PREVALENCE, CORRELATES AND EXPERIENCES OF PERINATAL DEPRESSION IN OMAN

Abstract

Background: Perinatal depression is known to have detrimental effects on both the mother and the child. Little research has examined the prevalence, risk factors, and experiences of perinatal depression in Middle Eastern countries, including Oman. This thesis therefore examines these gaps in the literature through the use of mixed method research. Methods: This thesis consists of three separate studies which follow a sequential and logical progression. The first was a systematic review of systematic reviews which provided a global picture of the prevalence and correlates of perinatal depression, and investigated potential influences on those prevalence rates, including population characteristics and the methodological quality of the systematic reviews undertaken. The second was a longitudinal study to examine the risk factors associated with changes in depressive symptoms from the third trimester of pregnancy to two-eight weeks after delivery, using the Edinburgh Postnatal Depression Scale (EPDS), with a cut-off of ≥12. The final study was a qualitative study using semi-structured interviews that investigated the views and experiences of healthcare professionals (HCPs) and perinatal patients relating to perinatal depression. Findings: The systematic review of systematic reviews included 128 publications, of which 54 (42.2%) reported on the prevalence of perinatal depression and 74 (57.8%) examined its correlates. The average global prevalence of perinatal depression, antenatal depression, and postnatal depression was 26.3%, 28.5%, and 27.6%, respectively. Major correlates of perinatal depression included a personal history of mental illness, stressful life events, lack of social support, lifetime history of abuse, marital conflicts, maternity blues, childcare stress, chronic medical conditions, pre-eclampsia, gestational diabetes mellitus, exposure to second-hand smoke, and sleep disturbance. The quantitative study, which included a sample of 306 patients, of whom 276 completed the study, identified four groups of women based on the EPDS scores: 1) antenatal depression (8.82%; n = 27); 2) ante- and postnatal depression (14.38%; n = 44); 3) postnatal depression (12.09%; n = 37); and 4) non-depression (54.90%; n = 168). Depressive symptoms were associated with low-birthweight babies (d = 0.50), confirming depression's negative effects on perinatal health outcomes. The three depression groups had higher antenatal Perceived Stress Scale (PSS-10) scores (ds > 0.52) than the non-depression group, while the non-depression group had higher antenatal and postnatal Maternity Social Support Scale (MSSS) scores (ds > 0.63), and better relationships with their mothers-in-law antenatally (d= 0.57). The third was a qualitative study of 15 HCPs and 15 patients, which identified four themes: 1) making sense of perinatal depression; 2) how to deal with perinatal depression; 3) barriers to addressing perinatal depression in primary perinatal care settings; 4) facilitators in detecting and managing perinatal depression. Conclusion: This PhD investigated a 'gap' in the literature using a mixed method design, revealing that perinatal depression has been neglected in primary health care systems in Oman despite the presence of depressive symptoms among perinatal women. It also revealed that various psychosocial and obstetric factors, some of which were comparable to those identified in more regularly studied populations, were shown to be associated with changes in depressive symptoms during the perinatal period. The final study revealed many barriers to identifying and managing perinatal depression at the patient, HCP, and system levels. These findings are not cultural or healthcare-related. The "Global North"—the UK and North America—also has many of these issues. Thus, patient, practise, and primary care interventions are needed to help global primary healthcare systems recognise and treat perinatal depression.

Date of Award	4 Apr 2023
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Dawn Edge (Main Supervisor) & Christopher Arden Armitage (Co Supervisor)