Prevalence of Common Mental Disorder And Associated Factors Among Pregnant Women Attending Abebebch Gobena Mother And Child Hospital Addis Ababa Ethiopia in 2022: Cross sectional study

doi:10.21203/rs.3.rs-2446394/v1

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Prevalence of Common Mental Disorder And Associated Factors Among Pregnant Women Attending Abebebch Gobena Mother And Child Hospital Addis Ababa Ethiopia in 2022: Cross sectional study

https://doi.org/10.21203/rs.3.rs-2446394/v1

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Introduction:

Common mental disorders (CMDs) are nonpsychotic mental health conditions like depression, anxiety, adjustment, and somatoform disorders that compromise daytoday functioning. Pregnancy and the transition to motherhood involve major physical and psychological changes in the expecting mothers.

Objective

To assess the prevalence of common mental disorders and associated factors among pregnant women in Abebech Gobena Hospital in 2022.

Method

Crosse sectional study was conducted from May to June 2022 at Abebech Gobena hospital. Systematic random sampling method was employed to select 421 study participants. The data were collected using structured questionnaire and face- to -face interview method. Data was entered in to Epi info 7.1 and export to (SPSS) version 20 for analysis. The association between dependent and independent variables was analyzed by using logistic regression. In bi-variable logistic regression (at p value < 0.25) was entered in to multivariable logistic regression. Adjusted odds ratio with 95% confidence interval was computed. Statistical significance was declared at p value of < 0 .05.

Results

From the total of 415 participant 85(20.5%) had common mental disorder. As of this result, participants were unplanned 2.9 times [AOR = 2.9, CI95%( 1.3, 6.7)] developed common mental disorder than planed pregnant. Pregnant women who reported history of chronic medical illness have 2.8 CMD than who didn’t (AOR = 2.8; 95%CI: 1.08—7.1). The odds of having CMD among participants who were lifetime alcohol use was 5.3 times (AOR = 5.304, 95% CI = 3.1, 7.1) than participants who did not use. Participants who had no husband support continuity of pregnant were 1.97 times more develop CMD (AOR = 1.97, 95% CI = 0.96, 4.04) as compared with who had husband support.

Conclusion and Recommendation:

In this study the prevalence of Common Mental Disorder in pregnant women was high. Chronic illness, alcohol use in lifetime, husband support and status of pregnancy were found to be significantly associated with common mental disorder. Therefore all stake holders would involve in providing special psycho-social support during pregnancy than ever at the time of ANC follow up.

Common mental disorder

Ethiopia

Pregnancy

Prevalence

Background

Common mental disorder(CMD) are nonpsychotic mental health conditions like depression, anxiety, adjustment, and somatoform disorders that compromise daytoday functioning (1). Pregnancy and the transition to motherhood involve major physical and psychological changes in the expecting mothers(2). Historically, pregnancy is a time of enjoyment and full-filling for women. Evidence indicates that there is an increase morbidity of depression and anxiety, during the period of pregnancy. There are a biological, psychological and social functional changes (3). Perinatal depression and anxiety are referred to as Common Perinatal Mental Disorders (CPMDs) as they represent the most common mental health problems faced by women during the perinatal period(4). Perinatal mental health is a leading public health issue because of its negative effect on both maternal and child outcomes and its significant economic cost to society if left untreated(5). Over the world 10% of pregnant women experience a mental disorder during pregnancy(6). The World Health Organization reported that almost one-in-three to one- in five pregnant women experienced a significant mental health problem in the developing countries(2). These Non-psychotic common antenatal mental disorders (CAMD) are more prevalent in low- and lower-middle-income countries (LMICs) particularly among poorer women with gender-based risks or psychiatric history (7). According to the world health organization in 2001, anxiety and depression they are the leading mental health cause of disability in the global burden of disease (8). The main contributing factors of antenatal CMD includes women’s marital status, unplanned pregnancy, gestational age, and bleeding(9). Depressive symptoms during pregnancy may have devastating consequences, not only for the women but also for the child and family (10). Common mental disorder such as depression, somatoform disorder and anxiety are increasingly, Recognized for their burden in low resource countries such as Ethiopia, Ethiopia is one of the low income countries with high rates of mental health problems among pregnant women which ranges 9.2–33% in different areas of the Ethiopia(9).

