1. A STUDY OF POSTPARTUM DEPRESSION
IN A FAST DEVELOPING COUNTRY:
PREVALENCE AND RELATED FACTORS
Abdulbari Bener*1,2,3 ,F.Tuna Burgut4
Suhaila Ghuloum5, Javaid Sheikh4
1Dept. of Medical Statistics & Epidemiology, Hamad General Hospital, Hamad Medical
Corporation, Dept. Of Public Health, Weill Cornell Medical College, Doha, Qatar
2 Dept. Evidence for Population Health Unit, School of Epidemiology and Health Sciences,
The University of Manchester, Manchester, UK
3Dept. of Public Health & Medical Education, Weill Cornell Medical College, Qatar
4Dept. of Psychiatry, Weill Cornell medical College, Qatar
5Dept. of Psychiatry, Hamad Medical Corporation, Doha, Qatar.

2. INTRODUCTION

3. INTRODUCTION
 Mental diseases are one of the most
common complications associated with
pregnancies and childbirth.
 It was reported that postpartum
depression (PPD) is one of the important
public health problems affecting maternal
and child health.

4. INTRODUCTION (Contd…)
 Postpartum psychological disorders lead
to maternal disability and disturbed
mother-infant relationship.
 Postpartum depression is a serious
disorder which has been estimated to
affect 13-20% of women in industrialised
nations.

5. INTRODUCTION (Contd…)
 It was identified that past history of
psychopathology, psychological
disturbance during pregnancy, poor
marital relationship, poor social support
and stressful life events are the primary
risk factors for developing postpartum
depression.
 This is the first study examining the
prevalence of postpartum depression and
associated risk factors among Arab
women in Qatar.

6. OBJECTIVES
The aim of this study was to determine the
prevalence and identify the risk factors of
postpartum depression among Arab
women in Qatar using Edinburgh
Postnatal Depression Scale (EPDS).

7. SUBJECTS
&
METHODS

8. SUBJECTS & METHODS
 Design: This is a prospective cross-sectional
study.
 Setting: The study was conducted at Primary
Health Care Centers in Qatar.
 Period of Study: January 2010 to May 2011.
 Subjects: A representative sample of 1669
mothers within 6 months after delivery were
approached and 1379 (82.6%) mothers
participated in this study.

9. SUBJECTS & METHODS (Contd…)
 Data Collection:
 The survey instrument was initially
tested on 100 patients who visited the
health centres and thus validated the
questionnaire.
 The study excluded mothers whose
postnatal period was over 6 months
and who refused to give consent to
take part in the study.

10. SUBJECTS & METHODS (Contd…)
Data Collection (Contd…):
 A validated structured questionnaire
was used to collect the socio-
demographic variables, psychiatric
history, interpersonal relationship, life
events and obstetric risks with the help
of qualified nurses.

11. SUBJECTS & METHODS (Contd…)
 The Edinburgh postpartum depression
scale (EPDS) was used to identify the
risk cases.
 The EPDS is a 10-item self-report scale,
specifically designed to screen for
postpartum depression in primary
care.

12. SUBJECTS & METHODS (Contd…)
 The EPDS is a reliable and valid
instrument, it has been used in a
number of international settings
 The EPDS is a reliable and valid
instrument, it has been used in a
number of international settings

13. The EPDS questionnaire has items such as:
1. Having been able to laugh.
2. Having looked forward with enjoyment
to things.
3. Having blamed oneself unnecessarily.
4. having been anxious or worried for no
good reason.
5. Having felt scared or panicky for no
good reason.

14. The EPDS questionnaire has items (contd..)
6. Experiencing overload.
7. Having been so unhappy that it has
caused sleeping problems.
8. Having felt miserable or sad.
9. Having been so unhappy as to have
cried.
10.Thoughts of harming oneself.

15. The EPDS questionnaire has items (contd..)
 Each item is scored on a 4-point scale
(0–3), the minimum and maximum total
score ranging from 0 to 30, respectively.
 A score of ≥12, the most commonly
used cut off, is used to distinguish
women suffering from depression from
those who are not.

16. EDINBURG POSTNATAL DEPRESSION SCALE: SCORING SAMPLE

17. STATISTICAL
ANALYSIS

18. STATISTICAL ANALYSIS
 Student-t test was used to ascertain the
significance of differences between
mean values of two continuous
variables.
 Chi-square analysis was performed to
test for differences in proportions of
categorical variables between two or
more groups.

19. STATISTICAL ANALYSIS (Contd…)
 Multivariate logistic regression analysis
using the forward inclusion and
backward deletion method was used to
assess the relationship between
dependent and independent variables
and to adjust for potential confounders
and orders the importance of risk factors
(determinant) for postpartum depression.
 The level p<0.05 was considered as the
cut-off value for significance.

