Researchers find 22% of new mothers in India suffer from PPD; financial difficulties, domestic violence top risk factors

Arun Sreenivasan, New DelhiWednesday, July 11, 2018, 08:00 Hrs  [IST]

An extensive meta-analysis conducted by a team of medical researchers has revealed that as many as 22 per cent of Indian mothers suffer from postpartum depression (PPD) and more resources are needed for capacity building in maternal mental healthcare in the country. While a mild depression, often called ‘baby blues’, is common in most of the new mothers, PPD requires medical care, and if left untreated, can affect a woman's ability to take care of herself or her baby.

The findings, based on systematic review and analysis of 38 studies involving 20,043 women, provide an estimate of the burden of PPD in Indian mothers and investigate some risk factors for the condition.

The in-depth report was prepared by Dr Ravi Prakash Upadhyay and Dr Sunil Kumar Singh from Vardhman Mahavir Medical College and Safdarjung Hospital in New Delhi, independent researcher Ranadip Chowdhury, Aslyeh Salehi from School of Health and Human Sciences in Australia, Kaushik Sarkar from Directorate of National Vector Borne Disease Control Programme in New Delhi, Bireshwar Sinha from Lady Hardinge Medical College in New Delhi, Aditya Pawar and Aarya Krishnan Rajalakshmi from Drexel University College of Medicine in the US, and Amardeep Kumar from Patna Medical College.

As per the research report, published recently by the World Health Organisation bulletin, the southern region of the country tops the PPD chart with an estimated overall pooled prevalence of 26 per cent, followed by eastern (23 per cent), south-western (23 per cent) and western regions (21 per cent). The northern region had the lowest prevalence (15 per cent). The pooled prevalence was higher, but not significantly so, for studies conducted in hospital settings than in community settings and in urban versus rural areas.

“India is experiencing a steady decline in maternal mortality, which means that the focus of care in the future will shift towards reducing maternal morbidity, including mental health disorders. Despite the growing number of empirical studies on PPD in India, there is a lack of robust systematic evidence that looks not only at the overall burden of PPD, but also its associated risk factors. Our current understanding of the epidemiology of postpartum depression is largely dependent on a few regional studies, with very few nationwide data. The current review was done to fill this gap,” the authors have observed.

Postpartum psychiatric disorders are divided into three categories: postpartum blues, postpartum psychosis and postpartum depression. Postpartum blues, with an incidence of 300?750 per 1000 mothers globally, may resolve in a few days to a week, has few negative effects and usually requires only reassurance. Postpartum psychosis, which has a global prevalence ranging from 0.89 to 2.6 per 1000 births, is a severe disorder that begins within four weeks after delivery and requires hospital stay. PPD, the third type, can start soon after childbirth or as a continuation of antenatal depression and needs medical attention.

Earlier studies had shown that the problem was more prevalent in low- and middle-income nations. A systematic review of studies in 11 high-income countries found that, based on point prevalence estimates, around 12.9 per cent of mothers were depressed at three months postpartum. However, data from 23 studies conducted in low- and middle-income countries, which included 38,142 women, was 19.2 per cent. “These estimates in low- and middle-income countries are similar to ours and, taken together, they support an argument for placing greater importance on maternal mental health as part of overall efforts to improve maternal and child health,” the report pointed out.

The authors have chosen studies for the systematic review in a precise and meticulous manner. Only original research done in India, within a cross-sectional framework of a few weeks to one year post-birth, was included. Research done in a specific population, for instance, mothers living with human immunodeficiency virus or mothers with any current chronic disease, was excluded. And studies published before 2000 were not considered for the review.

The report has listed several risk factors for PPD. The most commonly reported reasons are financial difficulties, domestic violence, past history of psychiatric illness in the mother, marital conflict, lack of support from the husband and birth of a female baby. Other reported risk factors include recent stressful life event, family history of psychiatric illness, sick baby or death of the baby and substance abuse by the husband.

Research has shown that PPD can predispose to chronic or recurrent depression, which may affect the mother?infant relationship and child growth and development. Children of mothers with PPD have greater cognitive, behavioural and interpersonal problems and are at greater risk of being underweight and stunted.