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Вестник К03НМУ № I - 2020
РАЗДЕЛ 4. ОРГАНИЗАЦИЯ ЗДРАВОХРАНЕНИЯ CHAPTER 4. PUBLIC HEALTH
УДК 618.2/.6:616.895.4-055.2
N. Abdieva1, L. Kosherbaeva2, Z. Sagyndykova2
Asfendiyarov Kazakh National medical university 1doctoral student
2department of Integrated Systems of Economics and Health Management PREVALENCE OF POSTPARTUM DEPRESSIVE DISORDER AMONG WOMEN IN ALMATY
This article contains the results of a survey that includes the Edinburgh Postpartum Depression Scale. A review of the literature showed that on average the prevalence of postpartum depression worldwide is 15-20%. According to the results, the prevalence of postpartum depression in Kazakhstan was revealed, which is significantly higher than the WHO data on the average prevalence of PPD, which indicates the need to pay more attention to the mental state of a woman in the postpartum period.
Keywords: depression, prenatal depression, postpartum depression, puerperal depression, mental health
Introduction: Postnatal depression (PND) is one of the most common causes of maternal distress representing a considerable public health problem affecting the mother, her baby, and her family [1].
Perinatal mental health problems have been studied in more than 90% of high income countries (HICs), whereas information is available only for 10% of low and middle income countries (LMICs) [2]. Studies conducted in HICs indicate a prevalence of 10-15% of perinatal mental disorders [3],[4]. It has been suggested that rates of first onset and severe depression are three times higher in the postnatal period than in other periods of women's lives [5].
The prevalence of PPD is highly variable in non-western countries and its manifestations may vary across cultures [6],[7]. For instance, previous reviews have shown that the prevalence of PND ranged widely from 0 to 60% globally, and from 3.5 to 63.3% in Asian countries [7],[8]. Social circumstance and biophysical stressors were described as factors contributing to PPD in many countries, issues of culture and traditions were more common in Asian women[9].
Symptom recognition, support, and treatment are essential as a lack of care leads to adverse outcomes, including further isolation, helplessness, and hopelessness[10]. Untreated postpartum depression can result in a person feeling a lack of bonding, gratification, or fulfillment in their role as a parent or miss cues for their infant, such as hunger or other needs[11], [12] . For children of parents with untreated depression, there is an increased risk of behavioural problems and delayed language, motor, social, and cognitive development [11], [13] . In the long-term, children can be at higher risk of continued emotional issues or exhibiting aggressive behaviours as adults [11].
The aim of our research work was to study the prevalence of depressive disorder in the postpartum period in Kazakhstan. Method: Postpartum 18 and more years old women of 12 months from the time of delivery themselves were interviewed. The questionnaire consisted of the Edinburgh postpartum depression scale. The survey involved 493 respondents, where 103 (21%) preferred to answer the questionnaire in Kazakh, other 390 (71%) in Russian language. The women were sent a
questionnaire link in two languages (Kazakh and Russian) by their phone numbers to the WhatsApp application and they could answer the questions at home at their convenient time online. They were contacted by prior consent through nurses. The survey results were interpreted as interpreted in the Registered Nurses'Association of Ontario. Assessment and Interventions for Perinatal Depression. 2nd ed. Toronto (ON): Registered Nurses 'Association of Ontario; 2018., where the data source is © 1987 The Royal College of Psychiatrists. Cox, J. L., Holden, J. M., & Sagovsky, R. (1987). Detection of postnatal depression. Development of the 10item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786. All algorithms for working with women in the postpartum period were given, including in the psychological state of women. Results: A total number of respondents were 493 who took part in the survey, 103 of them preferred to answer the questionnaire in Kazakh and the remaining 390 in Russian. Data of our results indicated a rate of 16 per cent (80) of possible depression as measured on the Edinburgh Postnatal Depression Scale (EPDS) (with a total score of 10 - 12). They can be assigned to re-test after 2-4 weeks to assess the degree of improvement or worsening of symptoms. 6.25 per cent (5) of them answered positively to the tenth question of the EPDS "I had a thought about self-harm" answered "Sometimes", they must conduct a full psychiatric examination. 24 per cent (120) of probable depression (with a total score of 13 or greater). They need to conduct a full diagnosis of depression by a doctor in accordance with accepted standards and to determine the severity of the disease. 34 per cent (41) of them responded to the tenth statement positively, who also need to further full examination of specialist. 59.4 per cent (293) of participants scored less than 10 points, indicating a minimal possibility of depressive disorder. But 2.7 per cent (8) of them also gave a positive answer to the tenth question about thoughts of self-harm. According to the results, a 42 per cent (208) prevalence rate of postpartum depressive disorder was found during the first year following childbirth. There were symptoms of a depression with points equal to or higher than 10 points or with a positive answer to the tenth question about thoughts of self-harm.
Table 1 - Results of the Edinburgh postpartum depression scale of all women participated in the questionnaire
Scored Points Number of respondents Also answered positively to question #10 Total Number Percentage of total women interviewed (493)
10-12 75 5 80 16,1%
13 or greater 79 41 120 24,3%
Scored less than 10 but answered positively to question #10 8 8 1,6% (2.7% of those who scored less than 10 points)
Total 208 42%
An interesting fact was that the number of women with symptoms of depression who wished to answer in Kazakh, 30.0% of all women who answered in Kazakh, compared with women
with symptoms of depression, 45.4% of the total number of respondents in Russian, had a difference at 15.4%.
