Elsevier

Comprehensive Psychiatry

Volume 49, Issue 3, May–June 2008, Pages 275-282
Comprehensive Psychiatry

A 6-month study of postpartum depression and related factors in Athens Greece

https://doi.org/10.1016/j.comppsych.2007.05.018Get rights and content

Abstract

Introduction

Postpartum depression (PPD) affects women in various sociocultural environments around the world during a sensitive period of their lives. The purpose of this study was to investigate the prevalence and time course of PPD in a Greek urban environment as well as possible relations of PPD with certain clinical and sociodemographic factors.

Method

The study was performed on a sample of 402 women that were recruited from a university obstetric clinic in Athens, Greece, during the first 24 hours after delivery. The women completed the Edinburgh Postnatal Depression Scale through telephone interviews. The telephone interviews were conducted the first week as well as the first, third, and sixth month after delivery. The first day after delivery, all women completed the Montgomery-Asberg Depression Rating Scale, the List of Threatening Experience, the State-Trait Anxiety Inventory, the Whitley Index, the Schalling-Sifneos Personality Scale, and the Maudsley Obsessive-Compulsive Inventory. In addition, the Blues Questionnaire was administered the first 3 days and the seventh day after delivery. Other clinical and sociodemographic data were obtained through questionnaires and personal interviews.

Results

A cutoff point of 12 in the Edinburgh Postnatal Depression Scale was used to define PPD. Eighty (19.8%) of the women in the sample experienced PPD during the first 6 months after delivery. The development of PPD was related significantly to the following factors: stressful events during pregnancy (P = .01), maternity blues on the seventh day after delivery (P = .01), obsessive preoccupation with cleaning (P = .04), and judgment that the baby is crying excessively at the first month interview (P = .02).

Conclusion

The women's emotional condition before and after delivery, obsessionality, and difficulties in regulating the infant's emotions appear to contribute to the development of PPD during the first 6 months after delivery.

Introduction

The first modern clinical observations on postpartum psychiatric disorders were made by Marce [1] in the middle of the 19th century. The International Classification of Disease (10th edition) states that the onset of postpartum depression (PPD) is restricted to the first 6 months after delivery, whereas the Diagnostic and Statistical Manual of Mental Disorder defines PPD as the depressive episodes that develops during the first month after delivery. Postpartum depression affects approximately 10% to 15% of women after delivery [2].

A hypothesis that has been formulated by a number of authors during the 1980s and 1990s was that PPD occurs more frequently in urban westernized societies. This difference has been attributed to both the transformation of family structure from the extended to the nuclear type and the medicalization of childbirth, which deprives women from the protective nature of traditional rituals concerning birth and puerperium [3], [4], [5]. Results from more recent studies conducted in Africa [6], the Far East [7], [8], [9], and the Middle East [10], [11] imply that PPD has similar prevalence rates in different societies and nations around the world. It is interesting, however, that the predicting factors of PPD in these environments are somehow different from those in Western societies. Such examples refer to the sex of the infant [8], [12], multiparity [13], and poor accommodation [14].

Although Greece's social structure is mainly Western European, the Greek society maintains many of its traditions. As in most of the southern European countries, such as Italy and Spain, family ties are still strong even in urban areas. The first months after Greek women give birth, they usually receive a lot of attention and support from their mothers or other close relatives.

This study attempts to investigate PPD in an urban area of Greece during the first 6 months after delivery and its relation to psychosocial and clinical factors.

Section snippets

Study design

This study was conducted in a university obstetric clinic in Athens. For the purposes of the study, 445 women were approached by a clinical psychiatrist the first day after delivery. Most of the approached women were admitted to the clinic on the day of delivery. The inclusion criteria were adequate knowledge of the Greek language (ability to read in Greek), birth of a healthy child (Apgar score of 9-10), and absence of the following: (a) history of psychotic disorder, (b) use of psychoactive

