INTRODUCTION:
“Health is wealth”. Health is imperative for all the human
beings especially for the women during the perinatal
period. The health of the perinatal women is meant
not only in the terms of physical but, it also includes mental, social and even
spiritual health. Healthier pregnant women could make healthy nation.
By using WHO definition of mental health, maternal mental
health can be defined as ‘a state of well being in which a mother realizes her
own abilities, can cope up with the normal stresses of life, can work
productively and fruitfully and is able to make a contribution to her
community’ (Rahman et al 2008). Maternal mental health is vital for mother
and growing fetus to overcome the future physical and mental health problems of
both.
Since the women undergo for an assortment of changes
during pregnancy her health may be affected, if she is not able to cope up
positively with the hormonal changes. Even though pregnancy is a normal
physiology, some personal and social factors lead pregnancy to end up with
several psychiatric disorders, especially like depression and anxiety in pregnancy.
Along with the physiological change the pregnant women undergo for
psychological changes with the influence of hormones. The incidence of
depression during pregnancy ranges from 4% to 16% (Halbreich,
2004).
Psychological disequilibrium is normal during life
transitions and in adapting to a change (WHO, 2004). The risk factors or
probable causes affects antenatal mental health were; physical stress, hormonal
changes, changes in body shape, performing daily living, meeting the needs of
family members and her children, past history of depression, domestic violence,
stressful life events, marital disharmony and lack of social support are all
together may affect the emotional equilibrium of the pregnant women.
Even though mild stress is optimal for development,
increased level of maternal stress results in low birth weight, shortened
gestational age, Intra uterine growth retardation, pre-term delivery,
spontaneous abortion, cognitive , motor deficits in CNS of fetus, increased
risks of malformations, asthma, mental and behavioral disorders and also risk
of diseases in adult hood.
Three major stress-related systems in pregnancy are; the neuroendocrine, immune/inflammatory, and cardiovascular
systems are plausible pathways for mediating the link between maternal mental
health and fetal developmental outcomes. The production and actions of a
placental corticotrophin releasing hormone appear to play a central role in
this process.
World Health Organization (WHO, 2001) estimates that
depression is projected to reach 2nd place of the ranking of DALYS
calculated for all ages, both sexes. Today depression is already the 2nd
cause of DALYS in the age category 15-44 years for both sexes combined. Already
the pregnant women is in risk for changes/disturbance in psychological state
and the statistics of WHO alarms that
the young married women in the lane of reproduction especially, during perinatal period they are, in need of guidance and counselling to get rid of psychological problems.
It is an alarming sign for the health care providers to
note especially, midwives to join hands with government programme
and proper implementation of satisfactory care in field of midwifery. The needed care aspect may be a simple one in
the view point of midwives, but it can prevent major incidences which enhances
morbidity and mortality of our nation.
The prevalence of antenatal psychological problems is high
over the world (Satyanarayana, Lukose
and Srinivasan, 2011). Bowen, Muhajarine
(2006) and Van, Spitz (2006) studies indicated the prevalence of antenatal
depression and/or anxiety ranges from 8% to 30%. Lee et al (2009) found that
prevalence of similar antenatal anxiety across all three trimesters. Bunevicius (2009) study noted that higher prevalence of
antenatal depression at 12-16 weeks (6.1%) as opposed to the third trimester
(4.4%) of pregnancy.
A study done in Pakistan by Karmaliani
et al 2009 reports that the prevalence rate of anxiety and/or depression at
20-26 weeks gestation to be 18%. The strongest factors associated with
depression/anxiety were physical/sexual and verbal abuse; 42% of women who were
physically and/or sexually abused and 23% of those with verbal abuse had
depression/anxiety compared to 8% of those who were not abused.
