A protocol of a cross sectional study to assess depression in antenatal mothers

Abstract

Background: Maternal depression is associated with a number of  adverse  maternal outcomes such as preterm birth, maternal dysfunction, maternal suicide and perinatal outcomes such as low birth weight, lower rates of breastfeeding, increase in diarrheal disease, hospitalisations, poor emotional, social development, lower academic achievements in adolescence and future mental health problems for the children of the mothers. Maternal depression has rightly been identified as a priority mental health condition and large scale community interventions in low and middle income countries (including India) have been shown in RCTs to be effective in not only improving maternal depression but also improve the perinatal outcomes. Given the scale, severity of the problem and strength of evidence available for effective interventions in the Indian context, there is a great opportunity for implementation research in this area. As a first step there is a need to understand the prevalence of the problem and associated risk factors in our context.

Aim: Aim of this study to understand the prevalence of maternal depression and associated risk factors among antenatal mothers attending Sri Ramachandra Medical College (SRMC) Obstetrics outpatient department.

Methods: A cross-sectional design will be employed for determining the prevalence, while a case control framework will be used for the risk factor analysis. Antenatal mothers will be startified according to the trimester of the pregnancy. Semi-structured socio demographic proforma; Patient Health Questionnaire  (PHQ-9 Tamil version), Generalised Anxiety Scale (Tamil Version) and Brief COPE (Tamil version) questionnaire will be administered for antenatal mothers who offer informed consent. Those who score above 10 points on the PHQ scale will be interviewed using the MINI diagnostic interview schedule for clarifying diagnosis. Those who are diagnosed with depression will be referred to the SRMC psychiatry department for treatment & follow up.

Analysis: Statistical analysis is to be done using computer software, to assess the prevalence of antenatal depression and the associated risk factors. Descriptive statistics will be used to describe the sample. Mean, standard deviation and range will be employed to describe continuous variables, while frequency distributions will obtained for categorical variables. The chi square and fisher’s exact tests will be used to assess the significance of associations between categorical variables. Multivariate analysis will be performed using stepwise backward logistic regression models