The epidemiology of pregnancy associated depression in Malta

The epidemiology of pregnancy associated depression in Malta

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Definition of the problem

Depression during pregnancy is a form of mental stress just like any other type of clinical depression and is the most prevalent form of psychiatric disorder during pregnancy. Most of this is caused by physiological factors due to hormonal changes, psychological and social changes. Depression can lead to developmental problems to the child due to the psychopathology of the mother. The child may not develop but the mother will be depressed and this could result in poor nutrition of both the mother and the child. It is estimated that 85% of women experience post partum mood disturbances. These symptoms lead to mental instability, irritability, weight loss and loss of appetite to the mother (Bogaerts. A, 2013, p. 93).

Depression in Pregnant women has been linked to poor nutrition in mothers, poor prenatal care in mothers, drug and substance abuse and risk of suicide. The prevalence of this condition has been associated with physical trauma to the mother is also more prevalent to the low-income earners due to financial constraints that they may have (Henshaw& Cox, 2009, p.42). Prevention of depression in expectant mothers will help to prevent potential morbidity and mortality rates among children and mothers substantially. This will be an important step in public health, as it will save many lives.

Prevalence and Data findings

According to a cohort study of volunteer 239 Maltese women, data statistics on the epidemiology of depression associated with pregnancy in Malta reveal that the prevalence in terms of the ICD-10 research principles was 15.5% at booking, 11.1% in the third trimester and 8.7% for the postpartum cases of which an approximate 3.9% showed the symptoms since delivery. This research was done on a population sample of 239 women who accepted to be interviewed on booking. These results show a confidence interval (CI) of 95% and a P-value of less than 0.05 which indicates that there is a probability of developing depression at a value of less than 0.05 per 100 pregnancies. The data was based on the Edinburgh postnatal depression scale (EPDS) and the Beck Depression Inventory (BDI).

Morbidity Rates

It was found out that the BDI scores were more than 17 for the women who had not received social support from a significant person. 24.2% of the women with unplanned pregnancy formed the greatest percentage of which the symptoms had the greatest effects. According to the WHO statistics, an estimated average value of 15% of the pregnant women show signs of depression during pregnancy. Data findings in this country were similar to those analyzed from a study in Brazil although it is afar much larger country than Malta (Field, 2008, p. 72).

A comparison of the above data from Malta was also made with the records obtained from other countries. It was established from previous studies that prevalence of antenatal depression was 14.2% in Brazilian women, 19% in Jordan compared to the 15.5% in Malta. Those living in Pakistan showed a prevalence rate of 48.8% and the highest mortality. The choice of a country like Pakistan is a good comparison as it gives the extreme value (Glover & O’Connor, 2002, p. 107).

Mortality Rates

High prevalence could be associated with the socio economic as well as the political factors influencing the women who live here. Being a politically unstable country with wars and unrest in each year, the subsequent effects on the psychological set up of the inhabitants are expected to be elevated especially the pregnant women. Turkey reveals a significant difference in data with prevalence rates estimating from 25% to 30% being although it is a developed country. Most of these findings if not all however were highly affected by the educational status of the general population, employment status and the availability of social support (World Health Organization, 2012, p. 37). The rates indicated that 28.4% (95%CI: 25.9-30.8) and 23.1% (95%CI: 20.9-25.4) respectively, for lower income countries, compared to 13% (95%CI: 10.5-13.5) and 9.6% (95%CI: 9.1-10.0) for higher income earning regions.

The data collected from the studies done on Malta indicates that the cases were not much deviated from the expected values. The number of the cases which had lead to mortality was minimal and almost negligible compared to the same study on some other European countries such as Turkey. The minimal cases of the pregnancy associated depression observed could be linked to the social support given to the women keeping in mind that this country is a cohesive catholic island. The most vulnerable population the women were at their first pregnancy as well as the ones who had conceived without consenting (Glover & O’Conner, 2002, p.118).

