Postnatal Depression Among Women In Mosul City ةبآكام

Background: Women around the world experience many physical and mental changes during pregnancy and even few months after birth. Postnatal depression (PND) is an example of these changes.PND is defined as nonpsychotic and an affective mood disorder affected woman after birth and may continue for months.Several researches in Arabic countries reported that the incidence of PPD among Arabic Muslim women ranges from 10% to 37%. Aims of the study: The aim of the present study was toassess the postnatal depression among women in Mosul city and to investigate the impact of age, parity, and infant gender factors. Material and method:A descriptive study was adopted as a quantitative approach for the present study. A sheet of demographical data was structured to use with Edinburgh Postnatal Depression Scale (EPDS) as a tool of the research to collect data.Each question has four choices scored (0-3). Seventy postnatal women were the study sample. The study conducted in AL-Khansa’a Teaching Hospital and AL-BatoolTeaching Hospital in Mosul city from 1 December 2012 to 1 April 2013. A standard statistical package for social sciences (SPSS version 18) was used for data analysis. Results:The present study found that 50% of the total sample were aged between(26-35) years,75.7 % of participants were unemployed, 58.5% of them were primiparous women. The criteria of selecting infant gender were 50% for male and 50% for female. The present study shows that women’s educational levels were48.5% primary school and 5.7% of respondents have history with some types of psychiatric problems, 61.4% of them have no history of abortion and 22.9% have history of preterm delivery.The results find in totally that around 65.7% of participants have scored between (0-12) depending on EPDS and 22.9 % of 41.4% of mothers aged between (16-25) years have scored (13-30). The results also find that 21.4% of 30% of the participants were primiparous women with symptoms of postnatal depression. Finally, 18.6% of 24.3% were the mothers who have delivered female, and they have symptoms of PND. Conclusion: The study concludes that there is an obvious relationship between the occurs of PND and women’s age, child parity, and infant gender although the most participants mothers indicate no symptoms or on the borderline of symptoms of PND depending of EPDS.


Abstract
Background: Women around the world experience many physical and mental changes during pregnancy and even few months after birth.Postnatal depression (PND) is an example of these changes.PND is defined as nonpsychotic and an affective mood disorder affected woman after birth and may continue for months.Several researches in Arabic countries reported that the incidence of PPD among Arabic Muslim women ranges from 10% to 37%.

Aims of the study:
The aim of the present study was toassess the postnatal depression among women in Mosul city and to investigate the impact of age, parity, and infant gender factors.Material and method:A descriptive study was adopted as a quantitative approach for the present study.A sheet of demographical data was structured to use with Edinburgh Postnatal Depression Scale (EPDS) as a tool of the research to collect data.Each question has four choices scored (0-3).Seventy postnatal women were the study sample.The study conducted in AL-Khansa'a Teaching Hospital and AL-BatoolTeaching Hospital in Mosul city from 1 st December 2012 to 1 st April 2013.A standard statistical package for social sciences (SPSS version 18) was used for data analysis.Results:The present study found that 50% of the total sample were aged between(26-35) years,75.7 % of participants were unemployed, 58.5% of them were primiparous women.The criteria of selecting infant gender were 50% for male and 50% for female.The present study shows that women's educational levels were48.5% primary school and 5.7% of respondents have history with some types of psychiatric problems, 61.4% of them have no history of abortion and 22.9% have history of preterm delivery.The results find in totally that around 65.7% of participants have scored between (0-12) depending on EPDS and 22.9 % of 41.4% of mothers aged between (16-25) years have scored (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30).The results also find that 21.4% of 30% of the participants were primiparous women with symptoms of postnatal depression.Finally, 18.6% of 24.3% were the mothers who have delivered female, and they have symptoms of PND.

Conclusion:
The study concludes that there is an obvious relationship between the occurs of PND and women's age, child parity, and infant gender although the most participants mothers indicate no symptoms or on the borderline of symptoms of PND depending of EPDS.

Recommendations:
The study recommends that mothers care and welfare centres should educate pregnant women during their visits about the mentally and physically changes that exist during pregnancy and after birth.In addition, provide social group therapy or social support to mothers during the first few days or months of postpartum to prevent PND.Keywords: postnatal, depression, women, EPDS.

