RESEARCH REPORT

 

OPEN ACCESS | Research Report | Published Online: 26^th  June 2025                                                                           

PROPORTION AND RISK FACTORS OF DEPRESSION AMONG PREGNANT WOMEN SEEKING ANTENATAL CARE AT A PRIMARY HEALTH CENTRE IN SOUTH INDIA

                                                                                                                                                                                                                  

Aiswarya R Kamath^1*, Mili Babu ², Anilkumar TV³

1. Senior Resident, Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi 2. Assistant Professor, Department of Psychiatry, Government Medical College, Thiruvanathapuram 3. Professor and Head, Department of Psychiatry, Government Medical College,Eranakulam

*Corresponding Author: Senior Resident, Department of Psychiatry, Amrita Institute of Medical Sciences, Kochi

Email: arkamath864@gmail.com  

 

INTRODUCTION

 

 

The antenatal period is considered a time of happiness and positive expectations; however, it can be a time of distress and difficulties for some. Pregnancy is also a period of increased risk for the onset or relapse of psychiatric disorders.¹ According to a cross-sectional study done in a tertiary care center in South India, the prevalence of antenatal depression was 36.75%.² In a community-based cross-sectional study conducted by George et al. in a coastal area in South India, the prevalence of antenatal depression was found to be 16.3%.³ Among pregnant women attending a rural maternity hospital in Bangalore, the prevalence of antenatal depression was 12%.⁴ Antenatal depression can have both short and long-term impacts on the mother, the child, the family, and society as a whole. Antenatal depression has serious consequences on the quality of life and social functioning of the mother.⁵ Hence, it would be important to know which risk factors may favour the occurrence of antenatal depression in order to carry out appropriate prevention interventions.⁶

We found that the following studies have reported some important risk factors of antenatal depression. Some risk factors for antenatal depression in the area of social and economic factors, obstetrical history, lifestyle, biological factors, and history of having mental illness have been studied.⁷ Past history of depressive disorder, history of taking treatment for psychiatric illness, and depression severity are important predictors of antenatal depression.^5,8,9 The employment status of the pregnant woman has been associated with a reduced risk of postpartum depression.¹⁰ The role of social support in decreasing peripartum depression has been demonstrated.¹¹ Studies have reported some important risk factors, which include past history or family history of mood disorder, single marital status, co-morbid medical illnesses, and lower socioeconomic status. Pregnant women who have a past history of postpartum depression, particularly with features of bipolarity, may be especially at higher risk of developing antenatal depression.¹²

Antenatal depression, despite its association with increased maternal morbidity risks, is not given much attention in developing countries.⁹ There are various reasons why mental health issues during pregnancy period have received lesser importance than in the postnatal period. There is a misconception in society that women are “hormonally protected” from emotional problems during their pregnancy period. In addition, there is a tendency to focus on physical health during the antenatal period instead of mental health and to wrongly attribute emotional disturbances to the physiological changes that happen during pregnancy.¹³ There is a need to develop methods for recognition and prompt intervention for antenatal depression in the background of locally pertinent risk factors to improve maternal and child outcomes.³ There is a paucity of studies related to antenatal depression in the primary care setting, especially in the South Indian state of Kerala. Hence, this study was conducted to estimate the proportion of depression among pregnant women attending primary care setting and to determine the risk factors contributing to the development of antenatal depression.

MATERIALS AND METHODS

A cross-sectional study was carried out at the main centre and 11 sub-centres in the field area of the Medical College Health unit of Primary Health Centre (PHC), Pangappara, Thiruvananthapuram, from August 2021 to July 2022 after Institutional Ethics Committee approval (HEC No:- 08/04/2021/MCT). From the reference study, the prevalence of depressive symptoms in antenatal women was 36.76%.2 The sample size was calculated using the formula n= 4pq/d2, taking d(margin of error) as 20%. The sample size was estimated to be 175. The antenatal outpatient clinic in the Primary Health Centre is open on all Tuesdays of the week. Through consecutive sampling, all women aged 18 and above with a confirmed pregnancy, attending the antenatal Outpatient clinic, were recruited to the study after obtaining informed consent. No identifiable information, such as name, address, or date of birth, was collected during data collection to ensure anonymity. The participants were given random registration numbers during data entry to ensure confidentiality.

