Date of Award
August 2024
Degree Type
Dissertation
Degree Name
Doctor of Philosophy
Department
Public Health
First Advisor
Paul Florsheim
Second Advisor
Emmanuel Ngui
Committee Members
Lance Weinhardt, Angela L Ofori-Atta, Kaboni W Gondwe
Keywords
Depression literacy, Maternal and child health, Perinatal depression, Postpartum depression, Prenatal depression, Social support
Abstract
Depression is a public health problem because it is one of the leading causes of disability among women worldwide. It has been found to be more common among women than men and has a higher prevalence in women of childbearing age. Depression affects up to 15% of women in high-income countries (HIC) and 20%–40% of women in low-income countries. Pregnancy and childbirth can increase the risk of depression. Depression during the perinatal period does not affect just the woman but her children and family too. Perinatal depression is associated with elevated risk of infant malnutrition, reduced or low maternal attachment to infants, increased rates of physical illness and additional depressive episodes. Perinatal depression commonly clinically presents as depressed mood, significant weight gain or weight loss, feelings of worthlessness, reduced self-esteem and self-confidence, sleep disturbances (insomnia or hyper-insomnia), lack of concentration, loss of energy, diminished pleasure in undergoing previously enjoyable activities, and suicidal ideation. The clinical symptoms of perinatal depression among women are similar to women who have depression unrelated to pregnancy or childbirth. Even though the symptoms of perinatal depression do not differ from that of women in the general population, the postnatal period is more likely to increase the risk of depression and hence contribute to the notion that perinatal depression is a sub-type of general depression. Depression after childbirth has been well documented and studied especially in developed countries, while prenatal depression has been less widely researched partly because of the misconception that women are hormonally protected from psychological disturbances during pregnancy. Women are also more reluctant to share their experiences with others due to the stigma associated with depression and the general expectation that pregnancy and childbirth are happy periods. Additionally, during this time, there is more emphasis placed on physical health than on mental health, and emotional complaints are mostly attributed to physical and hormonal changes that occur during pregnancy. It is sometimes difficult to distinguish between typical pregnancy symptoms (loss of appetite, energy, fatigue, sleep changes) that are common during pregnancy and symptoms that are related to depression. Perinatal depression is known to be under-detected and under-treated. Many women do not seek help for symptoms, do not know or cannot recognize the symptoms, or have limited access to resources. The goals of this research were to examine the effect of perinatal depression on 1) adverse birth outcomes (low birth weight and preterm birth); 2) maternal complications (labor complications and postnatal complications); 3) maternal morbidity (gestational diabetes, preeclampsia/hypertension); and 4) maternal and infant attachment. It also explored the knowledge, attitudes and perceptions (KAPS) of perinatal depression among women in a clinical setting in Accra, Ghana. This study was conducted in the Korle-Bu Teaching Hospital (KBTH) located in the capital city of Ghana, Accra. It was a longitudinal study with the data collected at 2 time points – during pregnancy and after birth (6 weeks postpartum). Descriptive statistics, Logistic and Linear regression analysis was used to determine factors associated with antenatal and postnatal depressive symptoms. A total of 238 participants were included in the study during the prenatal assessment, and 189 participants were included in the postnatal assessment. At the prenatal assessment, 24.8% of participants reported mild depressive symptoms (>4), while at the postnatal assessment, 32.4% reported mild depressive symptoms (>4). Several factors were found to be associated with mild perinatal depressive symptoms, including maternal age, multiparity, postnatal complications, postnatal social support, ethnicity (specifically Ewe, an ethnic group predominantly located in the Volta Region of Ghana), and postnatal attachment. Prenatal depressive symptoms were not associated with prenatal attachment or preterm birth. However, there was an association between prenatal depressive symptoms and social support and depression literacy. Mothers who experienced prenatal depressive symptoms had higher odds of postnatal complications and were more likely to experience postnatal depressive symptoms. The results also indicated a significant positive association between gestational diabetes and postnatal depression. Additionally, postnatal attachment was found to be associated with postnatal depression. Although this study found low rates of severe depressive symptoms among women at a tertiary hospital in Accra, the findings that about one-quarter of prenatal patients and about one-third of postnatal patients reported some depressive symptoms highlight the need for assessment and prevention for all pregnant women. Factors associated with perinatal depressive symptoms in Ghana included maternal age, multiparity, postnatal complications, social support, and depression literacy. It is important to enhance social support and mental health literacy to mitigate depressive symptoms and promote perinatal attachment. While this study did not find a direct association between prenatal depressive symptoms and preterm birth, previous pregnancy experiences and social support do play significant roles. Therefore, comprehensive support systems and education are crucial in reducing adverse birth outcomes in Ghana.
Recommended Citation
Hesse, Naa Dede, "PERINATAL DEPRESSION IN A TERTIARY HOSPITAL IN ACCRA, GHANA – CONSEQUENCES ON MATERNAL AND CHILD HEALTH" (2024). Theses and Dissertations. 3582.
https://dc.uwm.edu/etd/3582