Prevalence of Psychiatric Morbidity in Postnatal Mothers

INTRODUCTION: Pregnancy is most often viewed from physiological perspective view because of the dramatic physical changes that occur from conception through the pregnancy, delivery and during the immediate postpartum period. The primary focus of the pregnancy as viewed by the health care providers, friends and family of the expected parents centered mainly on women’s physical changes and health status ( Elaine Z Welling, 1998). What remains to be highlighted is, pregnancy is clearly one of the most profound psychological event in human life. It is an ultimate psychosomatic experience (Donald Sloan Johnson, 1994). Pregnancy and puerperium are sufficiently stressful to provoke mental illness. Such illness may represent the recurrence or exacerbation of a pre existing psychiatric disorder or it may be the onset of a new disorder. The department of Health and Human services has reported that 1 of every 8 persons will suffer from a depressive disorder and that the rate is almost doubled for women (Depression Guideline Panel, 1993). Unfortunately depression is appropriately treated in fewer than a fourth of affected women. (American College of Obstetrician and Gyanecologists, 1993 a). The under recognition of depression frequently occurs in primary care settings where most medical care is obtained. Similarly, women who suffering from postpartum depression are often not properly identified and treated. AIM OF THE STUDY: To evaluate the prevalence of psychiatric morbidity in postnatal mothers who had been delivered in Maternity Hospital, Egmore, Chennai. OBJECTIVES OF THE STUDY: 1. To study the prevalence of psychiatric morbidity among the postnatal mothers. 2. To study the prevalence of postpartum depression among the postnatal mothers. 3. To study the prevalence of postpartum psychosis among the postnatal mothers. 4. To study the effect of socio demographic variable with psychiatric morbidity in postnatal mothers. 5. To study the effect of General physical and obstetric variable with psychiatric morbidity in postnatal mothers. MATERIALS AND METHODS: The Study has been carried out in Maternity Hospital, Egmore. PERIOD OF STUDY: March 2007 to August 2007 (six months). DESIGN OF STUDY: Descriptive study. SELECTION OF SAMPLE: 500 postnatal mothers who delivered in Maternity Hospital, Egmore. INCLUSION CRITERIA: i. All patients delivered at Egmore Maternity Hospital with Tamil as mother Tongue. ii. Patients who have given written informed consent for study. EXCLUSION CRITERIA : i. Patients with medical complications like a. chronic hypertension, b. diabetes mellitus, c. hypothyroidism, d. epilepsy, e. chronic liver disease, f. bronchial asthma, ii. Patients with severe obstetric complications like a. severe anemia, b. severe PIH, c. AP eclampsia, PP eclampsia, d. GDM complicating pregnancy, e. Heart diseases complicating pregnancy, f. APH & PPH. iii. Patients who are not willing to give consent for study. SUMMARY: The present study is an attempt to find out the incidence of Psychiatric sequalae among the post natal mothers and to study the influence of socio demographic, obstetric, general physical variable with psychiatric morbidity. The sample in this study consisted of 500 postnatal mother out of which 20 patients did not come for followup. Among 480 patients 56 (11.7%) cases had psychiatric morbidity among which 52 (10.8%) had postpartum depression, 4 ( 0.8%) had postpartum psychosis. Among 56 patients with psychiatric morbidity various sociodemographic, obstetric and general physical variables were analysed for statistical significance. Among the socio demographic variables Age, sex of baby, religion, marital status and education status had no significance in influencing psychiatric morbidity. In occupation of spouse unskilled group found to be more affected due to poverty, low socioeconomic status and low literacy. In the Habit of spouse, Husband’s alcoholism and smoking will increase the violence against women, marital conflict and financial burden for delivery and Infant care which will definitely increase the risk. There is increase of morbidity in love marriage and nuclear family system due to lack of parental and social support. Previous psychiatric illness and family H/O alcoholism and mental illness were found to influence the present morbidity. 11 Among the obstetric variables Gravida, mode of delivery, baby condition at birth had no significant influence. There seems to be an increased morbidity in unbooked group due to lack of physical and mental care. In previous obstetric history dead born and preterm delivery has significant influence. Among general physical variable height, weight, mild anemic status, mild PIH had no significant influence. CONCLUSION: In my study I conclude that prevalence of psychiatric morbidity which is significant problem to postnatal mothers it needs proper attention and focus. To reduce and prevent the morbidity, Antenatal mothers with high risk for psychiatric morbidity should be identified at right stage, in an clinic and given proper focus in terms of counseling and education to mother, husband and to the family to alleviate forthcoming stress in her confinement. All postnatal mothers should be routinely screened for psychiatric morbidity with a standardized rating scale which will make possible to diagnose and treat this at the earliest which will bring forth the healthy child and healthy mother to society. Optimally the obstetrician should have an established screening and referral process for new mothers to enhance the detection and treatment of psychiatric morbidity