who had no history of miscarriage and had a normal delivery.

Depression was lower in women who had a son than in women who had a daughter.

The incidence of depression in cases of unwanted pregnancies was higher for parents. The prevalence of depression was higher in single women and mothers who fed their infants hybrid. The results of this study also showed that it was higher in the first delivery and the average incidence of depression was higher in women whose child had a medical problem at birth. (Table2).

 

 

 

 

Table 1: Demographic characteristics of women with preterm labor in Jahrom city.

Maternal demographic characteristics

N (%)

Maternal demographic characteristics

N (%)

age

<20

1 (9)

Abortion history

Yes

32 (27.8)

 

21-25

72 (62.6)

 

No

83 (72.2)

 

26-30

37 (32.2)

Type of delivery

Vaginal

68 (59.1)

 

31-35

5 (4.3)

 

Cesarean

47 (40.9)

level of education

Lower than Diploma

10 (8.7)

Child's gender

Girl

75 (65.2)

 

Diploma

52 (45.2)

 

Boy

40 (34.8)

 

Advanced Diploma

16 (13.9)

Unintended pregnancy

Yes

12 (10.4)

 

bachelor's degree and higher

37 (32.2)

 

No

103 (89.6)

Spouse's level of education

Lower than Diploma

14 (12.2)

child's unwanted gender from father's point of view

Yes

9 (7.8)

 

Diploma

59 (51.3)

 

No

106 (92.2)

 

Advanced Diploma

5 (4.3)

child's unwanted gender from mother's point of view

Yes

9 (7.8)

 

bachelor's degree and higher

37 (32.2)

 

No

106 (92.2)

Job

Housewife

85 (73.9)

Child's feeding

Breast milk

60 (52.2)

 

Employed

30 (26.1)

 

Milk powder

42 (36.5)

Number of children

1

52 (45.2)

 

Hybrid milk

13 (11.3)

 

2

34 (29.6)

Infant's medical problems

Yes

82 (71.3)

 

3

29 (25.2)

 

 

 

Number of pregnancies

1

52 (45.2)

 

No

33 (28.7)

 

2

24 (20.9)

 

 

 

 

3

39 (33.9)

 

 

 

 

 

Table 2: The relationship between demographic characteristics and depression in women with preterm labor in Jahrom city

Maternal demographic characteristics

Depression

p-value

Maternal demographic characteristics

Depression

p-value

 

Mean±SD

 

 

Mean±SD

 

age

20-25

15.82±13.31

 

Abortion history

Yes

5.19±7.76

0.001

 

 

 

 

 

No

17.87±13.04

 

 

26-30

12.49±12.24

 

Type of

delivery

Vaginal

19.21±13.79

0.001

 

31-35

6.4±13.76

 

 

Cesarean

7.3±7.84

 

level of

education

Lower than Diploma

12.6±12.01

0.152

Child's

gender

Girl

17.99±13.98

0.001

 

Diploma

13.04±13.47

 

 

Boy

7.5±7.5

 

 

Advanced Diploma

20.75±13.07

 

Unintended

pregnancy

Yes

15.66±13.19

 

 

bachelor's degree and higher

13.86±12.49

 

 

No

3±2.09

0.001

Spouse's

level of

education

Lower than Diploma

14.29±12.76

0.996

child's

unwanted gender

from father's

point of view

Yes

15.56±12.91

 

 

Diploma

14.34±13.44

 

 

No

0.00±0.00

0.001

 

Advanced Diploma

15.2±14.77

 

child's

unwanted gender

from mother's

point of view

Yes

15.56±12.91

 

 

bachelor's degree and higher

14.24±12.97

 

 

No

0.00±0.00

0.001

Job

House wife

13.68±13.18

0.254

Child's

feeding

Breast milk

17.1±11.07

0.001

 

Employed

16.2±12.84

 

 

Milk powder

5.55±6.79

 

Number of

children

1

22.54±13.55

0.001

 

Hybrid milk

30±17.1

 

 

2

7.44±8.73

 

Infant's

medical problems

Yes

 

14.77±12.08

0.123

 

3

7.72±6.69

 

 

 

 

 

Number of

pregnancies

1

22.54±13.55

0.001

 

No

13.27±15.47

 

 

2

6.63±7.69

 

 

 

 

 

 

3

8.15±7.9

 

 

 

 

 

 

 

 

Discussion:

The results of the present study about the prevalence of depression in women with preterm labor showed that 41.7% of women had mild to moderate levels of depression. Neshat Ramesh et al. [3] showed that the risk of preterm labor was higher in women with anxiety, stress and depression than other women [3]. Depression during pregnancy can lead to self-neglect, lack of appropriate prenatal care, lack of self-care, inadequate nutrition, smoking, excessive taking medication, low birth weight, and preterm delivery [1]. The first psychological sign of depression is a decrease in motivation and interest, which leads to reduced activity and efficiency, reduced life expectancy, reduced self-care, and a tendency to die in the person [14]. Baiami, quoted from McKay et al. (2001), reported that depressed and highly stressed pregnant women have a lower level of performance than the other women [2].

