Deniz ÇALIŞKAN, Kenan KÖSE, M. Esin OCAKTAN, Oya ÖZDEMİR, Bedriye ÖNCÜ

Antepartum and postpartum depression in a primary health care cemter area

Amaç: Topluma dayalı bu çalışmada, Park Sağlık Ocağı bölgesinde yaşayan gebe kadınların gebelikte ve doğum sonrası depresyon skorlarını izlemek ve depresif duygu durum ile ilişkili faktörleri değerlendirmek amaçlanmıştır. Gereç ve Yöntem: Park Sağlık Ocağı bölgesinde araştırma sırasında tespit edilen tüm gebeler (n=66) Edinburgh Doğum Sonrası Depresyon Ölçeğini (EPDS) ve bir anket formunu gebelik sırasında bir kez, doğum sonrası iki kez (2.haftada ve 6. ayda) olmak üzere, toplam üç kez doldurmuşlardır. Depresif duygu durum tanısı için, EPDS kesme noktasına göre 13 ve üzeri puan olası depresif duygu duruma işaret etmiştir. Bulgular: Tüm grubun ortalama EPDS puanı gebelikte, postpartum her iki ölçümden de yüksektir (ardışık olarak p=0.054, p=0.003). EPDS skoru kesme noktası üzerinde olan kadın oranı gebelik döneminde %31.8 iken, doğum sonrası 2. hafta %22.7'ye, doğum sonrası 6.ayda %19.7'ye azalmıştır. Doğum sonrası depresif duygu durum varlığı ile doğumun şekli ve annenin çalışma durumu ilişkili bulunmuştur. Tartışma: Bu çalışma ile, depresif bozukluk riskinin kadınlarda sadece doğum sonrası dönemde değil, gebelikte de ortaya çıkabileceğini ve sağlık personelinin doğum sonrası olduğu kadar gebelik döneminde ruhsal durum değişikliklerini gözden kaçırmaması gerektiği sonucuna varılmıştır.

Bir sağlık ocağı bölgesinde doğum öncesi ve doğum sonrası depresyonun değerlendirilmesi

Aim: The aim of this community based study was to follow depression scores of pregnant women after delivery and to determine factors associated with depressive mood in a primary health care center area. Material and Method: In this study, all pregnant women (n=66) living in Park Health Center Region in Ankara, completed a questionnaire and Edinburgh Postnatal Depression Scale (EPDS) once in pregnancy and twice in postpartum period at 2nd week and 6th month. EPDS scores above cut off point (?13) indicated possible depressive mood. Results: Mean EPDS score in pregnancy was higher than both postpartum measurements (p=0.054, p=0.003 respectively). Number of women with EPDS scores above cut-off declined in time as follows: 31.8% during pregnancy, 22.7% at postpartum 2nd week, 19.7% at postpartum 6th month. Associated factors with postpartum depressive mood were type of delivery and working status (p