By using Edinburg Postnatal Depression Scale (EPDS) Imran and Haider 2009 found that
42.7% of the Pakistan women had antenatal depression. Out of 213 women 91
(42.7%) scored above the cut-off for antenatal depression. More women reported
problems in their marriage, problems with parents/in laws, history of domestic
violence, past history of psychiatric problems and history of postnatal
depression. In the obstetric risk factors history of previous miscarriages,
still births, and complications in previous pregnancy reached statistical significance.
Women with antenatal depression had more obstetric complications during
delivery like low birth weight, low mean of APGAR scores at 1 and 5 minutes
following birth.
Albeit the pregnancy changes are
normal process and common for all the women, the family as well as the health
care providers must take enormous interest for supporting the pregnant women to
come across the changes positively. The present study can help the midwives to
have more awareness, to reduce the life stress in antenatal period among women
and family. Also, it may be an eye opener, for producing healthy babies, and
the findings could encourage consideration of preventive strategies for
antenatal that were highly stressed during pregnancy and after delivery.
The National Institutes of Health (NIH) and the World
Health Organization (WHO) recommended that the role of maternal stress during
pregnancy should be given high research priority. And also the above mentioned
facts created interest in the researcher to study the psychological wellbeing
of antenatal women attending selected maternity hospitals OPD at Belgaum.
Statement of the problem;
A study to assess the level of psychological wellbeing of
antenatal women attending selected maternity hospitals OPD at Belgaum, Karnataka.
Objectives of the study:
1. To assess the
level of psychological wellbeing among antenatal mothers
2. To analyze the
difference of psychological wellbeing among antenatal women
3. To associate
psychological wellbeing of antenatal women with selected demographic variables.
Operational definitions:
Psychological Wellbeing: in this study it refers to
positive mental states like happiness, satisfaction, self acceptance, positive
relationships, personal growth, purpose in life, facing the challenges and autonomy.
Antenatal Mother: in this study it refers to a
woman who is pregnant, belongs to any three trimesters of pregnancy.
Maternity hospital: in this study it refers to a
hospital that provides care for women during pregnancy and childbirth and for
newborn infants.
Review of literature:
De Almeida et al (2012) did a descriptive study was
to examine the prevalence of probable psychiatric disorders during pregnancy
and related sociodemographic
causative factors among 712 women between the 16th and 36th
week of pregnancy receiving prenatal care in 18 basic health units in southern
Brazil. PRIME-MD was used to assess mental disorders. The result of the study
shows that: the prevalence of probable mental disorder in 41.7% of the women,
and most prevalent diagnosis was major depressive disorder (21.6%), followed by
generalized anxiety disorder (19.8%). A multivariate analysis showed that the
factors most significantly associated with a probable psychiatric disorder
were: the fact that the pregnant woman did not work or study: PR = 1.25 (95%CI:
1.04-1.51); the fact that the pregnant woman did not live with her spouse: PR =
1.24 (95%CI: 1.01-1.52); the fact that the pregnant woman had two or more
children: PR = 1.21 (95%CI: 1.01-1.46). A high prevalence of probable mental
disorder was observed. The increased search for health care by pregnant women
provides an opportunity for screening, diagnosing and treating these disorders
under the primary health care system.
Jennifer et al (2005) under took an observational
cohort study to assess the health status experienced by multi-ethnic women
during and after pregnancy at USA. The study revealed that; physical function
declined, from a mean score of 95.2 prior to pregnancy to 58.1 during the third
trimester, and improved during the postpartum period (mean score 90.7). The
prevalence of depressive symptoms rose from 11.7% prior to pregnancy to 25.2%
during the third trimester, and then declined to 14.2% during the postpartum
period. Insufficient money for food or housing and lack of exercise were
associated with health status before, during and after pregnancy.
