Screening for Mental Health Disorders among Pregnant Women Availing Antenatal Care at a Government Maternity Hospital in Bengaluru City

By Johnson, Avita; George, Meera et al. | Indian Journal of Psychological Medicine, July-August 2018 | Go to article overview

Screening for Mental Health Disorders among Pregnant Women Availing Antenatal Care at a Government Maternity Hospital in Bengaluru City


Johnson, Avita, George, Meera, Goud, B., Sulekha, T., Indian Journal of Psychological Medicine


Byline: Avita. Johnson, Meera. George, B. Goud, T. Sulekha

Introduction: Antepartum anxiety and depression are two of the most common risk factors for the development of postpartum depression. Women are at a higher risk of developing depression and suffering from mental disorders during pregnancy and the postnatal period. Psychopathological symptoms during pregnancy have physiological consequences for the fetus, such as impaired blood flow leading to low birth weight, as well as cognitive delay and behavioral problems. Objectives: To screen antenatal women for common mental health disorders and to determine the factors associated with mental health disorders during pregnancy. Methods: A cross-sectional study among 208 pregnant mothers in the third trimester attending the antenatal clinic at a Government Maternity Home in a low-income urban area of Bengaluru was conducted using clinical interview schedule-revised (CIS-R) questionnaire as a screening tool for detecting the presence of mental morbidity. Data collected were analyzed using SPSS version 16. Results: In the study population, 12 (5.8%) screened positive for antepartum mental morbidities, of which depression was the most common. 3.8% of all women screened positive for depression, with 15.4% demonstrating depressive symptoms. Overall, 82 (39.4%) had the presence of one or more psychological symptoms, including fatigue, irritability, anxiety, and problems with sleep and concentration but scored less than the CIS-R cutoff score of 12. Factors associated with the presence of antepartum mental morbidities included poor relationships with their spouse, poor/satisfactory relationship with siblings or in-laws, as well as the desire to have a male child. Conclusion: In the study population, 12 (5.8%) screened positive for antepartum mental morbidities. Considering the effects on quality of life for these women as well as poor fetal outcomes associated with maternal mental morbidity, it is important to include screening and treatment of mental morbidity as a part of routine antenatal care.

Introduction

Pregnancy is a particularly vulnerable time during a woman's life. In addition to common health problems during pregnancy, including gestational diabetes, hypertension, and anemia, mental health issues also pose a large problem. Depression is the leading cause of disability for women worldwide,[1] and pregnancy has been associated with an increased risk of depressive episodes.[2],[3]

Postpartum depression is a relatively well-known phenomenon, but studies have shown that depression is also often present in pregnancy, with as many as 12.7% of pregnant women having an episode of major depression.[4] It has been found that 23% of women with postpartum depression started experiencing symptoms of depression during pregnancy.[5] Having an antenatal anxiety disorder has also been found to be a strong risk factor.[6],[7] Studies on antenatal anxiety have indicated that generalized anxiety disorder is the most common, with a prevalence of about 8.5%-10.5%, followed by panic disorder (1.4%-5.2%) and obsessive-compulsive disorder (1.2%-5.2%).[8],[9],[10],[11],[12] Stressful life events during pregnancy, a lack of social support, and a previous history of depression have been identified as important risk factors for mental morbidities during pregnancy as well. Childcare stresses, pregnancy and obstetric complications, poor relationship with their partner, and lower socioeconomic status have also been identified as moderate-risk factors for depression in pregnancy.[6],[7]

Antepartum mental health issues are of public health concern because of the implications for the health of both the mother and child. Depression during pregnancy has been associated with poor attendance at antenatal clinics, substance abuse, and low birth weight, all of which can lead to neonatal morbidity and mortality.[13],[14] Anxiety disorders are associated with elevated maternal cortisol, which is a predictor of negative neonatal outcomes, impaired cognitive development, and future behavioral problems. …

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