Globally, around 450 million people are living with mental illness, Accounts for about one-third of mental illness globally (11). Perinatal mental health disorders have been studied in 90% of high-income countries and only in 10% of middle and low- income country(12). In high-income countries, about 10% of pregnant women and 13% of mothers of infants have significant mental health problems, depression, and anxiety being the most common(13). Mental disorders are common causes of morbidity and mortality for women in the perinatal period, In the UK and Ireland, from 2009 to 2013 there were 3.7 deaths per 100,000 pregnancies from mental health-related causes during or up to 1 year after the end of pregnancy, 101 women died by suicide over the same period, representing one in seven of all maternal deaths(14).

The prevalence is much higher in low- and middle-income countries(15). Common mental disorder among pregnant women is associated with reduced social participation and caregiving capacity and constitute a significant public health problem (13). Every pregnancy is accompanied by emotional, psychological, and cognitive changes(3). Untreated common mental disorder (CMD) which is affecting women during the childbearing years is an important health problem in low and middle-income countries(16).

Maternal CMD affected 15.6% of women during pregnancy and 19.8% during the postnatal period. Evidence is accumulating from middle-income4–6 and low-income7–9 countries that the children of mothers with CMD have less optimal growth, cognitive, and language development even when taking social adversity into account(17).

Depressive disorders are predicted to be the second leading cause of global disability burden by 2020 (18). Depressive disorders led to a global total of over 50 million Years Lived with Disability (YLD) in 2015 The estimated prevalence of depression worldwide is increased by 18.4% from 2005 to 2015 (19).

In Brazil, 9.3% of the population have symptoms related to anxiety and 5.8% have depression (11) Low and lower-middle-income countries the non-psychotic perinatal common mental disorder (CMD) is common primarily among poorer women with gender-based risks or psychiatric history(9).

10% of pregnant women experience a mental disorder during pregnancy, and those in low- and mid- low-income countries (LMICs) are disproportionately impacted due to higher prevalence of mental health in sub-Sahara country(6). In Nigeria Ibadan Oyo state 2017 “Women whose husbands had no job were significantly more depressed/anxious 2.13 times compared to those whose husbands had a permanent job, Women in their first pregnancy were 2.35 times more likely to exhibit depression/anxiety than those who had been pregnant before women, who did not plan the current pregnancy two times were more likely to be depressed/anxious (20).

In Ethiopia, according to 2013 global report by the World Health Organization (WHO), maternal mortality is estimated to be 420/100,000 live births

In this harsh reproductive health context, it is perhaps not surprising that the prevalence of Common mental disorders during the antenatal period, mostly depression and anxiety (15.6%), is found to be higher in pregnant women in Ethiopia(21).Even though Ethiopia is one of the low income countries with high rates of mental health problems in pregnant women, no more awareness about the treatment of this mental problems including common mental disorder (9). The rationale for investigating CMD in pregnant women is that, because pregnancy is a period of physiological mal-adjustment, psychological and social factors may impose vulnerability to develop mental distress(7). In order to guide an appropriate interventions, it is critical to understand the extent to which pregnant women are prone to CMD, Therefore interventions are required that address both the social and medical risk of CMD and the disabilities and economic deprivation that are a consequence of CMD(21). Most of the studies conducted on psychiatric disorders during pregnancy in Ethiopia are focused on postpartum depression, here with there are limited number of studies done on the prevalence of ante partum depression and anxiety disorders in general and in urban Ethiopian(22). Community-based cross-sectional study conducted in Illu ababor in 2018 showed the prevalence of rate common mental disorders as 27.2% (23). Study conducted in Somali region in 2020, an institutional-based cross-sectional study, 24.3% of women had antenatal depression (24).