Rich et al (2006) have done a cohort study to
assess the socio-demographic predictors of antenatal and postpartum depressive
symptoms among women in a medical group practice at USA. The study done among
1662 mothers selected in mid-pregnancy and postpartum with the tool Edinburg
Postnatal Depression Scale. The results were: The prevalence of depressive
symptoms was 9% at mid-pregnancy and 8% postpartum. Black and Hispanic mothers
had a higher prevalence of depressive symptoms compared with non-Hispanic white
mothers. These associations were explained by lower income, financial hardship,
and higher incidence of poor pregnancy outcome among minority women. Young
maternal age was associated with greater risk of antenatal and postpartum
depressive symptoms, largely attributable to the prevalence of financial
hardship, unwanted pregnancy, and lack of a partner.
The strongest risk factor for antenatal depressive
symptoms was a history of depression (OR = 4.07; 95% CI 3.76, 4.40), and the
strongest risk for postpartum depressive symptoms was depressive symptoms
during pregnancy (6.78; 4.07, 11.31) or a history of depression before
pregnancy (3.82; 2.31, 6.31).The study concluded that financial hardship and
unwanted pregnancy are associated with antenatal and postpartum depressive
symptoms. Women with a history of depression and those with poor pregnancy
outcomes are especially vulnerable to depressive symptoms during the childbearing
year. Once these factors are taken in account, minority mothers have the same
risk of antenatal and postpartum depressive symptoms as white mothers.
Deborah et al (2006) did a study to examine perinatal mental health issues, ethnic differences, and
co-morbidity among pregnant women in Hawaii. 84 participants aging 18–35 were
recruited for the study. Data collected by interview at their initial prenatal
visit about substance use, depression, and anxiety. Study results shown that: 61% of women screened
positive for at least one mental health issue. 13% of all pregnant women
reported drinking during pregnancy with 5% reporting problem drinking, 15%
reported smoking cigarettes on a regular basis, 5% of pregnant women had
probable depression, and 13% of pregnant women had probable anxiety. The study
concluded that; the importance of screening and treatment for mental health
issues early in pregnancy in Hawaii.
Saqib et al
(2011) done a cross-sectional survey at
Islamabad to assess the mental and physical health of pregnant women and
compare the differences between those residing in urban and rural
settings. Data collected from 179
pregnant women, 83 and 96 from both rural and urban areas respectively. Results
of the study were: role imitations because of Physical Problems (p=0.020),
General Health Perceptions (p=0.001) and Role Limitations because of
Emotional Problems (p=0.023) had statistically significantly lower scores in
rural women as compared to urban women. The study concludes that; self-perceived
mental and physical health was better in urban pregnant women than in rural
women.
Justin et
al (2008) have done a comparative study on influence
of single-mother status and level of partner support in a partnered
relationship, on antenatal emotional health in Australia. Antenatal
demographic, psychosocial and mental health data, as determined by Edinburgh
Postnatal Depression Scale (EPDS) score, were collected from 1578 women. The
association between these variables, and marital status, was investigated using
logistic regression. The study results have shown that: 62 women (3.9%) were
identified as single/unpartnered. Elevated EPDS
scores (<12) were found in 15.2% (240/1578) of the total cohort and 25.8%
(16/62) of the single/unpartnered women. EPDS scores
were significantly lower for single/unpartnered women
than for women with unsupportive partners (8.9±5.3 vs
11.9±6.5, p<0.001). Compared to the partnered cohort, single/unpartnered women were more likely to have experienced
≥2 weeks of depression before the current pregnancy (p<0.05), a
previous psychopathology (p<0.001), emotional problems during the current
pregnancy (p<0.01) and major life events in the last year (p<0.01).
Binary logistic regression modeling to predict antenatal EPDS scores suggests that
this is mediated by previous psychiatric history (p<0.001) and emotional
problems during pregnancy (p=0.02). The present study reiterates the
contribution of psychosocial risk factors as important mediators of antenatal
emotional health.
