Received 13 August 2015; accepted 18 September 2015; published 21 September 2015

ABSTRACT

Introduction: Postpartum Depression is one of the commonest complications of the postpartum period. In Cameroon, little is known about this condition. Our objective was to determine the prevalence and identify the risk factors for postpartum depression. Methodology: The study was carried out at the Yaoundé Gyneco-Obstetric and Pediatric Hospital, from November 4th 2013 to April 4th 2014. All the women between the 4th and 6th week after birth who gave their consent were included. A pretested questionnaire including demographic, psychosocial, maternal and infant variables as well as the Edinburgh Postnatal Depression Scale (EPDS) was filled. A woman with an EPDS score ≥12 was considered having postpartum depression, while a score < 12 ruled out a postpartum depression. Results: We recruited 214 women, among whom 50 had an EPDS score ≥ 12, giving a prevalence of 23.4% of postpartum depression. After multivariate analysis, the risk factors of postpartum depression were: lack of satisfaction in the marital relationship, recent financial problems, recent conflicts with the partner, baby blues, difficulties in feeding the baby and problems with the baby’s sleep. Conclusion: Postpartum depression is common and associated to specific risk factors in our setting.

Keywords:

Postpartum Depression, Prevalence, Risk Factors, Cameroon

1. Introduction

Becoming a mother is associated with emotional distress in about 30% of women [1] -[2] . The postpartum period is of particular vulnerability for decompensations or the outbreak of some psychiatric disorders [3] . Postpartum depression (PPD) is one of the most common complications in women in the postpartum period [4] . Its prevalence is estimated between 10% and 20%, with an average prevalence of 13% [5] . This figure depends on the geographic location and the socio-economic conditions. In sub-Saharan Africa, studies have reported a prevalence of 6.6% in Uganda, 14.6% in Nigeria, 34.7% in South Africa, and up to 50.8% in the Democratic Republic of Congo [6] - [9] .

The diagnosis is difficult because of the variability in clinical presentation. In addition, some health professionals do not have the required competence for diagnosis. Therefore, postpartum depression is often confused with baby blues or postpartum psychosis.

The causes are not well known. Some authors have identified several disposing factors to the disease. The most encountered are: a personal history of depression or other psychiatric condition, family history of psychiatric disorder, anxiety and depression during pregnancy, the baby blues, the stress due to the infant, to binding life events, to marital relationship or insufficient social support [10] [11] .

The occurrence of postpartum depression can have serious consequences, not only on the mother but also on the mother-infant dyad and indirectly hinder the psycho affective development of the child; hence the importance of early detection. The Edinburgh Postnatal Depression Scale (EPDS) [12] is an internationally recognized tool used for the screening of PPD. This self-administered questionnaire is simple and quick to use. Its acceptability by patients themselves makes it a tool of choice. It consists of 10 multiple choice items rated each on a scale of 0 - 3, giving a total score ranging from 0 to 30 [13] .

To the best of our knowledge, there are very few available studies on postpartum depression in Cameroon. Thus, the present study was conducted with the general objective to determine its prevalence and identify the risk factors in our environment.

2. Methodology

It was an analytical case-control study, carried out at the Yaoundé Gyneco-Obstetrics and Pediatric Hospital and (YGOPH), which is a referral hospital dedicated to the mother and child health. The study period covered 5 months; from November 4th 2013 to April 4th 2014. All women who presented at the postpartum consultation, vaccination or routine pediatric consultation with a child aged 4 to 6 weeks were included. The recruited women had given birth to a live or dead baby at a term ≥ 28 weeks. They should not be under treatment for a given psychiatric disorder. The sampling was consecutive and based on a calculated minimum sample size of 48 women per group.

Data was collected using a pretested questionnaire with two sections. The first section included sociodemographic characteristics, the relationship with the partner (satisfaction and recent conflicts within the last 3 month), social support from the father of the child, family and friends, stressful life events in the 3 months preceding the birth, personal and family history of psychiatric disorders, obstetric history (parity, history of complications during pregnancy or during delivery or postpartum complications), the experience of the conception, pregnancy and childbirth and the relationship with the newborn. These factors were assessed by yes or no type questions. The second part consisting of the Edimburg Postpartum Depression Scale (EPDS) proposed by Cox et al. in 1987, and better used between the 4th and 6th week postpartum [12] .

Before inclusion, women received oral and written information about the study. The coded questionnaire was filled by the patient after reading and signing the consent form. For those who could not read nor write; the questionnaire was administered by a female member of the research team. A woman with an EPDS score ≥ 12 was considered having postpartum depression, while a score < 12 ruled out a postpartum depression. All the women with a score ≥ 12 were referred to a psychiatric center for a specialized care.

Data were analyzed using Chi-square and Fisher’s exact test. Risk factors were identified by calculating the odds ratio (OR) with a 95% confidence interval (CI). P-values less than 0.05 indicate statistical significance. We then made several logistic regressions to eliminate confounding factors.

This study was approved by the Institutional Ethics Committee of Research for Human Health of the Yaounde Gyneco-Obstetrics and Pediatric Hospital.

3. Results

Two hundreds and fourteen women were included. The ages ranged from 15 years to 45 years with a mean age of 28.15 ± 5.22 years.

