Comorbid Postpartum Anxiety and Depression and Associated Factors in Mothers with Pre-Term Births: A Descriptive Comparative Study.
Authors: Mutua Joyce , Kigamwa Pius , Ng'ang'a Pauline , Tele Albert , Kumar Manasi 
Published: April 2020

Abstract
Introduction

Postpartum depression has been widely studied in relation to peripartum mental health disorders in women in low and middle income countries (LMICs). However, comorbid anxiety and depression and its precursors such as stress associated with neonatal care in hospital, survival of the baby, social support and maternal family dynamics are understudied in sub-Saharan Africa (SSA). Our focus was to determine the proportion of comorbid postpartum depression and anxiety among mothers of preterm infants receiving intensive care in newborn unit at Kenyatta National Hospital (KNH), compared to mothers of full-term healthy infants attending Mother Child Health Clinic (MCHC) at Umoja Health Center (UHC) in order to establish the association between comorbid anxiety and depression among mothers with pre-term babies and identify independent predictors of comorbid depression and anxiety.

Method

This is a descriptive comparative study, where 172 mother-infant dyads; 86 mothers from with term deliveries and 86 with pre-term deliveries were recruited. The participants completed the self-reported Socio-demographic questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Kessler’s 10 (K10) and Patient Health Questionnaire-4 (PHQ-4) to screen for levels of depression, psychological distress and anxiety. Chi-square tests was used to establish the association between comorbid depression and anxiety and socio-demographics. Multivariate logistic regression was used to assess the independent predictors of comorbid depression and anxiety.

Results

The overall proportion postpartum depression as measured by EPDS (>=13) was 44.2%, of these 77.6% were mothers with pre-term babies. Similarly, out of 35.1% who screened positive for anxiety 75% (n=45) of them were mothers with pre-term babies. Out of the 26.2% of mothers with psychological distress 75.6% (n=34) of them were mothers with pre-term babies. A total of 43 (25%) screened positive for comorbid depression and anxiety of these 83.7% were (n=36) mothers with pre-term babies. After controlling for all significant associations at bivariate level: the odds of comorbid depression and anxiety was about 6 times more among the mothers with pre-term birth as compared to full term births (A.O.R=5.75; p=0.002), 4.76 times more (A.O.R=4.76; p=0.043) among mothers who reported intimate partner violence as compared to those who did not and 5.95 times more among mothers who screened positive for psychological distress (A.O.R=5.95; p<0.001) as compared to those who screened negative.

Conclusion

This study found that there are higher proportions of mothers with depression, anxiety, and general distress among mothers with preterm births. Risk factors like IPV and psychological distress should be addressed in postpartum mothers regardless of full term or preterm births as a basic health right of a woman who has delivered. The health care team in Newborn Unit and in postnatal wards at KNH need to be sensitized around how to identify early signs of psychological disturbance among mothers of preterm infants in NICU. Routine group psychological counselling to NICU mothers soon after admission, and thereafter, to allay their fears and anxieties. It would be critical to carry out routine courses around maternal mental health for nursing staff.