A 6-month study of postpartum depression and related factors in Athens Greece
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)
- et al.
Postnatal depression in Japanese women. Detecting the early onset of postnatal depression by closely monitoring the postpartum mood
J Affect Disord
(2000) - et al.
Obsessional-compulsive complaints
Behav Res Ther
(1977) - et al.
Maternity blues in Athens, Greece. A study during the first three days of puerpartum
J Affect Disord
(2007) Postpartum psychiatric disorders
Lancet
(2004)- et al.
Endocrine factors in the etiology of postpartum depression
Compr Psychiatry
(2003) - et al.
Psychosocial correlates of prepartum and postpartum depressed mood
J Affect Disord
(2000) - et al.
Antenatal risk factors for postpartum depression: a synthesis of recent literature
Gen Hosp Psychiatry
(2004) - et al.
Obsessive-compulsive symptoms in pregnancy and the puerperium: a review of the literature
J Anxiety Disord
(2003) - et al.
Comorbid depression in obsessive compulsive disorder (OCD): symptomatic differences to major depressive disorder
J Affect Disord
(2005) - et al.
A systematic review of the epidemiology of somatisation disorder and hypochondriasis
J Psychosom Res
(2004)
The relationship between alexithymia, depression and sleep complaints
Psychiatry Res
Traite de la Folie des femmes enceintes des Nouvelles Accouchees et des Nourrices
Predictors of postpartum depression. An update
Nurs Res
Post natal mental illness: a transcultural perspective
Soc Psychiatry Psychiatr Epidemiol
An overview of postpartum psychiatric disorders
NAACOGS Clin Issues Perinat Women's Health Nurs
Prospective study of the psychiatric disorders of childbirth
Br J Psychiatry
Post-partum depression and the mother-infant relationship in a South African peri-urban settlement
Br J Psychiatry
Gender, poverty and postnatal depression: a study of mothers in Goa, India
Am J Psychiatry
A psychiatric epidemiological study of postpartum Chinese women
Am J Psychiatry
Postnatal depression in Turkey: epidemiological and cultural aspects
Soc Psychiatry Psychiatr Epidemiol
The prevalence of early postpartum psychiatric morbidity in Dubai: a transcultural perspective
Acta Psychiatr Scand
Prevalence of postpartum depression in Edime, Turkey, and related factors
J Reprod Med
The evaluation of determinants of early postpartum low mood: the importance of parity and inter-pregnancy interval
Eur J Obstet Gynaecol Reprod Biol
Multicentre prospective study of perinatal depression in Japan: incidence and correlates of antenatal and postnatal depression
Arch Womens Ment Health
Detection of postnatal depression: development of the 10-item Edinburgh Postnatal Depression Scale
Br J Psychiatry
Perinatal psychiatry. use and misuse of the Edinburgh Postnatal Depression Scale
Validation of the Edinburgh Postnatal Depression Scale on a community sample
Br J Psychiatry
Manual for the State-Trait Anxiety Inventory
Cited by (48)
The role of stress in perinatal depression and anxiety – A systematic review
2024, Frontiers in NeuroendocrinologyPersonality traits as a risk factor for postpartum depression: A systematic review and meta-analysis
2022, Journal of Affective DisordersPregnancy-related anxiety among Chinese pregnant women in mid-late pregnancy under the two-child policy and its significant correlates
2020, Journal of Affective DisordersPostpartum depression among women who have experienced intimate partner violence: A prospective cohort study at Moshi, Tanzania
2017, Journal of Affective DisordersCitation 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.
Pregnancy, perinatal and postpartum complications as determinants of postpartum depression: The Rhea mother-child cohort in Crete, Greece
2018, Epidemiology and Psychiatric Sciences