The prevalence and factors influencing postnatal depression in a rural community

Abrahams, Johanna Magdalena (2011-12)

Thesis (MCur)--Stellenbosch University, 2011.

Thesis

ENGLISH ABSTRACT: Mental health is still the step-child of Health Services, although many studies show the serious negative impact it has on the mother, baby and the family. Knowledge about Postnatal Depression (PND) and associated risk factors which influence the development of PND is vital for early detection and intervention. Worldwide PND affects on average 10-15% of women after giving birth regardless of socio-economic status, race or education. Studies also reveal that the prevalence of PND is as high as 40-60% amongst women after giving birth. The goal of the study was to investigate the prevalence and factors influencing PND in a rural setting, in the Witzenberg Sub-district. The objectives included determining the prevalence of PND and identifying the contributing risk factors associated with PND. A descriptive explorative research design with a quantitative approach was applied. The target population was (N=1605) mothers, 18 years and older who gave birth in this Sub-district in one year, a convenience sampling method was used to select the study sample of (n=159/10%) participants who met the criteria and who gave voluntary permission to take part in the study. Validity and reliability was supported through the use of validated questionnaires EPDS and BDI including a questionnaire based on demographical, psychosocial and obstetrical data. In addition experts in statistics, nursing and psychiatry were consulted including language experts who validated the correctness of the Afrikaans and Xhosa translated questionnaires. A pilot study was conducted to test the feasibility of the study and all data was collected personally by the researcher with the support of two trained field workers. Ethics approval was obtained from Stellenbosch University and permission from the Department of Health, Provincial Government of the Western Cape, including informed written consent from each participant. The data was analysed with the assistance of a statistician and are presented with histograms and frequency tables. The relationship between continuous response variables and nominal input variables was analysed using analysis of variance (ANOVA). Various statistical tests were applied to determine statistical associations between variables such as the chi-square tests using a 95% confidence interval. Non-parametric tests such as the Mann-Whitney U–test or Kruskal-Wallis test were used for randomised design. Levene’s test was used for Homogeneity of Variance and the Bonferonni test of probability. The study revealed that 50.3% of the mothers, who participated in the study, had PND. Various risk factors were determined in this study that influences the development of PND. Results include statistical associations between PND and the following: - unplanned babies and unwelcome babies (p=<0,01) - life events (p=0.01) - partner relationship (p=<0.01) - family and social support (p=<0.1) Furthermore, the majority of the participants (53.8%) with PND (n=80) had a history of a psychiatric illness which was shown with significance (p=<0.01), the majority of the participants (63.5%) were unmarried and 23.8% were teenagers who suffered from PND. Recommendations include promoting healthy lifestyles, empowerment of women, prevention of teenage pregnancies, early and holistic assessment for symptoms of PND and approriate referral. In conclusion the prevention and promotive measures, early detection of PND and appropriate referrals and treatment are critical in managing maternal, child and family well being.

AFRIKAANSE OPSOMMING: Geestesgesondheid blyk die stiefkind van gesondheidsdienste te wees, ten spyte daarvan dat navorsing die negatiewe impak wat dit op moeder, baba en die gesin het bevestig. Kennis van postnatale depressie (PDN) en verwante risiko faktore wat die ontwikkeling van PND beïnvloed is van uiterste belang vir die vroeë opsporing en ingryping daarvan. PND affekteer gemiddeld 10%-15% van vroue wêreldwyd wat dit ervaar nadat hulle geboorte geskenk het, ongeag sosio-ekonomiese status, ras of opleiding. Navorsing dui daarop dat die voorkoms van PND so hoog is soos 40%-60% onder vrouens nadat hulle geboorte geskenk het. Die doel van hierdie studie was om die prevalensie van PND en die faktore wat PND beïnvloed in ’n landelike nedersetting in die Witzenberg Subdistrik te ondersoek. Die doelwitte sluit die bepaling van die prevalensie van PND in en die identifisering van die risiko faktore wat daartoe aanleiding gegee het. ’n Beskrywende verkennende navorsingsontwerp met ’n kwantitatiewe benadering is toegepas. Die teikengroep was (N=1605) moeders, 18 jaar en ouer wat geboorte geskenk het in hierdie subdistrik binne een jaar. ’n Gerieflikheidssteekproef metode is gebruik om die deelnemers (n=159/10%) te selekteer wat aan die kriteria voldoen het en vrywillig toestemming gegee het om aan die studie deel te neem. Geldigheid en betroubaarheid is gerugsteun deur die gebruik van geldige vraelyste, naamlik EPDS en BDI wat ’n vraelys insluit wat gebaseer is op demografiese, psigososiale en verloskundige data. Hierbenewens is deskundiges in statistiek, verpleegkunde en psigiatrie geraadpleeg, asook taalkundiges wat die taalkorrektheid van Afrikaans en Xhosa vertaalde vraelyste nagegaan het. ’n Loodsondersoek is uitgevoer om die haalbaarheid van die navorsing te toets en alle data is persoonlik deur die navorser met die hulp van ’n opgeleide veldwerker ingesamel. Etiese goedkeuring is verkry van die Universiteit van Stellenbosch en toestemming van die Departement Gesondheid, die Provinsiale Regering van die Wes-Kaap, asook skriftelike toestemming van elke deelnemer. Die data is ontleed met die bystand van ’n statistikus en is deur frekwensie tabelle aangebied. Die verhouding tussen volgehoue/aaneenlopende respons veranderlikes en nominale inset/invoer veranderlikes is ontleed deur gebruik te maak van die analise van variansie (ANOVA). Verskeie statistiese toetse is toegepas om die statistiese assosiasies tussen veranderlikes vas te stel soos die chi-kwadraat toetse deur ’n 95% betroubaarheidsinterval te gebruik. Nie-parametriese toetse soos die Mann-Whitney U-toets of Kriskal-Wallis toets is gebruik vir ewekansige ontwerp. Levene se toets is gebruik vir homogeniteit van variansie en die Bonferonni toets vir waarskynlikheid. Die toets het bewys dat 50.3% van die moeders wat aan die studie deelgeneem het, het PND. Verskeie risiko faktore is in hierdie studie vasgestel wat die ontwikkeling van PND beïnvloed. Resultate sluit statistiese assosiasie tussen PND en die volgende in: - onbeplande babas en onwelkome babas (p=<0,01) - lewensgebeure (p=0.01) - lewensmaat verhoudings (p=<0.01) - familie en maatskaplike ondersteuning (p=<0.1) Vervolgens het die meeste van die deelnemers (53.8%) met PND (n=80) ’n geskiedenis van ’n psigiatriese siekte met ’n beduidenis (p=<0.01), die meeste van die deelnemers (63.5%) is ongetroud en 23.8% is tieners wat aan PND ly. Aanbevelings sluit die bevordering van gesonde leefstyle, die bemagtiging van vrouens, voorkoming van tienerswangerskappe, vroeë en holistiese assessering van simptome van PND in en die aangewese verwysing. Daar kan tot die slotsom gekom word dat voorkoming- en bevorderingsmaatstawwe, vroeë opsporing van PND en aangewese verwysings en behandeling, krities is in die hantering van moeder-, kind- en gesinswelstand.

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