The result from this study will help primarily hospitals for plan and strengthen the system of screening, diagnoses and treatment of common mental disorders among pregnant women at the hospital. It was created awareness for the hospital, government, and others concerning bodies about the magnitude of the disorder and the need for improving diagnostic common mental dis order among antenatal care (ACMD). Generally, this study will be used as baseline information for further studies. It also helps any organization or individual who wants to study this title.

Study design and setting

Facility-based cross-sectional study was conducted on 421 pregnant women who were attending at Abebech Gobena Maternal and Child (MHC) Hospital. The hospital is found in Addis Ababa Lame Kura sub-city woreda 02. Abebech Gobena maternal and child hospital is established in 2021. The hospital gives maternal and child health service. The hospital services gives family planning, delivery, antenatal care, postnatal care, expanded program on immunization (Epi) and neonatal intensive care unit (NICU) service. The hospital had 14 health centers and one hospital catchment. On average quarterly data shows 1294 pregnant women follow monthly. The study was conducted from July 1–30, 2022.

Sample size and sample procedure

All pregnant women attending at antenatal care service clinic were taken as a source population while those pregnant mothers who were available during data collection period were considered as a study population. The total number of pregnant mothers who will visit the clinic within the three months of data collection period was calculated and used to determine the interval, and systematic random sampling technique was used to include every three pregnant mothers available at the clinic during the data collection period. A single population proportion formula with an assumption of 95% confidence level, a 5% margin of error and a 46.6% had common mental disorder among pregnant women in Hawasa referral hospital(21). Then the final calculated sample size was 421.

Sampling procedure and Technique

Systematic random sampling techniques were used to select by taking 2022 hospital monthly antenatal care follow report, from previously three consecutive average monthly (February, March and April) data which was 1294. Study participants by using skip interval of K = N/n = 1294/421 = 3.075 ≈ 3, n = total sample size K = skip interval N = Total study population. 1294 the number of quarterly attend in 2022. The first study participant was selected by lottery method first cases that attend the hospital on the day of data collection and then follow every 3th study participant.

Study variable

The dependent variable was Common Mental Disorder and measured as a dichotomous variable (yes/no). We measured PTSD as a dichotomous variable (yes/ no). Independent variables included socio-demographic factors (age, sex, educational status and occupational status), clinical variables (history of chronic medical illness), substance-related factors (alcohol consumption, cigarette smoking, khat chewing), while psychosocial factors embraced social support

Operational definition

Common mental disorder

Defined based on the cut off score of the self-reporting questionnaire (SRQ-20) items, participants who score 6 or more would take as CMD(7).

History of mental illness

when subjects have at least one or more known self-reported mental illness before the study period.

Alcohol use

Ever use was defined as use of alcohol even once in lifetime, and current use was defined as use of alcohol in the past three months

Khat use

Ever use was defined as use of khat even once in lifetime, and current use was defined as use of khat in the past three months.

Smoking ciggarate

Ever use was defined as use of cigar ate even once in lifetime, and current use was defined as use of ciggarate in the past three months.

Chronic medical illness

When subjects have at least one or more known self-reported chronic disease before the study period.

Data Collection Procedures and tools

A structured questionnaire was used to collect data on socio-demographic variables, socio-economic status, psychosocial factors, clinical factors and substance chronic medical problems, stage of pregnancy, and the presence of mental illness. The study employed the self-reporting questionnaire 20 of item (SRQ-20). This consists of 20 yes/no questions with a reference period of the previous thirty days. It had an acceptable level of reliability and validity in developing countries and is recommended by the world health organization (WHO) as a screening tool. It has previously been used to measure maternal illness in a four-country study which included Ethiopia where a cut-off score of 6 or more was used to separate probable non-cases of common mental disorder.