Scored Points Number of respondents Also answered positively to question #10 Total Number Percentage of the total number of women interviewed in Russian (390)
10-12 67 3 70 17,9%
13 or greater 69 32 101 25,9%
Scored less than 10 but answered positively to question #10 6 6 1,5%
Всего 177 45,4%
Table 3 - Results of the Edinburgh postpartum depression scale of women responding in Kazakh language
Scored Points Number of respondents Also answered positively to question #10 Total Number Percentage of the total number of women interviewed in Kazakh (103)
Scored equal to 10 or more but less than 13 points 8 2 10 9,7
Scored equal to 13 or more 10 9 19 18,4
Scored less than 10 but answered positively to question #10 2 2 1,9
Всего 31 30,0%
Screening tool support in obtaining specific clinical information about the person's possible depression symptoms. This, in turn, informs the next steps of assessment and development of the care plan in conjunction with the person. It is important to note that the screening tools listed are never diagnostic in nature. Thus, the results of the study cannot be confirmed by the diagnosis of Depression, but only indicate the possibility of this disorder based on the symptoms of a depressed state from the answers to the Edinburgh postpartum depression scale. The total score reflects the probability of depression, but not the severity. Discussion:
Components of screening tools for perinatal depression vary. Many screening tools incorporate a series of statements
Table 4
reflecting different signs or symptoms of depression and persons are asked to rank their symptoms. For example, the EPDS can be used to determine increased risk for depression and uses a self-rated listing of symptoms including feelings of guilt, hopelessness, sadness, lack of concentration, irritability, loss of interest in usual activities, thoughts of self-harm or suicide, as well as physical symptoms such as fatigue and changes in appetite [14]. A synthesis of evidence on postpartum depression that included a value analysis found the use of the EPDS as beneficial resulting in improved mental health in comparison to standard care, although all of the studies did not demonstrate statistical significance [15].
SCREENING TOOL SCREENING TOOL DESCRIPTION SPECIFIC TO PERINATAL DEPRESSION?
Edinburgh Postnatal Depression Scale (EPDS) (Cox, Holden, & Sagovsky, 1987) - Widely recommended as a first stage screening instrument. - The most commonly used instrument for perinatal depression screening. - A 10-item scale asking persons to rate emotional depressive symptoms over past seven days. - Has been validated for use with both pregnant and postpartum persons up to one year following childbirth. - The total score reflects the probability of depression, but not the severity. - A total score of 9 - 10 has a positive predictive value (PPV) (i.e., the proportion of positive and negative results in statistics that are true positive and true negative results) of 9 - 64 per cent for major depression; a total score of 12 - 13 has a PPV of 17 -100 per cent (SIGN, 2012, p. 13). - Available publicly at no cost. - Written for a grade three level of education. - Tested among various cultures to determine cutoff scores and associated sensitivity and specificity levels. - Translated into many languages. - ncludes three items—(i.e., blame self unnecessarily, been anxious or worried for no good reason, and felt scared or panicky for no very good reason)—that have been validated as a subscale for anxiety (Birmingham et al., 2011). These same three items are found to perform as well as the full screen, with - YES - Can be used to screen both prenatal and postpartum depression
Вестник К03НМУ № I - 2020
100 per cent sensitivity as a modified and condensed screen based on findings of a cross-sectional study
JM_
Table 4 from Registered Nurses'Association of Ontario. Assessment and Interventions for Perinatal Depression. 2nd ed. Toronto (ON): Registered Nurses 'Association of Ontario; 2018. Analyzing previous scientific work on postpartum depression, we chose Edinburgh postpartum depression scale and Beck
Depression Inventory for determining depressive disorder among postpartum women.
Conclusions: Our results indicate numbers higher than the average WHO data, which suggests the need for more careful monitoring of women in the postpartum period.
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Н.К. Эбдиева, Л.К. Кошербаева, З.Р. Сагиндыкова
АЛМАТЫДАFЫ ЭЙЕЛДЕР APACbIHAAFbl БОСАЖАННАН КЕЙ1НП ДЕПРЕССИВТ1 ЖAF ДАЙДЫН, ТАРАЛУ К0РСЕТКШ1
tywh: Бул ма;алада Эдинбургты; босанганнан кешнп депрессия шкаласы бар сауалнаманыц нэтижей бершген. Эдебиетке шолу бугал элемде босанганнан кешнп депрессияныц таралуы орташа есеппен 15-20% курайтынын керсетп. Нэтижелерге сэйкес, Каза;станда босанганнан кешнп депрессияныц таралуы аны;талды, бул керсетгаш босанганнан кешнп дерессияныц таралуыныц Б¥¥-ныц
орта есеппен алынган мэлiметiне ;араганда элде;айда жогары екешн керсетп, ал бул босанганнан кешнп кезецде эйелдердщ психикалы; жагдайына кебiрек кещл белу ;ажетттпн керсетедъ
ТYЙiндi сездер: депрессия, босанганга дешнп депрессия, эйелдердщ психикалы; денсаулыгы.
Н.К. Абдиева, Л.К. Кошербаева, З.Р. Сагиндыкова
РАСПРОСТРАНЕННОСТЬ ПОСЛЕРОДОВОГО ДЕПРЕССИВНОГО СОСТОЯНИЯ СРЕДИ ЖЕНЩИН ГОРОДА АЛМАТЫ
Резюме: Эта статья содержит результаты опроса, который включает в себя Эдинбургскую шкалу послеродовой депрессии. Обзор литературы показал, что в среднем распространенность послеродовой депрессии во всем мире составляет 15-20%. Согласно результатам, была выявлена распространенность послеродовой депрессии в Казахстане, которая значительно выше данных ВОЗ
среднестатистическойй распространенности ПРД, что указывает на необходимость уделять больше внимания психическому состоянию женщины в послеродовом периоде.
Ключевые слова: депрессия, пренатальная депрессия, послеродовая депрессия, психическое здоровье женщин.
