Mothers at risk of postpartum depression in Sri Lanka: A population-based study using a validated screening tool

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Abstract

Background

Postpartum depression is an important public health concern. The prevalence of postpartum depression is estimated to be 18% worldwide. The purpose of this study was to estimate the prevalence of mothers at risk of postpartum depression in Sri Lanka and to investigate its associated risk factors.

Methods

This was a cross-sectional study conducted among 975 mothers in Galle district, Sri Lanka. The prevalence of mothers at risk of postpartum depression was assessed using the Edinburgh Postpartum Depression scale (EPDS) which has been validated for screening for mothers at risk of postpartum depression in Sri Lanka with a cut-off score 9 or more. Prevalence was estimated using a cut-off 9 or more, 10 or more, 11 or more and 12 or more to assess the difference in prevalence using unvalidated cut-offs for screening. Data from routine records on pregnancy, delivery and postnatal care was collected to investigate possible predictors of EPDS score 9 or more (risk of postpartum depression). Univariate and multivariable logistic regressions were performed to identify risk factors for EPDS score 9 or more (risk of postpartum depression).

Results

The prevalence of mothers with EPDS score 9 or more was found to be 9.4% (95%CI: 7.8–11.4); EPDS score 10 or more was 5.6% (95%CI: 4.4–7.3). EPDS score 9 or more (risk of postpartum depression) was associated with the following risk factors: Former history of mental illness (aOR 32.9, 95%CI: 7.9–136.2), high maternal age 30–39 (aOR 2.2, 95%CI: 1.3–3.8), BMI 25.0–29.9 (aOR 2.6, 95%CI: 1.5–4.5), hypertension (aOR 3.6, 95%CI: 1.2–10.9) and newborn death (aOR 28.9, 95%CI: 4.5–185.1). One in five women reported thoughts of self-harm.

Conclusion

Around one in ten mothers in Sri Lanka experience symptoms of postpartum depression, highest risk among mothers who reported former history of mental illness and newborn death. The prevalence estimates were lower with a higher cut-off for screening and this highlights the importance of using the validated cut-off for screening in future studies on postpartum depression in Sri Lanka. Mothers at increased risk should be identified in antenatal care and are important targets of referral.

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Most cited references 34

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Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

J Cox, J. Holden, R Sagovsky (1987)

The development of a 10-item self-report scale (EPDS) to screen for Postnatal Depression in the community is described. After extensive pilot interviews a validation study was carried out on 84 mothers using the Research Diagnostic Criteria for depressive illness obtained from Goldberg's Standardised Psychiatric Interview. The EPDS was found to have satisfactory sensitivity and specificity, and was also sensitive to change in the severity of depression over time. The scale can be completed in about 5 minutes and has a simple method of scoring. The use of the EPDS in the secondary prevention of Postnatal Depression is discussed.

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Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.

Jane Fisher, Meena Cabral de Mello, Vikram Patel … (2012)

To review the evidence about the prevalence and determinants of non-psychotic common perinatal mental disorders (CPMDs) in World Bank categorized low- and lower-middle-income countries. Major databases were searched systematically for English-language publications on the prevalence of non-psychotic CPMDs and on their risk factors and determinants. All study designs were included. Thirteen papers covering 17 low- and lower-middle-income countries provided findings for pregnant women, and 34, for women who had just given birth. Data on disorders in the antenatal period were available for 9 (8%) countries, and on disorders in the postnatal period, for 17 (15%). Weighted mean prevalence was 15.6% (95% confidence interval, CI: 15.4-15.9) antenatally and 19.8% (19.5-20.0) postnatally. Risk factors were: socioeconomic disadvantage (odds ratio [OR] range: 2.1-13.2); unintended pregnancy (1.6-8.8); being younger (2.1-5.4); being unmarried (3.4-5.8); lacking intimate partner empathy and support (2.0-9.4); having hostile in-laws (2.1-4.4); experiencing intimate partner violence (2.11-6.75); having insufficient emotional and practical support (2.8-6.1); in some settings, giving birth to a female (1.8-2.6), and having a history of mental health problems (5.1-5.6). Protective factors were: having more education (relative risk: 0.5; P = 0.03); having a permanent job (OR: 0.64; 95% CI: 0.4-1.0); being of the ethnic majority (OR: 0.2; 95% CI: 0.1-0.8) and having a kind, trustworthy intimate partner (OR: 0.52; 95% CI: 0.3-0.9). CPMDs are more prevalent in low- and lower-middle-income countries, particularly among poorer women with gender-based risks or a psychiatric history.

