Maternal depression is associated with a number of adverse maternal outcomes such as preterm birth, maternal dysfunction, maternal suicide and perinatal outcomes such as low birth weight, lower rates of breastfeeding, increase in diarrheal disease, hospitalisations, poor emotional, social development, lower academic achievements in adolescence and future mental health problems for the children of the mothers. Maternal depression has rightly been identified as a priority mental health condition and large scale community interventions in low and middle income countries (including India) have been shown in RCTs to be effective in not only improving maternal depression but also improve the perinatal outcomes. Given the scale, severity of the problem and strength of evidence available for effective interventions in the Indian context, there is a great opportunity for implementation research in this area. As a first step there is a need to understand the prevalence of the problem and associated risk factors in our context.
Aim of this study to understand the prevalence of maternal depression and associated risk factors among antenatal mothers attending Sri Ramachandra Medical College (SRMC) Obstetrics outpatient department.
A cross-sectional design will be employed for determining the prevalence, while a case control framework will be used for the risk factor analysis. Antenatal mothers will be startified according to the trimester of the pregnancy. Semi-structured socio demographic proforma; Patient Health Questionnaire (PHQ-9 Tamil version), Generalised Anxiety Scale (Tamil Version) and Brief COPE (Tamil version) questionnaire will be administered for antenatal mothers who offer informed consent. Those who score above 10 points on the PHQ scale will be interviewed using the MINI diagnostic interview schedule for clarifying diagnosis. Those who are diagnosed with depression will be referred to the SRMC psychiatry department for treatment & follow up.
Statistical analysis is to be done using computer software, to assess the prevalence of antenatal depression and the associated risk factors. Descriptive statistics will be used to describe the sample. Mean, standard deviation and range will be employed to describe continuous variables, while frequency distributions will obtained for categorical variables. The chi square and fisher’s exact tests will be used to assess the significance of associations between categorical variables. Multivariate analysis will be performed using stepwise backward logistic regression models
Maternal wellbeing has been defined as a state in which a mother realizes her abilities, is able to cope with the common stresses of life and can offer meaningful contribution to her community (
Multiple risk factors have been shown to be associated, which vary depending on the local and cultural factors. Financial difficulties, non-arranged marriage, marital conflict, preference for male child, previous miscarriage, still birth, child with special needs, domestic violence, partner with alcohol dependence (
Depression in mothers is associated with poor quality of life (WHO report 2007), increase in suicidal behavior (
High quality studies in low and middle-income countries have shown that it is possible to successfully target maternal depression through lay workers (
Yet, services for screening and treatment of maternal depression have not been oranized even in most tertiary care settings in India. There are few studies on antenatal depression from India.
The aim of this study is to evaluate the prevalence of antenatal depression and the associated risk factors in a tertiary care maternity hospital as a first step towards organizing treatment services for effective intervention.
This study will be conducted in Obstetrics & Gynaecology department (O&G) of the Sri Ramachandra Medical College & Research Institute (SRMC & RI) in Chennai. The antenatal clinic is a busy unit with an average of about 60 outpatients assessed every day.
A cross-sectional design will be employed for determining the prevalence, while a case control framework will be used for the risk factor analysis.
In this study all patients attending the antenatal clinic who are above the age of 18 and are able to provide informed consent will be eligible to participate. Patients with mental subnormality and those who refuse consent will be excluded.
We estimate that the study will be conducted from January to March 2019.
The sample size calculated was 207 using the following assumptions: prevalence of antenatal depression to be 16% (
The participants will be screened for depression and evaluated for associated risk factors. Those who screen positive will be interviewed further for diagnostic evaluation. Patients who qualify for a diagnosis of depression will be referred to the psychiatry department of the SRMC hospital for further management
The MINI-Plus 5.0.0 is an internationally validated brief structured interview that is used extensively as a diagnostic tool for psychiatric disorders from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition and the International Classification of Diseases-10. The reliability and validity of this instrument is well established (
The GAD-7 was designed for use in primary care patients. It consists of a self-report questionnaire that allows for the rapid detection of generalised anxiety disorder. Subjects are asked if they were bothered by anxiety related problems over the past two weeks by answering seven items on a 4-point scale. The total scores ranged from 0 to 21. At a cut-off score of 9, the GAD-7 had a sensitivity of 89 % and a specificity of 82 % for detecting GAD compared with a structured psychiatric interview (
The Brief COPE (Tamil version) is a well validated scale that has been used extensively to assess coping with cancer, depression, and HIV. This is a 28 item scale scored from 1-4 for each question (
A semistructured proforma with the following content will be used to get information about some key associated factors.
Statistical analysis is to be done using computer software, to assess the prevalence of antenatal depression and the associated risk factors. Descriptive statistics will be used to describe the sample. Mean, standard deviation and range will be employed to describe continuous variables, while frequency distributions will obtained for categorical variables. The chi squared and fisher’s exact tests will be used to assess the significance of associations between categorical variables. Multivariate analysis will be performed using stepwise backward logistic regression models.
This study is approved by the Institutional Ethics Committee, Sri Ramachandra Medical College & Research Institute. Results will be published in a relevant scientific journal.
Antenatal depression can have potentially long-lasting effects on the child mother and the family. Early identification and treatment can go a long way in mitigating this. Evaluating the prevalence and associated risk factors for antenatal depression will enable provision of maternal mental health services. Such an approach will foster a positive relationship between Obstetrics and Psychiatry departments, lessen the stigma and pave a way for holistic care in general hospital setting. There is huge variability in prevalence of depression, based on study setting, trimester of pregnancy. Our study will help to understand the nature and prevalence of risk factors for depression and anxiety in antenatal mothers, their coping abilities and help us to plan for an intervention addressing those risk factors, there by promoting the well-being of mother and the child.