According to recent studies, it seems that women are more susceptible to depression during pregnancy than in the postpartum period [15]. There was a significant relationship between depression and the number of pregnancies, the number of children, the abortion history, the type of delivery, the child's gender, the unintended pregnancy, child's unwanted gender from the father's and the mother's point of view, and type of child nutrition. Mothers with the first pregnancy had experienced depression more than the other ones. Women with a history of abortion had a lower incidence of depression than those without a history of abortion. Depression in women with a vaginal delivery was higher than women with cesarean delivery. The prevalence of depression was more in the mothers with only one child than the others and mothers who had delivered a girl baby experienced a higher level of depression than the mothers with a boy. Also, the results showed that the incidence of depression was the highest in the mothers who used hybrid milk to feed their babies. Recent estimates project that, by 2050, rates of depression will increase by 35% in adults and more than double in older adults [16]

Neshat Ramesh et al. [3] described the factors affecting preterm labor as the mother's age, socioeconomic class, and the number of pregnancies [3]. In the studies, the major role of mothers' depression in the psychological development of the child has been discussed [17, 18]. In his study, Aulin stated that inadequate self-care during pregnancy can increase the risk of adverse outcomes such as preterm delivery [19]. It is also noted that the symptoms of postpartum depression are more in mothers with low socioeconomic status and inadequate social support [18]. Dissatisfaction with life and unintended pregnancy are contributing to the depression [18]. The most highlighted contributing factor of postpartum depression is dissatisfaction with the spouse [20]. Caesarean may cause negative emotional effects in some women such as the feeling of deprivation, sin, and failure in vaginal delivery, which leads to adaptive problems in the mother [21]. Adewuya et al. (2005) and Ukpong (2006) also mentioned cesarean delivery as a risk factor for postpartum depression [22,23]. Moreover, it has been shown that teaching, nursing, counseling, joking with patients, helping patients to achieve maximum activity, encouraging the use of socialization and relaxation techniques, improving the patients’ spirituality and relationships with their family, friends and relatives, and inculcating a feeling of connectedness to a greater source are effective in increasing the patients’ hope[24].

Conclusion:

The results of the present study indicated a high prevalence of mild depression in women with preterm labor in Jahrom city in 2018. The results also showed that there is a significant relationship between depression and the number of pregnancies, the number of children, the abortion history, the type of delivery, the child's gender, unintended pregnancy, child's unwanted gender from the father's and the mother's point of view, and type of child nutrition.

Acknowledgments

This article was derived from an approved research project with an ethics approval code: IRR.JUMS.REC.1394.136 from Jahrom University of Medical Sciences. The authors would like to acknowledge the research deputy of Jahrom University of medical sciences for their financial support, as well as the sincere cooperation of the authorities of health centers affiliated to Jahrom University of Medical Sciences.

 

 

 