Response rate and sample characteristics

Of the 445 women that were approached the first day after delivery, 43 were excluded from the study giving a response rate of 90.3%. Of the 43 women that were excluded, 20 (46.5%) could not read Greek (all of them were immigrants), 12 (28%) refused to participate, 4 (9.3%) gave birth to a child who faced serious medical problem, 4 (9.3%) were found to have depression on day 1 after delivery (MADRS >20), 2 (4.6%) were suffering from a chronic somatic disease (hepatitis C caused by IV heroin use

Discussion

According to the results of this study, PPD in a Greek urban environment has similar time of onset, prevalence, and course as in other European and North American countries. It is interesting, though, that the relation found between PPD and poor marital relationship and unemployment has been reported in the literature in studies coming mainly from non-Western countries. In addition, probably, women obsessed with cleaning who feel that their baby cries excessively and had experienced stressful

References (56)

  • L. De Gennaro et al.

    The relationship between alexithymia, depression and sleep complaints

    Psychiatry Res

    (2004)
  • L.V. Marce

    Traite de la Folie des femmes enceintes des Nouvelles Accouchees et des Nourrices

    (1858)
  • C.T. Beck

    Predictors of postpartum depression. An update

    Nurs Res

    (2001)
  • R. Kumar

    Post natal mental illness: a transcultural perspective

    Soc Psychiatry Psychiatr Epidemiol

    (1994)
  • R. Kumar

    An overview of postpartum psychiatric disorders

    NAACOGS Clin Issues Perinat Women's Health Nurs

    (1990)
  • J.L. Cox et al.

    Prospective study of the psychiatric disorders of childbirth

    Br J Psychiatry

    (1982)
  • P. Cooper et al.

    Post-partum depression and the mother-infant relationship in a South African peri-urban settlement

    Br J Psychiatry

    (1999)
  • V. Patel et al.

    Gender, poverty and postnatal depression: a study of mothers in Goa, India

    Am J Psychiatry

    (2002)
  • D.T. Lee et al.

    A psychiatric epidemiological study of postpartum Chinese women

    Am J Psychiatry

    (2001)
  • A.E. Danaci et al.

    Postnatal depression in Turkey: epidemiological and cultural aspects

    Soc Psychiatry Psychiatr Epidemiol

    (2002)
  • M.T. Abou-Saleh et al.

    The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective

    Acta Psychiatr Scand

    (1997)
  • G. Ekuklu et al.

    Prevalence of postpartum depression in Edime, Turkey, and related factors

    J Reprod Med

    (2004)
  • S.A. Gürel et al.

    The evaluation of determinants of early postpartum low mood: the importance of parity and inter-pregnancy interval

    Eur J Obstet Gynaecol Reprod Biol

    (2000)
  • T. Kitamura et al.

    Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression

    Arch Womens Ment Health

    (2006)
  • J.L. Cox et al.

    Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale

    Br J Psychiatry

    (1987)
  • J.L. Cox et al.

    Perinatal psychiatry. use and misuse of the Edinburgh Postnatal Depression Scale

    (1994)
  • L. Murray et al.

    Validation of the Edinburgh Postnatal Depression Scale on a community sample

    Br J Psychiatry

    (1990)
  • C.D. Spielberger et al.

    Manual for the State-Trait Anxiety Inventory

    (1970)
  • Cited by (48)

    • Postpartum depression among women who have experienced intimate partner violence: A prospective cohort study at Moshi, Tanzania

      2017, Journal of Affective Disorders
      Citation Excerpt :

      This problem is worsened by society due to lack of societal awareness of the problem of depression and seeking help to professionals, families or friends is not the culture of Tanzanians (Kaaya et al., 2010). Early detection of PPD and those at increased risk of PPD may therefore minimize complications suffered by mothers and their babies, and should therefore be considered as a fundamental element of good obstetric care (Gonidakis et al., 2008; Ludermir et al., 2010; Tiwari et al., 2008). Results from this study indicates PPD is a problem for many women, In the presence of violence women (and men) become depressed is obviously not at all surprising, but the most vulnerable group are the women, especially in low income countries, therefore there is a need to train health workers and create an awareness about depression in wider society.

    View all citing articles on Scopus
    View full text