Mangoli TR and
Mohammad A. (2003) conducted a research to screen cases suspected of mental
disorders among pregnant women referred to health service centers and private
midwifery clinics at Iran. Data collected from 400 pregnant women for the
study. The point prevalence in total was demonstrated at 32%. The highest and
the lowest rates of prevalence respectively were interpersonal (44.3%) and
psychosis (10.3%). Mean comparison of dimensions of SCL-90-R indicated a
significant difference at least in one dimension with the following variables:
gestational age, ranking in pregnancy, occupation, number of children,
unplanned pregnancy, infertility history, importance of fetal sex for woman or
her husband, husband's education and employment, worried about beauty, lack of familial
support, unavailability for health care services, stressful events and high
risk pregnancy factors. The study concluded that the prevalence of mental
disorders in pregnant women is higher than the general population.
METHODS AND MATERIALS:
Research approach and design
A Non-Experimental, Descriptive survey approach was used
in this study.
Research Setting of the study
The study was conducted in selected Maternity hospitals
OPD, Belgaum.
Variables
Dependent variable
: Psychological wellbeing of antenatal women.
Independent Variable : Age, Months of pregnancy,
Education, Employment, Husband’s education, Husband’s employment, Type of
family, Residential area, Religion, Family monthly income, Years of marital
life, Married within, No. of children, History of abortion, Health problems in
present pregnancy and Other health disorders.
Sample and sample technique
Target population was all the antenatal women attending
selected maternity hospitals OPD, Belgaum. 134 samples were studied. A
Non-Probability, Purposive and Convenient sampling technique was used.
Research tool
• Part I : Demographic
variable
• Part II:
General Health Questionnaire -12 (GHQ-12).
The GHQ-12 is a standardized tool and it consists of both
positive and negative statements. The positive statements are 1,3,4,7,8,12 and
negative statements are 2, 5, 6, 9, 10, and 11. The reliability score of the
standardized GHQ-12 is r = 0.90.
Data collection method
Self reporting method was used to collect the data.
Major findings of the study
The major findings of the study presented as follows:
Findings related to socio-demographic data:
A majority of 62.7% belongs to
below 20 years old (Fig 1) and 46% of the samples were in third trimester. Most
of them 23.1% were non-literates (Fig 2) and 87.3% of the sample was home
makers (Fig 3). Most of the samples 55.2% were from joint family.
53.7% of the antenatal women were from
rural area, 75.4% belongs to Hindu religion (Fig 4) and 52.2% of the samples
are with family monthly income of Rs.3001-4000/- (Fig 5).
Fig 5: Percentage
Distribution of Family Monthly Income of Antenatal Women
Majority 53% of the samples were married
since 3 years (Fig 6), 75.4% of the antenatal women were married in
non-relations (Fig 7) and 55.2% were having 1-2 children.
Fig 6: Percentage Distribution of Years of Marital Life Antenatal Women
Fig 7: Percentage Distribution of Marriage with Relation or Nonrelation among Antenatal Women
8.96% antenatal women had abortion
previously, 97.8% not had any health problems in present pregnancy and 0.75%
had other health disorders.
Findings related to psychological wellbeing among
antenatal women:
97.8% of the antenatal women were having
normal psychological wellbeing and 2.24% had evidence of distress (Fig 8).
The mean score on psychological
wellbeing was 5.61 with a standard deviation of 3.20.
Fig 8: Percentage
Distribution of Level
of Psychological Wellbeing among Antenatal Women
Table1: Total and classified frequency of psychological
problems faced by antenatal women
(N=134)
|
Psychological Problems |
Number |
Percentage (%) |
|
Unable to concentrate |
6 |
4.5 |
|
Lost much sleep |
10 |
7.5 |
|
Not playing a useful part |
8 |
5.9 |
|
Indecisiveness |
20 |
14.92 |
|
Under stress |
8 |
5.97 |
|
Couldn’t overcome difficulties |
9 |
6.72 |
|
Unable to enjoy normal activities |
5 |
3.73 |
|
Unable to face problems |
8 |
5.97 |
|
Feeling unhappy and feeling depressed |
2 |
1.5 |
|
Losing confidence |
3 |
2.24 |
|
Thinking of self as worthless |
2 |
1.5 |
|
Feeling unhappy |
2 |
1.5 |