Screening for postpartum depression at Rahima Moosa mother and child hospital

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the Degree of Master of Medicine in Obstetrics and Gynaecology Johannesburg 2016Background Postpartum depression is the most common psychopathology encountered in the period following childbirth. In addition to increasing the risk of maternal suicide and infanticide, it is associated with significant morbidity, adversely affecting the patient, infant and family. Despite postpartum depression being an important public health issue it remains poorly recognised and underdiagnosed. The current South African context in which obstetric care is delivered to patients focuses predominantly on physical health. No screening policy for postpartum depression is currently recommended in South Africa. The aim of this study was to determine the proportion of patients at risk of postpartum depression by screening mothers at six weeks postnatally using the Edinburgh postnatal depression scale. Methods Patients delivered by vaginal delivery and caesaerean section at Rahima Moosa Mother and Child Hospital were randomly selected from delivery records for recruitment to the study. A baseline sociodemographic, medical and obstetric questionnaire was completed at the enrolment visit in all patients that consented to participate. Participants were then contacted telephonically six weeks later. The Edinburgh postnatal depression scale was sent via text message to patients and they were allowed time to respond at their convenience. Participants were contacted to retrieve their responses and formulate scores. Screen positive patients were identified by a score of thirteen or greater on the Edinburgh postnatal depression scale or a positive response to thoughts of self or infant harm and were offered referral to the department of psychiatry. Results A total of 178 patients were screened for postpartum depression using the Edinburgh postnatal depression scale. The main outcome measured was the proportion of screen positive participants who exceeded the threshold score on the Edinburgh postnatal depression scale or responded positively to thoughts of deliberate self or infant harm. Forty-eight participants screened positive resulting in 27.0% of the study population being at risk of postpartum depression. Sociodemographic, medical and obstetric variables were analysed in screen positive compared to screen negative participants to establish possible correlations between these variables and outcome. None of the variables proved to be significantly associated with being screen positive for postpartum depression. Conclusion The results of this study when compared to the prevalence findings of local and international studies suggest that postpartum depressive symptomology is common in urban South Africa. Since this study did not establish a statistically significant relationship between possible predisposing factors and the risk of postpartum depression, no specific variables have been implicated in predicting postpartum depression in our study population. These findings support the need for universal screening for postpartum depression in South Africa. Further research to investigate risk factors for postpartum depression in a South African setting is recommended.MT201