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1. Kessler RC. Epidemiolgy of women and depression. Journal of Aff ective Disorders 2003;74:5-13.
2. Steiner M, Dunn E, Born L Hormones and mood:from menarche to menopause end beyond. Journal of Aff ective Disorders 2003;74:67-83.
3. Kara B, Cakmakli P, Nacak E ve ark. Doğum sonrası depresyon, In Turkish. STED 2001;10:333-334.
4. Danaci AE, Dinc G, Deveci A et al. Postnatal depression in Turkey: epidemiological and cultural aspect. Soc Psychiatry Psychiatr Epidemiol 2002;37:125-129.
5. Lane A, Keville R, Morris M et al. Postnatal depression and elation among and their partners: prevalence and predictors. British Journal of Psychiatry 1997;171:550-555.
6. Inandi T, Elci OC, Ozturk A ve ark. Risk factors for depression in postnatal fi rst year, in eastern Turkey. International Journal of Epidemiology 2002;31:1201-1207.
7. Andersson L, Sunström-Poromaa I, Bixo M et al. Point prevalence of psychiatric disorders during the second trimester of pregnancy: a population-based study. Am J Obstet Gynecol 2003;189:148-54.
8. Matthey S, Barnett B, Ungerer J et al. Paternal and maternal depressed mood during the transition to parenthood. Journal of Aff ective Disorders 2000;60:75-85.
9. Lee DTS, Yip SK, Chiu HFK et al. Detecting postnatal depression in Chinese women. British Journal of Psychiatry 1998;172:433-437.
10. Cooper PJ, Tomlinson M, Swartz L et al. Post-partum depression and the mother-infant relationship in South African peri-urban settlement. British Journal of Psychiatry 1999;175:554-558.
11. Aff onso DD, De AK, Horowitz JA et al. An international study exploring levels of postpartum depressive symptomotology. Journal of Psychosomatic Research 2000;49:207-216.
12. Cooper PJ, Murray L. Clinical review: Postnatal depression. BMJ 1998;316:1884-1889.
13. Morris-Rush JK, Freda MC, Bernstein PS. Screening for postpartum depression in an inner-city population. Am J Obstet Gynecol 2003;188:1217-19.
14. Gotlib IH, Whiff en VE, Mount JH et al. Prevalence rates and demographic characteristics associated with depression in pregnancy and the postpartum. J Consult Clin Psychol 1989;57:269-74.
15. Wilson LM, Reid AJ, Midmer DK et al. Antenatal psychosocial risk factors associated with adverse postpartum family outcomes. Can Med Assoc J 1996;154:785-799.
16. Evans J, Heron J, Francomb H et al. Cohort study of depressed mood during pregnancy and after childbirth. BMJ 2001;323:257-260.
17. Ahokas A, Kaukoranta J, Aito M. Eff ect of oestradiol on postpartum depression. Psyhopharmacology 1999;146:108-110.
18. Abou-Saleh MT, Ghubash R, Karim L et al. Hormonal aspect of postpartum depression. Psychoneuroendocrinology 1998;23;465-475.
19. Mc Elderry D. Screening of adolescent females for depression before, during and after pregnancy. Opinions in Pediatric and Adolescent Gynecology 2001;1,14:131-33.
20. Murray L, Cooper P.J. Postpartum depression and child development. Psychological Medicine 1997;27:253-60.
21. Meighan M, Davis MW, Th omas SP et al. Living with postpartum depression: the father’s experience. MCN 1999;24:202-208.
22. Lovejoy MC, Graczyk PA, O’Hare E et al. Maternal depression and parenting behaviour: A meta-analytic review. Clinical Psychology Review 2000;20: 561-592.
23. Engindeniz AN, Kuey L, Kultur S. Th e Turkish version of Edinburgh Postnatal Depression Scale; A Study of Validity and Reliability. Spring Symposium First Book. Psychiatry Association Press, Ankara;2000.
24. Georgiopulos AM, Bryan TL, Yawn BP et al. Population-Based Screening for Postpartum Depression. Obstetrics&Gynecology 1999;93:654-657.
25. Costa DD, Larouche J, Dritsa M et al. Psychosocial correlates of prepartum and postpartum depressed mood. Journal of Aff ective Disorders 2000;59:31-40.
26. Hung CH, Chung HH. Th e eff ect of postpartum stres and social support on postpartum women’s health status. International Journal of Nursing Practice 2001;36;676-684.
27. Bugdayci R., Sasmaz T, Tezcan H ve ark. A cross-sectional prevalence study of depression At various times after delivery in Mersin province in Turkey. Journal of Women’s Health 2004;13:63-68.
28. Gürel SA, Gürel H. Th e evaluation of determinants of early postpartum low mood: the importance of parity and interpregnancy interval. European Journal of Obstetrics&Gynecology and Reproductive Biology 2000;91:21-24.
29. Ekuklu G, Tokuç B, Eskiocak M ve ark. Prevalence of Postpartum Depression in Edirne,Turkey and Related Factors. J Reprod Med 2004;49:908-914.
30. Chaaya M, Campbell MR, El Kak F et al. Postpartum Depression: Prevaence and determinants in Lebanon, Archives of Womens Mental Health 2002;5:65-72.
31. Johnstone SJ, Boyce PM, Hickey AR et al. Obstetric risk factors for postnatal depression in urban and rural community samples. Australian and New Zealand Journal of Psychiatry 2001;35: 69-74.
32. Hana B, Jarman H, Savage S. Th e clinical application of three screening tools for recognizing post-partum depression. Journal of Advanced Nursing 2004;10:72-79.
33. Huang YC, Mathers N. Postnatal depression-biological or cultural? A comparative study of postnatal women in the UK and Taiwan. Journal of Advanced Nursing 2001;33:279-287.
34. Josefsson A, Lisbeth A, Berg G et al. Obstetric, Somatic and Demographic Risk Factors for Postpartum Depressive Symptoms. Obstetrics&Gynecology 2002;99:223-228.
35. Beck CT. Predictors of Postpartum Depression, Nursing Research 2001;50:275-285.
36. Yoshida K, Marks MN, Kibe N et al. Postnatal depression in Japanese women who have given birth in England. Journal of Aff ective Disorders 1997;43:69-77.
37. Th ome M. Predictors of postpartum Depressive Symptoms in Icelandic Women. Archives of Womens Health 2000;3:7-14.