Screening for antenatal depression in women attending the Chris Hani Baragwanath academic hospital antenatal clinic
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Date
2019
Authors
Maisto, Alexandra Stephanie
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Abstract
BACKGROUND: Antenatal Depression is very common in South Africa, resulting in
a significant burden to those affected and potentially resulting in long term negative
outcomes for their children. Multiple associated risk factors exist amongst the
vulnerable socio-economically disadvantaged population. Screening for antenatal
depression and associated risk factors may assist with the identification of cases and
in the development of treatment interventions that serve to alleviate the burden.
Interventions need to be population specific in order to be effective. Further South
African studies are required to determine the prevalence and determine region
specific risk factors.
AIMS: To establish the prevalence of depressive symptoms and describe the
associated socio-demographic features in a sample of women attending the
Antenatal clinic at Chris Hani Baragwanath Hospital.
OBJECTIVES: To screen for antenatal depression, using the EPDS in the antenatal
clinic at the Chris Hani Baragwanath Hospital. To describe the results of the
screening and demographic factors and compare biographical information and a
positive screen on the EPDS to establish associations, and to describe the attitude of
these women towards information and treatment options for depression.
METHODS: A cross sectional and descriptive research design was used. Primipara
and multipara pregnant women were recruited from the CHBAH antenatal clinic. The
interview consisted of a biographical questionnaire, review of the antenatal card as
well as completion of the EPDS. The prevalence of depressive symptoms were
calculated, as determined by EPDS cut off scores of 13 or greater and 10 or greater,
together with their 95% confidence intervals. The Relative Risks for an elevated
EPDS score (of 13 or greater) for each significant risk factor was determined using
binomial regression
RESULTS: 32% of the sample had a score of greater than 10 on the EPDS and
23,5% scored greater than 13. There were strong associations between certain
variables: not having tertiary education (RR 0.46; 95% CI 0.23-0.90), an unwanted
pregnancy (RR 2.78; 95% CI 1.89-4.07) and the presence of life stressors during
pregnancy (RR 2.03; 95% CI 1.39-2.96). Most participants favoured treatment at their
local clinic; individual talk therapy (51.9%) was the first choice of treatment and only
23,8% would accept medication as an option.
CONCLUSIONS: Antenatal depression is highly prevalent in South Africa. The
detection of associated factors is important in determining high-risk groups for
targeted interventions can be put in place. Screening should be introduced into
routine antenatal care to improve the pick up rate of depressive symptoms in women
at risk and population specific, accepted, targeted interventions be put in place.
Description
A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand Medical School, Johannesburg, in partial fulfilment of the
requirements for the degree Masters of Medicine in the branch of Psychiatry.
Johannesburg, 2019