ABSTRACT
After childbirth, a mother can experience varied emotions ranging from joy and pleasure to sadness and crying bouts. These feelings of sadness and tearfulness are called “baby blues,” and they tend to decrease over the first 2 weeks after delivery. While women experiencing baby blues tend to recover quickly, post-partum depression (PPD) tends to be longer and severely affects women’s ability to return to normal function. The purpose of this study was to qualitatively explore postpartum depression among mothers attending St. Joseph Hospital, Koforidua.
Eleven mothers attending postnatal clinic were recruited from the St. Joseph Hospital, Koforidua to participate in the study. A structured interview guide was used as the data collection tool. The three main themes which emerged after content analysis of the transcribed data were; understanding of postpartum depression, their perceived causes as well as participants’ perceived effects of postpartum depression. The findings of the study illustrated that, there are several gaps in knowledge among mothers who are potential victims of postpartum depression. The perceived causes of postpartum depression although still unclear, have a multifactorial cause that needs to be targeted with urgency to prevent its prevalence. The debilitating effects of postpartum depression are as well acknowledged and cited by participants.
CHAPTER ONE
INTRODUCTION
Background to the Study
Childbirth is a demanding and tiring experience (Bennett et al., 2016; Wallén et al., 2021). During pregnancy, a woman undergoes numerous hormone-related, physiological, mental, and psychological alterations (Stewart & Vigod, 2019). Massive changes take place in the mother’s familial and interpersonal life after the birth of her child from a range of joy and satisfaction to depression (Stewart & Vigod, 2019). Depression is one of the most common psychiatric conditions among women of reproductive age (Parsons et al., 2012). It is the leading cause of disease burden among childbearing women who have a depressive episode within 4 weeks of giving birth (Guintivano et al., 2018). About 20-40% of women in developing countries experience depressive symptoms during or after childbirth (Abbas et al., 2017). Half. Depressive symptoms affect 10%-20% of mothers worldwide during the postpartum period (Abbas et al., 2017). Half of depressed women are likely to experience a depression episode after giving birth (Bennett et al., 2016).
Postpartum depression (PPD) is a mild mental and behavioural disorder that begins within 6 weeks of delivery, according to the International Classification of Diseases (ICD-10) (Stewart & Vigod, 2019). Clinical manifestations of PPD include depressed mood, decreased pleasure in almost all activities, insomnia or hyper insomnia, significant weight loss or gain, psychomotor agitation or retardation, loss of energy, feelings of worthlessness and excessive guilt, low self-esteem and self-confidence, difficulty concentrating, and suicidal ideation (Guille et al., 2013; Guintivano et al., 2018).
It usually occurs within 4-6 weeks of childbirth, but it can last for months or even a year (Stewart & Vigod, 2019). Furthermore, up to 50% of women will experience it again during subsequent pregnancies. This illness has a proclivity to progress to major depression and may pose a significant risk of morbidity and mortality in under diagnosed cases (Weobong et al., 2009)
Even though every woman is at risk of developing postpartum depression, women who have children at a young age are more likely to develop it (Alshikh Ahmad et al., 2021; DeSa et al., 2022; O’Mahony et al., 2012). Low education level, poverty, poor social support, and childbirth without the presence of relatives were factors that increased the risks of depressive symptoms after delivery (Islam et al., 2017).
PPD prevalence rates vary greatly by location; the disorder is thought to be three times more common in developing countries than in developed countries (Suri et al., 2017). Globally, the prevalence of PPD among mothers’ range from 0.5% to 60.8% (Abbas et al., 2017; DeSa et al., 2022; Halbreich & Karkun, 2006). In recent years, it has been discovered that PPD may affect up to 30% of all women after delivery, with severity ranging from mild and moderate in 50-80% of women to intensive psychosis in less than 1% of women (Suri et al., 2017). It was discovered in Sub-Saharan Africa to range from 12.5% to 27.1% during pregnancy and from 10.0% to 34.5% post-natally (Mekonnen et al., 2018). Similarly, using the Edinburgh Postnatal Depression Scale (EPDS), a study in Cape Town discovered that 39% of pregnant women screened positive for depressed mood and 34.7% of postnatal women were diagnosed with depression (Bennett et al., 2016; Sawyer et al., 2010). Furthermore, a Ugandan study discovered that 43% of postpartum women had depressive symptoms on the EPDS (Kakyo et al., 2012). In Ghana, the World Health Organization (WHO) estimates that over 650,000 people are suffering from a form of severe mental disorder. One form of mental disorder that continues to affect women is postpartum depression.
Postpartum depression is characterized by extreme sadness, hopelessness, recurring thoughts of death, and the risk of the mother harming herself (Schwab-Reese et al., 2017). Thus, their emotional, social, and cognitive development of children of depressed mothers was impaired (Baumgartner et al., 2014).
