Brief report
The prevalence of perinatal depression and its associated factors in two different settings in Brazil

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Abstract

Background

The prevalence of antepartum and postpartum depression (PPD) and its association with certain risk factors was evaluated.

Method

The Edinburgh Postnatal Depression Scale (EPDS) was applied and sociodemographic data was obtained at the beginning of the third trimester of pregnancy and at 4–6 weeks postpartum.

Results

The prevalence of depression was 24.3% during pregnancy (n = 600 women) and 10.8% in the postpartum period (n = 555). The factors independently associated with antepartum depression were the absence of a partner (PRadj 1.93; 95%CI: 1.44–2.58), a lower socioeconomic class (1.75; 1.18–2.60), being non-white (1.48; 1.09–2.01) and multiparity (1.32; 1.01–1.74). For postpartum depression, the factors were the occurrence of psychological violence (PRadj 3.31; 95%CI: 2.02–5.43), use of alcohol during pregnancy (2.14; 1.33–3.45), being non-white (1.85; 1.11–3.08) and physical violence (2.14; 1.13–4.08). The sensitivity of depression during pregnancy as a predictor of PPD was 75%, while specificity was 81%. There were no differences between the two settings.

Limitations

EDPS does not diagnose depression and as a screening instrument it could overestimate the true prevalence of depression.

Conclusions

The use of the EPDS instrument during pregnancy would allow a screening for identifying women at higher risk of developing PPD and then a proposal of specific interventions to manage this condition. Postpartum depression was prevalent in around 10% of the women and was associated with unfavorable sociodemographic conditions including the use of alcohol and with the occurrence of psychological and physical violence.

Introduction

Postpartum depression (PPD) is a common clinical condition affecting a large number of women worldwide, with prevalence as high as 20% in the first three months after delivery (Gavin et al., 2005). It exerts an economic, emotional and financial burden on woman, affecting her quality of life, marital and mother–child relationships, and the infant's psychosocial development (Marcus and Heringhausen, 2009). It is also associated with early childhood underweight and stunting in developing countries (Surkan et al., 2011).

Diagnosis of PPD is established with a structured clinical interview, using the criteria for mental disorders of the American Psychiatric Association (APA, 2000). During pregnancy, it is also possible to use scales to identify women at higher risk for PPD, particularly in the third trimester when prevalence is around 12% (Bennett et al., 2004). Identification while still pregnant may allow a timely intervention that could reduce the burden of the disease (Breedlove and Fryzelka, 2011).

Identification of the risk factors is important in order to establish prenatal screening policies. The need for universal screening for PPD has not yet been established despite the recognition that it would potentially benefit women (ACOG, 2010). Self-administered scales are used to screen individuals who may have depression. The most commonly used instrument worldwide is the EPDS (Edinburgh Postnatal Depression Score) developed by Cox et al. (1987) and validated in Brazil (Santos et al., 1999). The probability of depression depends on the cut-off point adopted and on the population studied, requiring previous validation.

The purpose of this study was to establish the prevalence of depression and identify associated factors in the third trimester of pregnancy and postpartum in low-risk pregnant women in two Brazilian settings: the city of Recife in northeastern region and the city of Campinas in the southeastern region.

Section snippets

Subjects and methods

This was a cross-sectional study where the women were evaluated on two separate occasions in a multiple temporal series approach. Depression was assessed antepartum (at the beginning of the third trimester) and postpartum (4–6 weeks after delivery). Sample size was calculated with a mean prevalence of PPD of 13% using the EPDS (Santos et al., 2007). To detect a minimum difference of 10%, with a 95% confidence limit and a power of 80%, 250 cases would be necessary. Considering a possible loss of

Results

Six hundred women were interviewed for depression during pregnancy and 555 during postpartum period (45 cases, 7.5% lost the second interview). The characteristics of women who did and did not participate in the second interview were similar. The overall prevalence of EPDS scores  12 was 24.3% during pregnancy and 10.8% postpartum, ranging from 20.3% (pregnancy) to 11.1% (postpartum) in Campinas and from 28.3% (pregnancy) to 10.5% (postpartum) in Recife. Only antenatal depression was

Discussion

This is the first study in Brazil using the EPDS during pregnancy and in the postpartum to evaluate factors associated with perinatal depression in women with no previous history. The 24% prevalence of depression in the third trimester of pregnancy and 11% of PPD are in agreement with data reported from other studies in the country.

It was around 20% when using a previously validated screening instrument during pregnancy (Faisal-Cury and Rossi-Menezes, 2007, Lovisi et al., 2005, Pereira et al.,

Role of funding source

This study was supported by CNPq (the Brazilian National Research Council), through application MCT/CNPq 14/2009, grant 476008/2009-3.

Conflict of interest statement

The authors declare that there are no conflicts of interest associated with this study.

Acknowledgements

We would like to thank Karla S. Pádua for training the interviewers and for all the input in the making of the study main questionnaire, and Maria H. Sousa for performing the statistical analysis procedures.

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