 The subjects were then administered the Edinburgh Postnatal Depression Scale (EPDS) questionnaire by the researcher. The EPDS is the most commonly used and acceptable screening tool for detecting depressive symptoms in the perinatal period worldwide; with a threshold of ?13, the EPDS had a pooled sensitivity and specificity of 88.9% (95%CI 77.4–94.9) and 93.4 (95%CI 81.5–97.8), respectively when validated in India. EPDS consists of 10 questions. The test can be completed within 5 minutes. The translated and back-translated Malayalam version of the EPDS questionnaire was used in the current study.16 The outcome variable was depressive symptoms.

A pre-tested semi-structured data collection questionnaire was used to collect information on the other variables- Age, religion, place of residence, educational qualification, occupation, marital status, educational qualification of spouse, occupation of spouse, type of family, family income, socioeconomic class, social support, previous pregnancy, history of infertility treatment, history of premenstrual syndrome, family history of mood disorder, history of medical illness, current trimester, past history of psychiatric illness. In the current study, women who were found to have depressive symptoms were referred to a tertiary care centre.

All the collected data were coded and entered into a Microsoft Excel sheet and re-checked and analyzed using SPSS statistical software version 22. The normality of distribution was checked using the Kolmogorov-Smirnov test. Quantitative variables were summarised using mean and standard deviation (SD) or using median and interquartile range, depending on the normality of the distribution. Categorical variables were represented using percentages and frequencies. Appropriate statistical tests were done based on the normality of the data. The distribution of scores on the Depression scale was not normally distributed. When the factors associated with depression were expressed as qualitative variables, the chi-square test was used to assess the statistical significance between the determinants of Depression. As the scores were not normally distributed, the Mann-Whitney test was used to determine the statistical significance of the difference between the means of the variables across two independent groups. The Kruskal-Wallis test was used to assess the statistical significance of the differences in means across independent groups for the variables. A p-value of < 0.05 was considered significant.

RESULTS

The antenatal women were screened with the help of an EPDS questionnaire, and the prevalence of depressive symptoms according to EPDS (score more than or equal to 13) was found to be 18.85%. (Table 1)

 

Table 1: Proportion of Depression based on EPDS

Depression based on EPDS score ?13
	N (%)
Yes	32(18.3%)
No	143(81.7%)

The total sample size was 175. In this study, age, religion, place of residence, educational qualification, occupation, marital status, educational qualification of spouse, occupation of spouse, type of family, family income, socioeconomic class, or social support were not found to be significantly associated with depression. (Table 2)

Table 2:  Association of Socio-demographic Variables with Depression

Variable	Groups	Depression		?2 value	P value
		Yes	No
Age Groups	20-25 years	10(31.25)	53(37.06)	0.79	0.673*
	26-30 years	16(50)	71(49.65)
	>30 years	6(18.75)	19(13.28)
Religion	Hindu	16(50)	81(56.64)	1.80	0.614#
	Christian	13(40.63)	42(29.37)
	Muslim	3(9.37)	19(13.29)
	Others	0	1(0.7)
Residence	Rural	23(71.87)	101(70.63)	0.02	0.889*
	Urban	9(28.13)	42(29.37)
Education	Graduate and above	8(21.1)	30(78.9)
	High school educated	18(17.1)	87(82.9)
	Primary school and below	6(18.8)	26(81.33.5)
Occupation	Semi-professional and professional	4(20)	16(80)
	Skilled worker, clerk/shopkeeper/farmer	10(20.8)	38(79.2)
	Unskilled and Semi-skilled worker	9(30)	21(70)
	Homemaker	9(11.7)	68(88.3)
Marital Status	Married	32(100)	130(90.9)	3.14	0.208#
	Divorced	0	3(2.1)
	Separated	0	10(6.99)
Family Type	Nuclear	11(34.38)	59(41.26)	0.52	0.769*
	Joint	11(34.38)	43(30.07)
	Extended	10(31.25)	41(28.67)
Socio-economic Status	Upper class	6(16.7)	30(83.3)
	Middle	9(22)	32(78)
	Lower	17(17.3)	81(82.7)
Social Support	Poor	12(37.5)	37(25.87)	0.490	0.783*
	Average<