Factors associated with postpartum depression among adolescents in Uganda

Postpartum depression (PPD) is a common and disabling public health complication of the postpartum period in women. It is believed to occur three times more commonly in developing countries than in the developed world and is more prevalent among women in the first six weeks after birth. Research suggests that postpartum depression is more commonly diagnosed among adolescents and may be a risk factor for poor growth and development in children born to these mothers. Therefore, adolescents are a special age group that requires specific health care maternal interventions in order to detect and treat post-partum depression.


Introduction
The postpartum period is associated with an increased risk for the development of maternal depression. Maternal depression is a common and debilitating mental disorder which has become of significant public health concern, most especially in the least developed countries [1]. These depressive disorders are classified into three categories based on severity and time of onset after child birth [2]. The baby or maternal blues occur in about 40 to 80 percent in mothers during the first postpartum month, and are usually mild, self-limiting and with little consequence to the health of the mother and child [3]. But, if it is not managed appropriately, the mother is at increased risk of suffering from postpartum depression. Postpartum depression has a prevalence of 13

Aim of study:
The aim of the study was to assess the manifestations and risk factors associated with postpartum depression among adolescents in Uganda.

Objectives: The magnitude of PPD in Uganda is under
documented. This explains the motivation of this paper, whose objectives are to assess the risk factors of postpartum depression among adolescents in Uganda.

Methods
In this short communication study, 16 [12]. A study carried out in an urban setting of Uganda which is evidenced by the participants' level of education that was secondary school reported that postpartum depression was significantly associated with young mothers (teenagers), mothers having unplanned pregnancies while they were single parents, congenital abnormalities in the baby, not preferred sex of the child and negative life occurrences before child birth and mother's illness [12]. Another study carried out in Uganda reported that postpartum depression was common among HIV/AIDS infected and affected mothers, unexpected death of a child or spouse, poverty most especially those in the rural setting and violence abuse among partners [13]. A similar study carried out among married adults in rural Uganda noted that polygamous spouses, marital problems, inability of the infant to breast feed, high parity and spouse support provided to the mother following child birth had statistical significant relationship with postpartum depression [14] (Table 1).

Discussion
The increase in teenage pregnancies has been partly attributed to the low level of education with at least three in every 10 of them having no education. 78% of adolescents are currently attending formal education and 22% are school drop outs before secondary level [7]. One in four adolescent girls aged 15-19 have had a child or are pregnant in Uganda but 42% of all adolescent pregnancies are unintended [15]. Unintended pregnancies are associated with adverse health effects like postpartum depression that inflict considerable burden to Ugandan economies. Adolescent mothers undergo a great deal of challenges as young mothers which later impacts their functioning during the postpartum period. These mothers suffer from an increased rate of postpartum depression symptoms [16]. In adolescents, postpartum depression is characterized by feelings of loss and sadness and, sometimes selfesteem is lost [17].
In addition, mothers may manifest with depressed mood, loss of energy, self-guilt, suicidal ideas. These adolescents sometimes have less concentration, are restless and agitated, irritable, anxious, unworthiness feelings, have disturbed sleep, and tearfulness [12].
In case of physical symptoms, these patients may present with chest pain, numbness, headaches and hyperventilation [4]. The factors associated with postpartum depression were found to be related to those in South Asia and SSA [18]. High parity has been implicated as a major contributing factor to PPD [19] found many associated factors although other countries have shown mixed evidence for example in the UAE, it is a protective factor for PPD, while in low-income countries like Nepal and Pakistan, high parity increases family stress and the risk of PPD [20]. This could be attributed to the physical and financial burden. In most Ugandan cultures, there is gender bias in favor of men who are dominating and looked at as future leaders. For pregnant women to be accepted in society, it has been discovered that majority expressed a strong desire to know the fetal sex at ultrasound [21,22].
This desire may be attributed to societal pressure. Studies in other countries like India show that the preference for male children is deeply rooted in Indian society. Thus, women who already have a female child face greater stress because of their wish that their new infant be a boy. In the event that the child is a girl, the risk of depression is greater [23]. Recently, a study by [24] revealed that untreated postpartum depression affects the health of the mother, infant and family. It was estimated that reductions in the prevalence of postpartum depression could lead to a reduction in impaired child growth and development by up to 30 percent. Data from developing countries suggest that maternal depression may be a risk factor for poor growth and development in young children [11]. PPD compromises child health outcomes [25] and has been associated with disturbances in the mother-infant relationship, bonding and in the child's cognitive development. What this study adds  Findings will provide a basis for health workers screening and treating PPD, this in turn will improve maternal infant bond and also promote good health of the mother and child;

Conclusion
 The findings from the study will highlight the manifestations and risk factors associated with PPD that nurses could base on to develop strategies to address it; this will contribute towards prevention of PPD;  The findings will stimulate more research to be done in Uganda and possibly be a basis for informed policy formulation.

Competing interests
The author declare no competing interests.

Authors' contributions
All the authors have read and agreed to the final manuscript. Table   Table 1: Articles used to answer the research objectives of factors associated with postpartum depression in adolescents