The second trimester was noted have reduction in the psychological morbidity and a commendable decrease in the symptoms of anxiety and depression were also observed. The morbidity was also noted to surge in the third trimester as the anticipation for partum arose. The low morbidity observed in the second trimester infers to the changing behavior of the mother and the adaptation to the condition of pregnancy. This was in line with the provisions in the WHO explanations that these changes do occur due to the hormonal stability achieved during the second trimester (Felice, 2010, p. 93).

Risk factors

The effects of the depression varied with the socio economic status of the female, the marital status, stress related to family life, past life events, the age and parity. There was a direct relationship of the occurrence of the condition with the number of the pregnancy. Women showed higher values of the symptoms of anxiety and depression as this is attributed to hormonal changes (Johnson, S, ea al, 2007, pg 277).

The risk factors could either be modifiable or non-modifiable. The former includes factors such as gender, age and past life events while the latter includes pregnancy, marital statuses, and drug/substance abuse. The confounding variables in this study include the race, ethnicity and the geographical location of the population under analysis. The role of the confounding variables is to aid in making generalizations concerning depression and how the dependent variables could influence development of depression among mothers.

Untreated cases were liked to pre-eclampsia, low birth weight babies, preterm deliveries and miscarriages. Their babies also had a high risk of having developmental problems and other complications (Tatano, 2006).

According to the WHO data findings, morbidity due to the occurrence of the symptoms for this condition were highly linked to the substance abuse, poor social support, a familial history of the depression or a past experience of depression. Certain risk factors such as the absence of a partner, physical trauma in the recent past of the mother, pregnancy complications and a young age aggravated the condition the more. (World Health Organization, 2012, pg 29).

The conditions that contribute to the level of depression are; the economic status of the people; in this case, people that are economically stable are less affected by the depression as they can use their money to settle a number of things whereas poor people are highly affected by the depression as they are always affected by the aftermath stress of settling and living on without money. Secondly, the marital status of the female; married people in most case tent to feel safer and secure compared to unmarried people (Bogaerts. 2013). The effect of the past event in life; the people that were greatly affected by the past events and have experience tend to be more affected than people who only hear of it. Lastly, the age and parity of the person is also likely to determine the effect of the depression on an individual.

Limitations & Recommendations

Limitations were also found in the analysis of this study. The selection criteria for most of the studies I analyzed were for voluntary interviewees that could predispose the data findings to bias. The information regarding mortality due to this type of a mental condition could be easily accessed due to the limited number of studies that have been carried out in Malta regarding this topic of investigation. ( HYPERLINK “http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=20096252” t “_blank”Lancaster CA, 2010). However, its limitation is that I did not present a concrete solution to the condition identified and therefore, the study, though effective, cannot be relied upon by the concerned stakeholders (such as the government). This forms the basis as why there is a need for continued research in order to get viable solutions.

To reduce the prevalence of the condition, proper social support for the pregnant women together with quality antenatal care should be emphasized in the health facilities. To reduce and control effects of the depression, proper medication with anti-depressants such as serotonin agonists is also important. Early diagnosis of the condition is crucial for the effectiveness of the treatment.

Despite the high prevalence of deaths from depression among expectant women, lack of studies on the strength of the risk factors, frequency of complication of the condition makes the situation worse. Also the high prevalence indicates that there should consider establishing national registry and a screening programme for the condition, but screening needs further epidemiological studies and the cost effect of this.

Conclusion

The condition is prevalent in the Maltese population and its impact, if left unresolved, potentially life-threatening complications would be on the increase. However, these findings have limitations since I did not find out the possible solutions which can be implemented to control the condition among expectant women, there are only suggestions which could have difficulties in implementing.

Future work ought to be done to establish the frequency and strength of modifiable and non-modifiable risk factors, burden that its complications present to the Maltese healthcare system and individuals. This should entail an intensive research and study. The confounding variables can be altered in future studies so as to create comparisons with present studies and make valif and authentic inferences. The future studies will entail analysis of risk factors and the stated confounding factors and how they influence development of depression among mothers in different parts of the world.

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