References

  1. Jabbari Z, Hashemi H, Haghayegh SA. Survey on effectiveness of cognitive behavioral stress management on the stress, anxiety and depression of pregnant women. J Health Syst Res 2013; 8(7):1341-7. (Persian).
  2. Bayrami M, Zahmatyar H, Bahadori KJ. Prediction strategies to coping with stress in the pregnancy women with first experience on based factors hardiness and social support. Iran J Nurs Res 2013; 7(27):1-9. (Persian).
  3. Neshat R, Majlesi F, Rahimi A, Shariat M, Pourreza A. Investigation the relationship between preterm delivery and prevalence of anxiety, stress and depression in pregnant women of dorrod health center, Iran in 2010. Iran J Obstet Gynecol Infertil 2013; 16(67):16-24. (Persian).
  4. Dalili M, Meybodi MA, Ghaforzadeh M, Farajkhoda T, Vardanjani HM. Screening of preterm labor in Yazd city: transvaginal ultrasound assessment of the length of cervix in the second trimester. Iran J Reprod Med 2013; 11(4):279.
  5. Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: a systematic review. Women Birth 2015; 28(3):179-93.
  6. Kamali Fard M, Alizadeh R, Sehati Shafaei F, Gojazadeh M. The effect of lifestyle on the rate of preterm birth. J Ardabil Univ Med Sci 2010; 10(1):55-63.
  7. Sohrabi D, Ghanbari Gorkani M. A survey on Risk factors and outcomes of women with preterm labor admitted to Valieasr hospital in Zanjan . J Urmia Nurs Midwifery Fac. 2011; 9 (2) . (Persian).
  8. Mehran N, Abbaszadeh F, Bagheri A, Noroozi M. Relation between Home Work and Preterm Labor. J Hayat 2013; 18(5):46-54. (Persian).
  9. Harrington AR, Harrington CCG. Healthy start screens for depression among urban pregnant, postpartum and inter conceptional women. Natl Med Assoc. 2007;99(3):226–31.
  10. Ashraf Khorramirad, Maryam Mousavi Lotfi, Alireza Shoori Bidgoli. Prevalence of Postpartum Depression and Related Factors in Qom. pajoohande. 2010; 15 (2) :62-66. (Persian).
  11. G. Khooshemehry, M.Sc., A. Shariati Feizabady, B.Sc., V. Naserkhaki, M.Sc.. Prevalence of Postpartum Depression and the Factors that Decides in Clinics in the North of Tehran. Sci J Hamadan Nurs Midwifery Fac. 2011; 19 (1) :59-69. (Persian).
  12. Pazande F, Toomians J, Afshar F, Valaei N. Prevalence of depression in parturients referring university hospitals in Tehran in 1999 . Feyz. 2002; 6 (1) :66-70. (Persian).
  13. Shoja M, Shoja M, Shoja E, Gharaei M. Prevalence and affecting factors on preterm birth in pregnant women Referred to Bentolhoda hospital- Bojnurd. JNKUMS. 2016; 7 (4) :855-863. (Persian).
  14. Ghanei R, Golkar F, Aminpoor E. Foot carein depressed and non-depressed diabetic patients. Modern Cares J 2013; 10(2):124-31. (Persian).
  15. Omidvar SH, Kheirkhah F, Azimi H. Depression during pregnancy and its related factors. Med J Hormozgan Univ 2007; 11(3):213-9. (Persian).
  16. Jahromi MK, Javadpour S, Taheri L, Poorgholami F. Effect of nurse-led telephone follow ups (tele-nursing) on depression, anxiety and stress in hemodialysis patients. Global Journal of Health Science. 2016 Mar;8(3):168.
  17. Hen-Shaw C. Mood disturbance in early puerpenum: a review. Arch Women Ment Health 2003;2:33-42.
  18. Farzad M, Ghazi Mir Saeed SB. Association between type of delivery and maternal blue. Research in Medicine. 2005; 29 (4): 331-335. (Persian).
  19. Avelyn G. The relationship between prenatal self-care practices during prenancy and birth out comes among young mothers aged 16 to 24 years delivering at Gweru maternity hospital. [Master Thesis]. Zimbabwe, East Africa: Faculty of Medicine, University of Zimbabwe; 2014.
  20. Sehhatie shafaei F, Ranjbar koochaksariie F, Ghojazadeh M,
    Mohamadrezaei Z. Study of Relationship between Some Predisposing Factors and Postpartum Depression. J Ardabil Univ Med Sci. 2008; 8 (1) :54-61. (Persian).
  21. Pourkhaleghi N, Askarizadeh G, Fazilat-Pour M. Predicting Post-Partum Depression of Nulliparous Women: Role of Social Support and Delivery Type. JHC. 2017; 19 (1) :18-29. (Persian).
  22. Adewuya AO, Fatoye FO, Ola BA, Ijaodola OR, Ibigbami SM. Sociodemographic and obstetric risk factors for postpartum depressive symptoms in Nigerian women. J Psychiatr Pract. 2005;11(5):353-8.
  23. Ukpong DI, Owolabi AT. Postpartum emotional distress: a controlled study of Nigerian women after caesarean childbirth. J Obstet Gynaecol. 2006; 26(2):127-9.
  24. Poorgholami F, Mansoori P, Montaseri Z, Najafi K. Effect of self care education with and without telephone follow-up on the level of hope in renal dialysis patients: A single-blind randomized controlled clinical trial. International journal of community based nursing and midwifery. 2016 Jul;4(3):256.

 

 

 


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