20. STUDY FINDINGS

21. STUDY FINDINGS
The prevalence of postpartum
depression among the study
sample was 17.6%.

22. STUDY FINDINGS
There were statistically significant
differences observed between
depressed and non-depressed
mothers in their socio-demographic
characteristics;

23. STUDY FINDINGS
Mothers of age above 35 years (49.9% vs
39.2%; p<0.001),
Low education below intermediate level (51%
vs 35.8%; p<0.001),
Housewives (38.7% vs 29%; p=0.03),
Low monthly income (QR 5000-9999) (43.2% vs
32.2%;p<0.001)

24. STUDY FINDINGS
Maternal complications (38.7% vs 26.1%;
p<0.001) and caesarean section (36.2% vs
28.8%; p=0.022) were significantly higher
among depressed mothers compared to non-
depressed women.

25. STUDY FINDINGS
Financial difficulties (OR=2.04; p<0.001),
prematurity (OR=1.64; p=0.025),
poor family support (OR=1.52; p=0.016),
dissatisfaction in marital life (OR=1.26;
p=0.005),
poor marital relationship (OR=1.13; p=0.05)
were the main predictors of postpartum
depression.

26. Table 1: Socio-demographic characteristics of the studied
women according to PPD Status (N=1379)
Post partum Depression
Total Yes No
Variable N=1379 EPDS≥12 EPDS<12 p-value
n(%) N=243 N=1136
n(%) n(%)
Age(Mean±SD) 33.5±6.5 33.3±7.1 33.5±6.4 0.560
Age in Years
<25 Years 204(14.8) 48(19.8) 156(13.7)
25-34 Years 633(45.9) 74(30.3) 535(47.1) <0.001
>35 Years 542(39.3) 121(49.9) 445(39.2)
Education Level
Illiterate 104(7.5) 27(11.1) 77(6.8)
Primary 200(14.5) 50(20.6) 150(13.2)
Intermediate 276(20.0) 47(19.3) 180(15.8) <0.001
Secondary 440(31.9) 64(26.4) 405(35.7)
University 359(26.0) 55(22.6) 324(28.5)
Occupation
House Wife 424(30.7) 94(38.7) 330(29.0)
Professional 573(41.6) 90(37.0) 483(42.5)
Manual 126(9.1) 24(9.9) 102(9.0) 0.030
Business Women 180(13.1) 23(9.5) 157(13.8)
Army/police 76(5.5) 12(4.9) 64(5.6)

27. Table 1: Socio-demographic characteristics of the studied
women according to PPD Status. (Contd…)
Post partum Depression
Total Yes No
Variable N=1379 EPDS≥12 EPDS<12 p-value
n(%) N=243 N=1136
n(%) n(%)
Family income*QR
Less 5000 141(10.2) 66(27.2) 75(6.6)
5000-9999 471(34.2) 105(43.2) 366(32.2)
<0.001
10,000-14,999 326(23.6) 40(16.5) 286(25.2)
>15,000 441(32.0) 32(13.2) 409(36.0)
Consanguinity
Yes 518(37.6) 108(44.4) 410(36.1)
0.015
No 861(62.4) 135(53.6) 726(63.9)
Baby’s Gender
Boys 692(50.2) 119(49.0) 573(50.4)
0.678
Girls 687(49.8) 124(51.0) 563(49.6)
Transportation Access
Yes 1172(85.0) 188(77.4) 984(86.6)
<0.001
No 207(15.0) 55(22.6) 152(13.4)
How many Bedrooms at your home 5.0±2.3 5.3±2.5 5.0±2.1 0.043
How many people living at your home 6.0±3.1 6.5±3.3 6.0±3.0 0.020

28. Table 2. Association between stressful life events and postpartum
depression in studied women according to the PPD Status (N=1379)
Post partum Depression
Life Events Yes(EPDS≥12) No (EPDS<12) P-Value
N=243 N=1136
Relationship Problem n(%) n(%)
Relationship with your husband Good 68(28.0) 405(35.7)
0.022
Bad 172(72.0) 731(64.3)
Relationship with mother in law Good 72(29.6) 489(43.0)
<0.001
Bad 171(70.4) 647(57.0)
Strong family support Good 182(74.9) 984(86.5)
<0.001
Bad 61(25.1) 152(13.4)
Nanny to take of your child Yes 97(39.9) 472(41.5)
0.639
No 146(60.1) 664(58.5)
No Of Children’s (Mean±SD) Boys 2.0±1.2 2.0±1.2 0.945
Girls 1.6±1.0 1.5±1.0 0.691
Difficult to Manage with Income Yes 186(76.5) 789(69.5)
0.028
No 57(23.5) 347(30.5)
Satisfaction in your married life Good 154(63.5) 895(78.8)
<0.001
Bad 89(36.5) 241(25.7)
History of Depression Yes 28(11.5) 142(12.5)
0.674
No 215(88.5) 994(87.5)
Family history of depression Yes 42(17.3) 181(15.9)
0.604
No 201(82.7) 955(84.1)