To avoid serious PPD consequences, there is the need to understand the knowledge level of these women who are at risk of it and target tremendous actions to alleviate its occurrence because women suffering from PPD require a supportive spouse to help them get through this difficult time (Yan et al., 2020).
Statement of the Problem
Depression during pregnancy and the early postnatal period is a common condition that affects many women around the world (Acheampong, 2015; Alshikh Ahmad et al., 2021; Baumgartner et al., 2014; Kakyo et al., 2012). It affects up to 15% of high-income women and 20%-40% of low-income women (Bennett et al., 2016). Perinatal depression can have a negative impact on the lives of mothers, new-borns and their families (Guille et al., 2013).
Pregnancy and the postpartum period are critical times for maternal mental health, with up to 15% of postpartum women in high-income countries experiencing a mood disorder in the previous year, and a higher rate in low-income countries (Sawyer et al., 2010). In general, studies in Africa show that rates of depression during pregnancy and the postpartum period are significantly higher and may last longer than in high-income countries; in low-income countries, the prevalence of postpartum depression ranges from 14% to 50%, depending on the measure and criteria used (Okronipa et al., 2012; Parsons et al., 2012).
A systematic review of psychological well-being in Africa found that the average prevalence of postpartum depression was 18% across all studies examined (Sawyer et al., 2010). According to studies in high-income countries and a few small studies in Africa, mothers of sick, preterm, and low birth weight infants are at an even higher risk of perinatal mental illness, including depression, acute stress disorder, and post-traumatic stress disorder (Halbreich & Karkun, 2006; Lefkowitz et al., 2010; Mekonnen et al., 2018).
Ghana is a West African country with a population of approximately 32 million people. Maternal mortality (451 per 100 000 live births) and childhood mortality (8 per 100 live births) are both high (Acheampong, 2015) According to WHO, only 1% of patients with mental disorders in Ghana receive any type of psychiatric care (Weobong et al., 2009). Data on the prevalence, risk factors, and implications of postpartum depression for women, neonates, and their families are scarce. One study compared three screening instruments for postpartum depression and found that 11% of 160 respondents had clinically significant depression scores (Weobong et al., 2009). Another study investigated postpartum depression in HIV-positive women and discovered that 10% of them had depression symptoms at birth and 9% had those symptoms 6 months later (Okronipa et al., 2012).
Women’s health is a public concern, but little attention has been paid to the diagnosis of postpartum depressive symptoms. Even though low- and middle-income countries are home to nearly 90% of the world’s children (Kakyo et al., 2012; Parsons et al., 2012). Little is known about the understanding of maternal depressive symptoms in Ghana. Other studies have focused on quantitative assessment of women’s knowledge and others have focused on various aspects of the PPD neglecting the main subjects involved and are at greater risks. Hence, the current study aims to qualitatively explore the understanding of postpartum depression among mothers at St. Joseph Hospital in Koforidua.
Purpose of the Study
The purpose of the study is to explore postpartum depression among mothers at St. Joseph Hospital, Koforidua.
Specific Objectives
The specific objectives are to;
- describe what mothers at St. Joseph Hospital, Koforidua consider to be PPD
- explore the perceived causes of PPD among mothers at St. Joseph Hospital, Koforidua
- explore the perceived effects of PPD on postpartum mothers at St. Joseph Hospital, Koforidua
Research Questions
- What do mothers at St. Joseph Hospital, Koforidua consider to be PPD?
- What are the perceived causes of PPD among mothers at St. Joseph Hospital, Koforidua?
- What are the perceived effects of PPD among mothers at St. Joseph Hospital, Koforidua?
Significance of the Study
The significance of a study conveys the importance of the problem for different groups that may profit from reading and using the study (Matsui et al., 2020). It might also include why the study adds to scholarly research and literature in the field, about how the study helps improve practice and why the study will improve policy.
This research would bring to light the understanding, perceived causes and effects of PPD among mothers at St Joseph Hospital, Koforidua.
It will serve as a reference point to the Health Directorate, Health Ministry and stakeholders by giving them in-depth first of its kind mother-oriented understanding of PPD to help tailor policies and interventions towards them.
It will also create more awareness on the need for urgent and more help seeking friendly environment for those who have little or no knowledge about PPD.
In addition, the study will serve as an existing data for future academic writings of studies of its kind.
Limitations
- Respondents not truly revealing their knowledge regarding the topic being explored.
- Insufficient or limited resources including time and fund to carry out the study.
Operational Definition of Terms
HIC: High- Income Countries
EPDS: Edinburgh Postnatal Depression Scale
DSM IV-TR: Diagnostic and Statistical Manual of Mental Disorders
ICD-10: International Statistical Classification of Diseases
Organisation of the rest of the study
Chapter one, explored above, have introduced the study. The remaining chapters will be chapter two (which discusses the literature review), chapter three which will be about the methodology of the study, chapter four which will be on the study’s results and discussion and finally on the chapter five which will also talk about the summary, conclusions and recommendations of the study.