Regarding substance use such as cigarette smoking, alcohol drink and chat chewing once or more in lifetime. Chronic medical illness when subjects have at least one or a more known self-reported chronic diseases before the study period.

Data quality control and Management

The questionnaire was first prepared in English and translated in to local language (Amharic). It was pretested on 5% of the sample size a week before the beginning of the actual data collection period at Gandhi memorial hospital. Based on the pretest necessary revision was made to the questionnaire. At the end of each data collection day, the researcher checkout the completeness of the filled questionnaires. Any error, ambiguity, incompleteness, and other encountered problems were addressed on the follow day’s activities. Any missing values were checked before data analysis.

Data processing and analysis

Data was checked for its completeness, editing, clean and coded then enter into Epi info 7.2.01 and was exported to (SPSS) version20 for analysis. Descriptive analysis like percent and frequency were computed and presented using appropriate figure and table. Bivariate logistic regression was used to identify variable associated with common mental disorder among pregnant women. Variables with p-value < 0.25 in bivariate analysis were considered as candidates for multiple logistic regressions. Multiple logistic regressions were used to identify factors independently associated with dependent variables. P-value < 0.05 was considered statistically significant. Strength of association was measured using odds ratio, and 95% confidence intervals.

Socio-demographic characteristics

Out of the total 421 participants, 415 participants were included with response rate 98.6%. From those participants, 308(74.4%) were with age interval between 20 and 35 and 100(24.1%) were 35 age and above in this study. It was observed that the majority 374(90.1%) of the respondent are married. The educational status of the study group were 39(9.4%) are unable to write and read, 217 (52.3%) were elementary up to preparatory, 159(38.3%) were level above regarding occupation most 169(40.7% are house hold wife, 107 (25.8%) were private job considering income level monthly income level 1500–5000 income level were 175(40.7%) and 11000 and above are 60(14.5%) (Table 1).

Table 1

socio-demographic characteristics of common mental disorder among pregnant women attend Abebech Gobena mother and child hospital mother and child hospital Ababa, Ethiopia 2022(N = 415)
Variable	Frequency	Percent (%)
Age in year
≤ 19	7	1.7
20__34	308	74.2
≥ 35	100	24.1
Marital status
Single	29	7.0
Married	374	90.1
Divorced	6	1.4
Separated	6	1.4
Job description
Government employees	71	17.1
Private job	107	25.8
Daily labor	35	8.4
Student	18	4.3
House hold wife	169	40.7
Jobless	15	3.6
Monthly income
< 1500	42	10.1
1500–5000	175	42.2
6000–10000	136	32.8
> 11000	60	14.5
Number of house hold member
0–2	140	33.7
3–5	226	54.5
> 5	49	11.8
Number of alive children
0	142	34.2
1–2	159	38.3
≥ 3	114	27.5
Educational level
Unable write and read	39	9.4
Elementary up to preparatory	217	52.3
Level and above	159	38.3

Substance use, clinical factor and Obstetric & reproductive factors

Around twenty nine percent of women use traditional alcoholic drinks, “areke’, “tella”, “tej” (honey wine), or industrial beverages wine, bear at least once in their lifetime. Around 3% of study participants used khat in their lifetime and 3.4% of them smoke cigarette once or more in lifetime.

From those participants 5.3%, 1.4% and 5.8% had family history of mental illness, past history of mental illness and history of medical illness respectively. Almost half of the study participants were in 3rd trimester. Thirty three (8%) had unplanned pregnancies

Social support factor

From the study participants 50(12%) had no husband support during pregnancy.

Prevalence of common mental disorders among pregnant women

The prevalence of CMD among study participants were 20.5% (95% CI: 16.4–24.5%), with mean score of 2.57 (S.D ± 2.8). The minimum and maximum score of 0 and 12 respectively. Low symptom levels (SRQ scores 1–5) in 295 (71.1%) and no symptoms (SRQ = 0) 120 (28.9%) from study participant. (See Fig. 1 below).