29. Table 3: Maternal and Infant characteristics of the studied
women according to the PPD Status. (N= 1379)
Post partum Depression
Yes No
Maternal Characteristics EPDS≥12 EPDS<12 P-Value
N=243 N=1136
n(%) n(%)
Planned Pregnancy Yes 117(48.1) 617(54.3)
0.530
No 126(51.9) 517(45.7)
History of Fertility Yes 32(13.2) 116(10.2)
0.176
No 211(86.8) 1020(89.8)
Complication during pregnancy Yes 94(38.7) 295(26.1)
<0.001
No 149(61.3) 841(73.9)
Maternal Complications*
Anaemia 23(9.4) 48(4.2) 0.001
Bleeding 65(26.7) 170(15.0) <0.001
Blood Pressure 25(10.2) 27(2.4) <0.001
GDM 24(9.9) 70(6.2) 0.051
Miscarriage 8(3.2) 25(2.2) 0.435
Threatened abortion 3(0.9) 4(0.4) 0.109
Urinary infection 9(3.7) 5(0.5) 0.001
Mode of last Delivery
Vaginal delivery 155(63.8) 809(71.2)
0.022
C-Section 88(36.2) 327(28.8)

30. Table 3: Maternal and Infant characteristics of the studied
women according to the PPD Status. ( Contd…)
Post partum Depression
Infant Characteristics Yes No
EPDS≥12 EPDS<12 P-Value
N=243 N=1136
n(%) n(%)
Normal weight and height
Yes Yes 205(84.4) 986(86.8)
0.367
No No 38(15.6) 150(13.2)
Premature baby in ICU
Yes Yes 41(16.9) 135(11.9)
0.034
No No 202(83.1) 1001(88.1)
Mode of Feeding
Solely breast fed 74(30.5) 424(37.3)
Breast fed and formula 114(46.9) 590(51.9) <0.001
Formula 55(22.6) 122(10.7)
Strong preference for the baby gender
Yes 88(36.2) 360(31.7)
0.172
No 155(63.8) 776(68.3)

31. Table 4: Results of logistic Regression analysis
for predictors of Post partum Depression.
Odd 95% P Value
Independent Variables ratio Confidence
Interval
Difficulty to manage with income. 2.37 1.56 – 3.58 <0.001
Prematurity 1.64 1.06 – 2.54 0.025
Poor Family Support 1.52 1.0 – 2.14 0.016
Dissatisfaction in their married life. 1.26 1.0 – 1.47 0.005
Poor marital relationship 1.13 1.0 – 1.29 0.048

32. Table 5. Prevalence rate for postpartum depression
according to the country
Sample
Country Age Group Prevalence rate (%) Year Reference
Size
Australia 16-35 Years 4366 17.4% 2010 Yelland et al
Australia 18-44 Years 80 24.7% 2006 Miller et al
Australia 17-36 Years 52 25.1% 2007 Phillips et al
Brazil 14-47 Years 271 20.7% 2008 Tannous et al
Brazil 13-31 Years 410 19.0% 2000 Inacia et al
India Goa 18-37 Years 59 23% 2001 Patel et al
Pakistan 17-40 Years 149 36% 2006 Hussain et al
Morrocco 18-44 Years 144 18.7% 2005 Agoub et al
Oklahoma 18-35 Years 5586 26% 2005-2006 Crutcher et al
29.0% at 0-2 Months
36.6% at 3-6 months
Turkey 15-44 Years 1447 2004 Bugnayci et al
36.0 % a t 7-12 Months
42.7% at >13 Months
Dubai 25-34 Years 90 18.0% 1997 Abou Saleh and Ghubash
Bangladesh 17-41 Years 361 33% 2009 Gausia et al
USA 17-47 Years 192 23.4 1995 Hobfoll et al
Qatar 18-45 years 1379 17.6% 2010-2011 Bener et al

33. CONCLUSION

34. CONCLUSION
The present study revealed the following:
 The prevalence of postpartum
depression was higher than the rates
observed in developed countries.
 The prevalence of postpartum
depression was greatest among mothers
with lower socio-economic level such as
advanced age, low education and
illiteracy, housewives, low family income.

35. CONCLUSION (Contd…)
 Among the psychosocial factors, lack of
family support, marital disharmony,
stressful life events were significantly
associated with postpartum depression.
 Financial difficulties, prematurity, lack of
family support and poor marital
relationships have been reported as main
risk factors for developing postpartum
depression.

36. ACKNOWLEDGEMENT
This study was generously supported and funded
by the Qatar National Research Fund- QNRF
NPRP 30-6-7-44 and Weill Cornell IRB Ethical
Approval (WCMC-Q#2011-0008). The authors
would like to thank the Hamad Medical
Corporation for their support and ethical
approval (HMC MRC #10119/10)

37. THANK YOU!