Psychosocial Predictive and Protective Factors for Depression in Pregnancy and Postpartum Period.

INTRODUCTION: Women’s mental health during pregnancy and postpartum Period is a public health priority due to its impact on both maternal and Child health. Antenatal and postpartum period are characterized by Multiple changes in physical, hormonal, psychic and social milieu Which have a direct effect on their mental health. Consequently this Period is considered as high risk times for the onset of psychiatric Illness or exacerbation of preexisting psychiatric illness.1 The interplay of factors like family type, economic state, Education, marital relationship, social support, culture regulate the Intensity of these mental health alterations in pregnancy and Postpartum period. Pregnancy either induces or worsens(exacerbates) pre-existing Stress. This in turn has a negative impact on pregnancy. Sustained Stress can activate the Hypothalamo-Pituitary axis and further Compromise the maternal and fetal health. Depression is the most prevalent mental disorder in pregnancy And postpartum period2.Although pregnancy is considered a time of Emotional well-being, there have been studies to describe rates of Depression around 20% in developing countries,10-15% in developed Countries. Depression whether in pregnancy or postpartum is Categorized by the same criteria as in DSM-4 TR as for any depressive Episode in the general population. Depression with postpartum onset Is only used as a specifier carrying additional information regarding The onset. It can be due to major depressive disorder or bipolar Disorder. In about one third of depressed pregnant females, current Episode represents the first episode of major depression. While women With previous diagnosis of depression maintained on antidepressant Medication happen to be at an especially increased risk for relapse During pregnancy or postpartum. Frequently, depression during pregnancy can remain undetected. Distinguishing symptoms of depression from normal responses to Stressful experiences of pregnancy can be difficult. Such difficult -to - Distinguish symptoms include insomnia or hypersomnia, significant Decrease or increase in appetite, moderate to severe anxiety, somatic Complaints, low energy, etc. Clinical features confirming the diagnosis Of major depression include anhedonia, feelings of guilt, poor selfesteem, Worthlessness, hopelessness and suicidal thoughts. However, Risk of self –injurious or suicidal behaviour appears to be low in Antenatal depression.6,7 Antenatal depression is a non –psychotic depressive episode Arising anytime during pregnancy. Antenatal depression significantly Contributes to the psychiatric morbidity during pregnancy and adverse Obstetric and neonatal outcomes3,4. It is also identified as a serious risk Factor for postpartum depression. Undiagnosed antenatal depression, In the long term can disrupt maternal-child relationship and family Functioning5.Important reasons for antenatal depression remaining Undiagnosed ,untreated or undertreated are social stigma, Embarrasement to disclose low mood at a period of family rejoice by Women, failure to integrate questions regarding psychiatric symptoms And previous treatment into the obstetric history, incomplete or lack of Definitive treatment due to associated potential risks with fetal Exposure to psychotropic drugs. Postpartum is considered the period of increased physical and Emotional demands and a time of risk for the development of Depressive symptoms. Postpartum depression falls along a continuum Of mood disturbances with milder forms diagnosed as postpartum Blues, severe episodes as postpartum psychosis. The prevalence of Postpartum depression is described as falling between 10% and 15%.8,9 In postpartum depression symptoms persists beyond two weeks ,of Mild to moderate severity and causing functional impairment and Indistinguishable from characteristics of MDD that occur at other times In a woman’s life. Risk factors for postpartum depression are antenatal Depression, anxiety features during pregnancy and history of Depression previously. Depression during this period can impact Negatively on a wide range of outcomes like maternal deaths due to Suicide10, maternal-infant relationship11, child psychological Development12, infant nutrition and growth of the child14. Above all women with postpartum depression are at significant Risk with high rates of recurrence; as high as 50% in future Pregnancies15.Sequelae of untreated mood symptoms can lead to Chronic depression or recurrence with greater severity. However Medical causes for mood disturbances like thyroid dysfunction and Anaemia needs to be excluded prior to initiation of psychiatric Treatment. Hence in these women a thorough history, physical Examination and lab investigations pave way for confirming the Diagnosis of depression in postpartum period. Since the last decade there has been a shift from the narrow Concept of postpartum depression to detailed evaluation of the Spectrum of depressive symptoms arising in pregnancy in women. There are very few studies examining how antenatal depression And postpartum depression vary with respect to the demographic and Psychosocial characteristics. Analysis and comparison of the Correlation factors of depression during and after pregnancy will throw More light than exclusively focusing on postpartum depression. So we Have decided to investigate the psycho-social and demographic factors As to evaluate their predictive and protective effects on depression in Pregnancy and postpartum in a tertiary care obstetric setting