Postpartum depression and its association with social support: a cross sectional study at a maternity hospital in Kerala

Abstract

Background: Childbirth is associated with significant physiological changes as well as challenges related to psychiatric disorders. Postpartum depression (PPD) is one such condition associated with high levels of morbidity and mortality. Screening postpartum women for early identification of depression and its prompt treatment should be a crucial component of postnatal health care. Assessment of prevalence and correlates of postpartum depression hence becomes important. Methods: Cross-sectional assessment of mothers (n=250) during postnatal visits to the family planning clinics between four weeks and one year of delivery, using Edinburg Postpartum Depression Scale (EPDS), Social Support Questionnaire and a structured questionnaire for the assessment of psychosocial risk factors was carried out in a tertiary care postgraduate teaching hospital of north Kerala. Multivariate Regression Analysis was used to identify the risk factors for PPD. Results: 27.6% had postpartum depression (score of >11 in EPDS), and 18.4% had suicidal ideation. Factors associated with the presence of PPD included alcohol use of husband, marital discord, lack of family support and lack of physical help during the postnatal period. Difficulties during labour, the gender of the baby or postnatal complications did not have a significant association with PPD. Though there was a negative correlation between Social Support Scale (SSS) total score and EPDS score, it was not statistically significant. (Pearson's co-relation coefficient=-0.084, p= 0.186). Conclusion: Prevalence of depression in postnatal women is very high. Modifiable psychosocial factors have a close association with PPD, and these are opportunities for intervention as well. Considering the morbidity and mortality linked to untreated PPD, screening of postnatal women and routine provision of therapeutic services to them is suggested.