Depressive symptoms and psychosocial risk factors in high complexity obstetric patients admitted to a critical care obstetric unit in Cali, Colombia

Abstract

Depression is the main cause of years lossed due to disability in the world, and it affects 50% more women 50% than men. Perinatal depression has been linked with more anxiety, a chronic course, and disability than depression in other life stages. In spite of its high prevalence and serious health effects on both mother and foetus, it is frequently under-diagnosed. This study was performed on all high risk obstetric patients admitted to a critical care obstetric unit in Cali, Colombia, from January to June, 2014. Depressive symptoms and psychosocial risk factors were screened by means of a survey and the Edinburgh Prenatal Depression Scale (EPDS). A total of 695 women were included, of whom 30.2% had depressive symptoms on the EPDS, and 3.6% reported having self-injury thoughts in the last 7 days. Our findings are consistent with previous reports on a history of child abuse and family depression as risk factors. It was also suggested that lower socio-economic status is associated with more vulnerability. Early screening is needed to ensure timely detection and treatment.

Resumen

La depresión es la principal causa de años perdidos por discapacidad en el mundo, y en mujeres la carga de la enfermedad es un 50% mayor que en varones. La depresión perinatal tiene mayor asociación con ansiedad, cronicidad y discapacidad que en otras etapas de la vida y es poco reconocida a pesar de su alta prevalencia y sus graves efectos en la salud de la madre y el feto. Se realizó un estudio en pacientes ingresadas y valoradas en una unidad de alto riesgo obstétrico en el proceso de implementación del programa durante los meses de enero a junio de 2014; se utilizaron la Edinburgh Prenatal Depression Scale (EPDS) y un cuestionario previamente desarrollado para identificar la presencia de síntomas depresivos y factores de riesgo psicosocial. Se evaluó sistemáticamente a más de 600 mujeres, y se encontró que el 30,2% de las mujeres evaluadas tenían síntomas depresivos según la EPDS y el 3,6% había tenido ideas de autolesión en los últimos 7 días. Los factores relacionados evaluados indican una condición de vulnerabilidad de las mujeres con menor nivel socioeconómico. Los datos encontrados reiteran la importancia de detectar factores que tradicionalmente el personal de salud no identifica ni interviene a lo largo de la vida y particularmente durante la gestación.

Introduction

Depression is the most prevalent mental illness and the leading cause of disability-adjusted life years worldwide.¹ Depression is twice as prevalent among women than men. Prevalence peaks during reproductive age, the clinical course varies greatly, and there is a high risk of recurrence.

Perinatal depression is defined as an episode of major depressive disorder occurring either during pregnancy or within the first 12 months postpartum; it is more closely associated with anxiety, chronicity and disability than depression in other stages of life.2, 3, 4

Prenatal depression in particular, despite its high prevalence and serious effects on the health of the mother and the foetus, is a poorly recognised clinical entity. It increases the risk of both adverse perinatal outcomes and alterations in the development and health of the foetus until adulthood.5, 6, 7, 8, 9, 10, 11, 12, 13 Likewise, depression during pregnancy is the main predictor of postpartum depression and life-long recurrence of depressive episodes in women.14, 15

Prenatal depression is a risk factor for miscarriage, preeclampsia, preterm birth and low birth weight. It is also a risk factor for the child's health, and is associated with delayed psychomotor development, child abuse, depression, attention and behavioural disorders, dissocial disorder and poor academic performance.16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26

In Latin America, the prevalence of depression during pregnancy is estimated to be between 17.4% and 40.1%.27, 28, 29 In Colombia, estimates suggest that 32.8% of pregnant adolescents suffer from depression.³⁰

Studies have identified a series of risk factors for perinatal depression: personal and family history of mental illness, stressful life events in the year before pregnancy, conjugal conflict, domestic violence, single motherhood, social and economic deprivation, low educational level, unemployment, history of abuse during childhood, inadequate social support, young maternal age and loss of or separation from a parent before 16 years of age.27, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39 Some studies have also observed a certain interaction between these risk factors, suggesting that the higher the number of risk factors, the greater the severity of depressive symptoms.⁴⁰

The protective factors so far identified are: higher income, higher educational level, permanent or secure job, partner with a job, and adequate emotional and social support.28, 35

Different scales can be used to detect symptoms of perinatal depression. The Edinburgh Postnatal Depression Scale (EPDS), for example, is a short, self-administered 5–10 min scale designed to improve detection of postpartum depression in rural communities in developing countries, and has also been tested for use in the prenatal period.

The first step in treating perinatal depression and preventing negative outcomes in both the mother and baby is to introduce mechanisms for the early detection of depression or risk factors for depression in pregnant women.