3.1. Prevalence

The mean score on the Edinburgh Postnatal Depression Scale was 7.44 ± 5.65, with scores ranging from 0 to 26. Fifty women had a score ≥ 12 and were considered having postpartum depression, giving a prevalence of 23.4%.

3.2. Associated Risk Factors

3.2.1. Sociodemographic Characteristics

No socio-demographic variable was found to be a risk factor for postpartum depression, as shown in Table 1.

3.2.2. Psychosocial Factors

The psychosocial factors found to be risk factors associated with postpartum depression were: lack of satisfaction in the marital relationship (for married or cohabiting women), recent conflicts with the partner, recent financial problems and loss of employment (Table 2).

The lack of the father’s of the child support was the basis of many risk factors identified at univariate analysis: inadequate emotional or financial support, inability to rely or confide on him. The absence of family emotional support was also a risk factor resulting from analysis (Table 3). In the past history, abortion was significantly associated to postpartum depression (Table 4).

3.2.3. Obstetric Factors

The conditions in relationship with the last pregnancy associated with postpartum depression were: an unplanned pregnancy, an unwanted pregnancy, depressive symptoms during pregnancy and anxiety during pregnancy (Table 5 and Table 6).

3.2.4. Neonatal and Postnatal Factors

As shown in Table 7, having difficulties in feeding the baby and having trouble with his sleep were significantly associated with postpartum depression. At the same time, women who thought they had the baby blues were more likely to experience postpartum depression.

3.2.5. Factors Associated with Postpartum Depression after Logistic Regression

After logistic regression, lack of marital satisfaction, recent conflicts either with partner or child’s father, recent financial problems, baby blues, having difficulty feeding the baby and having trouble with the baby’s sleep remained significant factors associated with postpartum depression.

4. Discussion

4.1. Prevalence of Postpartum Depression

The prevalence of postpartum depression in our study was 23.4%. This figure is similar to the 23% of prevalence found in Nigeria by Owoeye et al. [14] . This can be explained by the fact that postpartum depression was

detected by the same tool in a similar setting: Edinburg Postpartum Depression Scale with a threshold score at 12 in women at 6 weeks postpartum in a referral hospital. However; this prevalence is higher than the average prevalence of 13% described by O’Hara and Swain in the Western [5] or the18.4% figure of Sawyer et al. in Africa [15] . At the same time, higher figures have been witnessed in some African countries: 43% in Uganda [1] and 50.8% in the Democratic Republic of Congo [9] . In these two studies, Edinburg Postpartum Scale was not the tool used to identify women with postpartum depression.

4.2. Risk Factors Associated with Postpartum Depression

At multivariate analysis, identified risk factors for postpartum depression were: lack of satisfaction in the marital relationship, recent conflicts with the partner, recent financial problems, difficulties in feeding the baby, problems with the baby’s sleep and baby blues.

The lack of satisfaction in the marital relationship is a well documented risk factor for postpartum depression. Authors from Africa, Asia and Europe have stated a significant association this factor and postpartum depression [16] - [19] . At the contrary, an Iranian study failed to reach a similar conclusion [20] .

As far as pregnancy and childbirth are concerned, the marital partner plays a major role. Therefore, a conflict with the partner is an obvious risk factor for postpartum depression. This has already been objected by Husain et al. in Pakistan [21] .

Recent financial problems are independent risk factors found in our study. This has been published as risk factor for postpartum depression by Amr et al. in Saudi Arabia [17] . The same authors also identified loss of employment as a risk factor.

Difficulty in feeding the baby is a stressful condition for the mother and significantly leads to postpartum depression, according to our findings. For Kakyo et al. in Uganda [1] , high levels of postpartum depression are significantly associated with having a child which is not feeding well. This association can be explained by the stress due the fear of malnourishment for the baby.

As well as difficulties in feeding the baby, problems with the baby’s sleep have been were found to be a risk factor for postpartum depression in our study. This can be understood by the fact that any disturbance of the baby sleep’s lead to the absence of sleeping for the mother, which is a stressful condition.

Signs of baby blues described by the mother after birth were independently associated with postpartum depression. Many studies have documented the same finding. For example, Lee et al. have stated baby blues as a risk factor for postpartum depression in China [22] .

Our results should be considered with some limitations, as women might not give the correct answers to the questions. In addition, the Edinburg Postpartum Depression Scale is a screening tool that shows depressive symptoms in the last 7 days, not an instrument for generating a diagnosis of depression. All women with a score ≥ 12 were oriented to a psychiatrist, but only few of them met him. All these might have introduced bias in this study.

5. Conclusion

This study stated the prevalence of postpartum depression in our setting at 23.4%. Independent risk factors associated with postpartum depression are: lack of satisfaction in the marital relationship, recent conflicts with the partner/father of the child, recent financial problems, baby blues, difficulties in feeding the baby and problems with the baby’s sleeping. The routine screening and management of postpartum depression in primary health care are recommended, so as to improve maternal and child wellbeing.

Cite this paper

Nadège DjodaAdama,PascalFoumane,Jean Pierre KamgaOlen,Julius SamaDohbit,Esther Ngo UmMeka,EmileMboudou, (2015) Prevalence and Risk Factors of Postpartum Depression in Yaounde, Cameroon. Open Journal of Obstetrics and Gynecology,05,608-617. doi: 10.4236/ojog.2015.511086

References

NOTES

^*Corresponding author.