INTRODUCTION:
Postnatal depression (PND) is a clinical mental complication and most common psychological disturbance that occur in the first to several months after baby birth.Pope et al. (2000) presented that the incidence of postnatal depression in most western is similar nonwestern cultures.But due to the stigma of mental problems may be under-reported in some cultures.Hormonal changes after childbirth and a combination of social and psychological factors may cause PND (CKS, 2010).There are many reasons that may lead mothers to suffer from PND.For instance, past history of depression or mental illness,family history of mental illness, prenatal depression, no supportive partner and family, unhealthy baby, and premature birth.(Mind, 2008;NICE, 2007;RCP, 2007).The symptoms of PND are different woman to another.Woman with PND may feel less ability to enjoy, blame herself, sad and miserable most of the time, lacking in motivation unable to cope, irritable, anxious, crying, difficulty concentrating or remembering things, no appetite difficulty making decisions, insomnia, low energy, low sex drive, sudden panic attacks that cause a rapid heartbeat, sweating, sickness or fainting, and thoughts about harming their child and suicidal ideation in severe cases of PND (CKS, 2010;Baby Centre, 2013;MIND, 2008;LindaandChaudron, 2003).RCP (2007) indicated that one in ten mothers experience postnatal depression.In addition, several researches in Arabic countries reported that the incidence of PPD among Arabic Muslim women ranges from 10% to 37% (Green et al., 2006;Chaayaet al., 2002).Therefore, the aim of the present study was toassess the postnatal depression among women in Mosul city and to investigate the impact of age, parity, and infant fender factors.

MATERIAL AND METHOD:
A descriptive study was adopted as a quantitative approach for the present study.A sheet of demographical data was structured to use with Edinburgh Postnatal Depression Scale (EPDS) as a tool of the research to collect data.EPDS contains ten questionsand it is easy to administer and has proven to be an effective screening tool.Each question has four choices scored (0-3).Mothers who scored thirteento thirty are likely to be suffering from a depressive illness of varying severity.Translated copy of the EPDS was available from Cox and Holden (2003).To eliminate the ethical issue, the study sample utilized a systematic random selection, with a target number of seventywomen who asked to sign a consent form as a part of their acceptance.The study conducted in AL-Khansa'a Hospital and AL-Batool Hospital in Mosul city from 1 st December 2012 to 1 st April 2013.A standard statistical package for social sciences (SPSS version 18) was used for data analysis.Table (1) presents the frequencies and percentages of participants' demographical data.It shows that 50% of the total sample of the study were aged between (26-35) years.58.5% of them were primiparous women with infant gender were 50% for male and 50% for female.The findings of women's educational levels were the highest percentage in 48.5% primary school.The results also show that 75.7 % of participants were unemployed, 5.7% have history with some types of psychiatric problems.For more, 61.4% of participants have no history of abortion and 22.9% have history of preterm delivery.The results find in totally that around 65.7% of participants have scored between (0-12) depending on EPDS which means that in general the most of participants women have no symptoms or on the borderline of symptoms of PND.

DISCUSSION:
The results presents in Table (1) that 50% of the total sample of the study aged between (26-35) years.58.5% of them were primiparous women.The criteria of selecting infant gender were 50% for male and 50% for female.The findings of women's educational levels were 4.2 % illiterate, 48.5% primary school, 31.5% secondary school, and 15.8% were college or higher educated.The results also show that 75.7 % of participants were unemployed, 5.7% have history with some types of psychiatric problems.For more, 61.4% of participants have no history of abortion and 22.9% have history of preterm delivery.The results find in totally that around 65.7% of participants have scored between (0-12) depending on EPDSwhich means that in general the most of participants women have no symptoms or on the borderline of symptoms of PND.Previous study resulted that the highest level of PND was among mothers aged < 20 years as table (2) demonstrates the relationship between the participants' age and PND (Governor et al., 2008).It presents that 22.9 % of 41.4% of mothers aged between (16-25) years have scored (13-30) that mean they have such symptoms of PND.In addition, table (3) shows the relationship between the PND and parity of children.21.4% of 30% of the participants were primiparous women with symptoms of postnatal depression.As Ibo Barbacsy (2011) indicated that high levels mental illnesses relate to primiparous women at six and twelve weeks after their delivering and Yehia and Mansour(2013) have reported that there was a prevalence of 27% in Jordanian primiparous women experienced some types of PND.Finally, table (4) reports the relationship between the gender of the infant and PND.It indicates that 18.6% of 24.3% were the mothers who have delivered female, and they have symptoms of PND.In the Arab countries and due to their cultures the women who have deliver daughters are receive less social and emotional support in particular if they have no male.Therefore, these women are more likely to be at risk for PND (Yehiaand Mansour, 2013;Al-Modallalet al., 2010).

CONCLUSION:
The study concludes that there is an obvious relationship between the occurs of PND and women's age, child parity, and infant gender although the most participants mothers indicate no symptoms or on the borderline of symptoms of PND depending of EPDS.Finally, the mothers who scored between thirteen to thirty in EPDS should be submitted to clinical assessment to confirm the diagnosis because this scale is not considered as a clinical judgment (Wisner et al., 2002).

RECOMMENDATIONS:
The study recommends that mothers care and welfare centres should educate pregnant women during their visits about the mentally and physically changes that exist during pregnancy and after birth.In addition, provide social group therapy or social support to mothers during the first few days or months of postpartum to prevent PND.

Table ( 3
) shows the relationship between the PND and parity of children.It found that 21.4% of 30% of the participants were primiparous women with symptoms of postnatal depression.