PPD can have significant detrimental effects on the mother as well as the child. Depressed mothers have negative and pessimistic thoughts. These thoughts can affect her relationships with her family and children. They can lead to conflicts and problems within the family. PPD can also lead to the neglect of the newborn baby and this weakens the mother-child relationship. This can affect the health of the new born child as well and he might develop serious disease as he does not get proper attention and care from the mother.
It can be severe enough to result in behavioral problems, cognitive dysfunction and developmental delay in the child. All the children of depressed mother have increased risk of developing psychiatric diseases, particularly depression. There are a number of risk factors which have been identified for developing PPD. In a meta-analysis of 84 studies, 10 major risk factors were identified. These included history of depression, prenatal depression, low self esteem, low socioeconomic status, unplanned pregnancy, etc. (Beck, 2001).
Similarly, a review of 12 research articles by Raid showed that problems in the family, lack of social support and low self esteem are major risk factors for PPD (Raid, 2007). A review by Robertson calculated effect sizes of different risk factors for PPD and it was found that depression during pregnancy, past history of depression, major life events and lack of social support are strong risk factors for developing PPD whereas psychological factors and problems in marital relationship are moderate risk factors and obstetric problems and low socioeconomic status are small risk factors (Robertson, 2004).
Bloch identified a few hormone-related risk factors for developing PPD. These include history of psychiatric illness (previous PPD), mood disturbances during third trimester and history of premenstrual dysphoric disorder (Bloch, 2006). A review by Halbreich included 143 studies and difference in the prevalence of PPD all over the world was analyzed. It was noted that the prevalence varied considerably between different groups and countries. A number of factors were identified accounting for this difference.
These include social stigma associated with mental illnesses in various cultures, poverty, social support, level of stress, health facilities and nutrition (Halbreich, 2006). There are a few other studies which mention socioeconomic status as a risk factor for PPD while others found that there is no link. Cox did not find an association between PPD (Cox, 1982) and socioeconomic status but Surtees identified socioeconomic status as a major risk factor for PPD (Surtees, 1983).
Although, there are a number of studies throughout the literature which identify the risk factors for PPD, only a few have examined the association exclusively between PPD and socioeconomic status. Moreoever, the results of different studies regarding socioeconomic condition as a risk factor for PPD are inconsistent in all the studies and a definite decision has not yet been reached. The studies which have been conducted have a number of limitations like small sample size, inclusion of only a few risk factors, etc.
These studies have also not studied the relationship between different risk factors and their overall impact on PPD. Therefore, there is need to establish strong association between different factors which increase the risk for PPD so that high risk individuals can be recognized easily and treated to reduce the debilitating effects of this condition. Recognizing the risk factors like low socioeconomic status will also help us in alleviating these factors which contribute to the disease progress.
The purpose of this study is to find the prevalence of PPD at single tertiary care centre and to find the risk factors associated with it. This study also aims to find an association between socioeconomic status and PPD. The hypothesis of this study is that PPD is a common entity and low socioeconomic status, i. e. low income and higher number of dependant members, increases the risk of PPD.