Factor associated with common mental disorder among pregnant women

Binary logistic regression model was used to identify the determinant factors: socio-demographic, psychosocial and social support, alcohol use, clinical and obstetric factors, past history of mental illness, family history of mental illness and status of pregnant.

All variables that had p < 0.25 in the bivariate analysis were included into the final model, (multivariate logistic regression). A p-value < 0.25 on bivariate analysis, were candidate for multivariate logistic regression analysis. From this result, alcohol use, clinical and obstetric factors, past history of mental illness, family history of mental illness, cigar ate smoking, husband support and pregnancy status were significant association with CMD.

In the multi-variable analysis model; four variables were found to be statistically significant at the level of p < 0.05. Accordingly: pregnancy status, alcohol use in a lifetime, chronic illness and husband support.

Participants who had unplanned pregnancy were 3 times [AOR = 2.9, CI 95% (1.3, 6.7)] developed common mental disorder than mothers who had planned pregnancy. Pregnant women who had a history of chronic medical illness had higher odds of experiencing CMD than who didn’t (AOR = 2.8; 95%CI: 1.08–7.1). The odds of having CMD among participants who were lifetime alcohol use were 5.3 times (AOR = 5.304, 95% CI = 3.1, 7.1) than who did not use alcohol. Participants who had no husband support were 2 times more develop CMD (AOR = 1.97, 95% CI = 0.96, 4.04) as compared with who had husband support (Table 2).

The objective of this study was to assess the prevalence and associated factors of common mental disorder among Abebech Gobena mother and child hospital, Addis Ababa Ethiopia. The SRQ-20 was used to assess the prevalence of common mental disorders among study participants. Participants having total scores of 6 or higher suggesting that they were experiencing a common mental disorder during their pregnancy. The current study showed that the prevalence of CMD among pregnant women attending at Abebech Gobena hospital was 20.5% (95% CI: 16.4–24.5%). This finding was in line with the study conducted in Kenya which is 17.5%( 9). However the finding of this study was higher than study conducted in rural Haryana, which was 15.3% rate of CMD among pregnant women (1). The first probable reason for different prevalence rate might due to difference in screening tools, health service coverage and socio-economic status.

This finding was lower than the study done in Brazil which was 63% (15). This difference might be due to difference in socio-cultural and study period. This result is similar with study done in Illu Ababor Oromia Ethiopia, 27.2% of pregnant women had CMD (28). On the contrary the finding of this study is lower than the finding reported from Hawasa referral hospital, southern part of Ethiopia showed 46.6% of pregnant women had common mental disorder and also this result is lower than study done in three administrative town (Robe, Goba and Gini ) Bale zone south east Ethiopia shows prevalence of CMD among pregnant women was 35.8%(10). This difference may be due to study design, health service coverage and difference in socio-cultural.

Regarding the factors affecting common mental disorder, chronic medical illness, alcohol use, husband support and pregnancy status were significantly associated with CMD in pregnant women who were attending Abebech Gobena mother and child hospital.

Study participant who had chronic illness were 2.8 times more likely to have CMD than those who had no chronic medical illness. This is consistent with the study done in Debra Birhan, North Ethiopia (8) and systematic review done in nineteen countries (14). Study participant who use alcohol in lifetime were 5.3 times having CMD than not use alcohol in lifetime. This is consistent with a systematic review done in nineteen country showed that using alcohol was 6 times more develop CMD than participants who didn’t use alcohol in lifetime (14). Participants those who had unplanned pregnancy were 2.9 times more likely to develop CMD as compared to those who had planned pregnancy. This result was supported by the finding Nigeria in Ibadan Oyo state showed that status of pregnant had significant associated with CMD (27). Participants who had no husband support were 2 times more likely to have CMD than women who had husband support. This finding is supported by the study done in Somali region, eastern part of Ethiopia (29). This is inconsistent with the finding from study done in Kenya (9). In this study, having previous history of mental illness not significantly associated with CMD among pregnant women, which is contradicted with study conducted Bangladesh (11).

