Prevalence and Risk Factors of Postpartum Depression in Two MOH Areas in Sri Lanka: A Mixed Methods Study
Background: Previous studies in Sri Lanka showed a high prevalence- 30% of postpartum depression (PPD). PPD screening using the Edinburgh Postnatal Depression Scales (EPDS) was included in postnatal care in 2012. This study aimed to estimate the prevalence of PPD in 2017 in two medical offices of health (MOH) areas, identify the association between risk factors and presence of postpartum depression, understand current practice, challenges, and suggestions of PPD screening in Sri Lanka.
Methods: The study consists of a population-based quantitative study and a qualitative study. PPD outcomes were assessed by mothers’ responses to the EPDS. Potential factors were extracted from routine paper-based medical records. The association was examined at unadjusted level first, and at adjusted level using multivariate linear regression and multivariate logistic regression models. Individual in-depth interviews were conducted among public health midwives. Framework approach was adopted to analyze the transcripts.
Results: The prevalence of PPD was 15.5% and 7.8% among mothers assessed 10 days postpartum (in Dankotuwa) and 4 weeks postpartum (in Bope Poddala), respectively. PPD was associated with earlier screening time, mothers’ delivery age > 35, >= 4 living children, and mothers’ illness. Mothers who attended prenatal sessions and whose partners were employed were less likely to report potential PPD. Other risk factors of PPD noted from interviews include socio-economic factors, interpersonal relationship, mother’s disease history, delivery method, and baby’s illness. The challenges of screening PPD included social stigma, mother’s difficulty of understanding EPDS and lack of privacy at home.
Conclusions: Mothers exposed to various socio-economic, interpersonal, and other risk factors deserve special attention. Family-based interventions, further cultural validation of EPDS, development of risk-assessing instrument could be introduced for future practice. Future research on other risk factors for PPD with larger sample size should be conducted, and qualitative research could engage other stakeholders in maternal mental health care to assess the accessibility, capacity, and quality of PPD care.
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