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Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.

Katherine L Wisner, Dorothy Sit, Mary McShea … (2013)

The period prevalence of depression among women is 21.9% during the first postpartum year; however, questions remain about the value of screening for depression. To screen for depression in postpartum women and evaluate positive screen findings to determine the timing of episode onset, rate and intensity of self-harm ideation, and primary and secondary DSM-IV disorders to inform treatment and policy decisions. Sequential case series of women who recently gave birth. Urban academic women's hospital. During the maternity hospitalization, women were offered screening at 4 to 6 weeks post partum by telephone. Screen-positive women were invited to undergo psychiatric evaluations in their homes. A positive screen finding was an Edinburgh Postnatal Depression Scale (EPDS) score of 10 or higher. Self-harm ideation was assessed on EPDS item 10: "The thought of harming myself has occurred to me" (yes, quite often; sometimes; hardly ever; never). Screen-positive women underwent evaluation with the Structured Clinical Interview for DSM-IV for Axis I primary and secondary diagnoses. Ten thousand mothers underwent screening, with positive findings in 1396 (14.0%); of these, 826 (59.2%) completed the home visits and 147 (10.5%) completed a telephone diagnostic interview. Screen-positive women were more likely to be younger, African American, publicly insured, single, and less well educated. More episodes began post partum (40.1%), followed by during pregnancy (33.4%) and before pregnancy (26.5%). In this population, 19.3% had self-harm ideation. All mothers with the highest intensity of self-harm ideation were identified with the EPDS score of 10 or higher. The most common primary diagnoses were unipolar depressive disorders (68.5%), and almost two-thirds had comorbid anxiety disorders. A striking 22.6% had bipolar disorders. The most common diagnosis in screen-positive women was major depressive disorder with comorbid generalized anxiety disorder. Strategies to differentiate women with bipolar from unipolar disorders are needed. clinicaltrials.gov Identifier: NCT00282776.

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Author and article information

Contributors

Therese Røysted-Solås:

ORCID: https://orcid.org/0000-0002-8254-2510

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: Writing – original draft

Sven Gudmund Hinderaker: Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: SupervisionRole: Writing – review & editing

Lasantha Ubesekara: Role: ConceptualizationRole: Writing – review & editing

Vijitha De Silva: Role: ConceptualizationRole: Data curationRole: MethodologyRole: Project administrationRole: Writing – review & editing

Yeetey Akpe Kwesi Enuameh: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 25 May 2022

Publication date Collection: 2022

Volume: 17

Issue: 5

Electronic Location Identifier: e0268748

Affiliations

[1 ] Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway

[2 ] Ministry of Health, Southern Province, Galle, Sri Lanka

[3 ] Department of Community Medicine, University of Ruhuna, Galle, Sri Lanka

Kwame Nkrumah University of Science and Technology, GHANA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: therese.solas@ 123456student.uib.no

Author information

Therese Røysted-Solås https://orcid.org/0000-0002-8254-2510

Article

Publisher ID: PONE-D-21-20712

DOI: 10.1371/journal.pone.0268748

PMC ID: 9132337

PubMed ID: 35613119

SO-VID: 458f04b1-8c35-428f-b018-a9ebe5823b43

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 24 June 2021

Date accepted : 8 May 2022

Page count

Figures: 0, Tables: 3, Pages: 12

Funding

The authors received no specific funding for this work.

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Data Availability All relevant data are within the paper and its Supporting Information files.

Mothers at risk of postpartum depression in Sri Lanka: A population-based study using a validated screening tool

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Most cited references 34

Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale.

Prevalence and determinants of common perinatal mental disorders in women in low- and lower-middle-income countries: a systematic review.

Onset timing, thoughts of self-harm, and diagnoses in postpartum women with screen-positive depression findings.

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