Conclusion

In this study the prevalence of Common Mental Disorder in pregnant women was 20.5%. Even if this prevalence was low when compared with previous studies done in different parts of Ethiopia, but it needs further work on this area. Chronic illness, alcohol use in lifetime, husband support and status of pregnancy were found to be significantly associated with common mental disorder. The result of this study indicated that common mental dis order was prevalent on pregnant. Therefore all stake holders would involve decreasing the prevalence of common mental disorder.

Recommendation

Based on the above result and conclusion the following recommendation were made Health professionals and institutions were expected to increase awareness on mental health. Pregnant women need to be encourage healthy by advice related to alcohol other substance related Women’s need special psycho-social support during pregnancy, so hospitals need to encourage psycho-social support during ANC follow up. Hospitals were not well structured on mental health and psycho social support, so RHB and stake holders need to integrate mental health and psycho-social service. It is recommended that Ethiopian Ministry of Health is better to incorporate mental health assessment tools for screening of CMD with existing ANC guidelines. Health facilities should strengthen the family planning coverage with different available contraceptive methods to address and decrease unplanned pregnancy.

Limitation of the study

This is a cross-sectional study it is difficult to determine temporal relationship between exposure and outcome variables, and common mental disorders may not imply causation.

AAMBC: Addis Ababa Medical and Business College, ANC: Antenatal Care, CI: Confidence Interval, CMD: Common mental disorder, CAMD: Common antenatal mental disorder, DM: Diabetes Mellitus, EPI Expanded program of immunization, HTN: Hypertension, Hx History, LMICs: Low and Middle Income Country, NICU: Neonatal Intensive Care Unit, PCMD: Prenatal Common Mental Disorder, SRQ: Self-report questioner and WHO: World Health Organization.

Ethical consideration

All procedures undertaken during data collection were in accordance with Institution Ethical Committee of Addis Ababa Medical and Business Colleges and the declaration of Helsinki. Letter of Ethical clearance was obtained from Institution Ethical Committee of Addis Ababa medical and Business College after approval of the proposal and letter of permission was obtained from research director, as well as permission letter was obtained from Addis Ababa health bureau Ethical Clearance Committee and Abebech Gobena mother and child hospital. The participants were informed about the aim of the study and no name was recorded, instead codes were used to maintain confidentiality. They were given the information sheet to read; and for those who were unable to read the data collectors read for them and asked them if they understood. The study participants were also informed of their right to refuse, withdraw, or refrain from answering questions they are not comfortable with and this would not have any reprisal. They were assured that their decision wouldn`t affect their future medical service. Finally, data were collected after obtaining written consent from those who were able to read and write and finger print from those study participants who were unable to read and write.

NB: This research (the proposal including the methods) was conducted with the accordance of Institution ethical committee of Addis Ababa Medical and Business College.

Consent for publication

Not applicable

Data availability

Data is exist upon request from the corresponding author.

Funding

Funding was not applicable

Competing interests

There is no conflict of interest.

Authors’ contributions

KM developed the study and was involved in the design, analysis, interpretation, report, and manuscript writing. KH, FA and DA were involved in conceptualization, analytical direction, writing of the paper, and careful editing of the main intellectual components. The final article was read and confirmed by all writers.

Acknowledgment

First of all, we would like to express my gratitude to the study participants, data collectors, and supervisors. Finally, we appreciate Addis Ababa medical and Business College for giving me the chance to conduct this study.

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No competing interests reported.

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Prevalence of Common Mental Disorder And Associated Factors Among Pregnant Women Attending Abebebch Gobena Mother And Child Hospital Addis Ababa Ethiopia in 2022: Cross sectional study

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