Prevalence of postpartum depression symptoms and their association with violence: a cross-sectional study, Cariacica, Espírito Santo, Brazil, 2017

Santos, Dherik Fraga; Silva, Ranielle de Paula; Tavares, Fábio Lúcio; Primo, Cândida Caniçali; Maciel, Paulete Maria Ambrósio; Souza, Renata Santos de; Leite, Franciéle Marabotti Costa

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Epidemiologia e Serviços de Saúde

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Original Article • Epidemiol. Serv. Saúde 30 (4) • 2021 • https://doi.org/10.1590/S1679-49742021000400002 copy

Prevalence of postpartum depression symptoms and their association with violence: a cross-sectional study, Cariacica, Espírito Santo, Brazil, 2017^* * Manuscript derived from the professional master’s degree dissertation entitled ‘Violence against women and postpartum depression: a study at a low-risk maternity hospital’, defended by Dherik Fraga Santos at the Federal University of Espírito Santo Postgraduate Program in Nursing in 2018. The study received funding from the Espírito Santo Research Support Foundation: File No. 80641393/2017.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To assess the prevalence of postpartum depression symptoms among puerperal women and their association with violence.

Methods

This was a cross-sectional study with puerperal women cared for at a public maternity hospital in Cariacica, ES, Brazil, in 2017. A questionnaire prepared by the authors and validated instruments were used. Pearson’s chi-square test was performed in the analysis and association was expressed in prevalence ratios (PR) and 95% confidence intervals (95%CI).

Results

Postpartum depression symptom prevalence was 36.7% (95%CI 31.6;42.0). Total family income was inversely associated with this prevalence (p<0.05). Mothers who were single (PR=1.75 - 95%CI 1.17;2.64), wished to abort (PR=1.96 - 95%CI 1.50;2.56), drank alcohol during pregnancy (PR=1.37 - 95%CI 1.00;1.86), experienced intimate partner violence in their lifetime (PR=1.94 - 95%CI 1.38;2.73), and during pregnancy (PR=1.41 - 95%CI 1.07;1.85), had higher prevalence of depression symptoms.

Conclusion

Postpartum depression symptoms are associated with marital status, wanting to abort, alcohol consumption during pregnancy and intimate partner violence.

Keywords:
Depression, Postpartum; Women’s Health; Postpartum Period; Violence Against Women; Intimate Partner Violence

Variables	n (%)	Prevalence % (95%CI)^a	p-value
Age (years)			0.014^b
14-19	82 (24.9)	48.8 (38.1;59.6)
20-29	173 (52.4)	35.3 (28.5;42.7)
30-44	75 (22.7)	26.7 (17.8;37.9)
Race/skin color			0.556^b
White	40 (12.1)	37.5 (23.8;53.5)
Black	82 (24.8)	41.5 (31.2;52.5)
Brown	188 (57.0)	35.6 (29.1;42.8)
Other	20 (6.1)	25.0 (10.5;48.6)
Religion			0.064^b
No	92 (27.9)	44.6 (34.7;54.9)
Yes	238 (72.1)	33.6 (27.9;39.9)
Schooling			0.003^b
Up to complete elementary education	197 (59.7)	44.2 (37.3;51.2)
Up to complete high school education	125 (37.9)	25.6 (18.7;34.0)
Up to complete higher education	8 (2.4)	25.0 (5.6;65.0)
Marital status			0.009^b
Married	93 (28.2)	26.9 (18.8;36.9)
Common law marriage	172 (52.1)	36.6 (29.7;44.1)
Single/dating	65 (19.7)	50.8 (38.7;62.8)
Total family income (minimum wages)			0.004^b
Up to 1	146 (44.2)	45.9 (37.9;54.1)
2-3	153 (46.4)	31.4 (24.5;39.2)
4 or more	31 (9.4)	19.3 (8.8;37.3)
Number of prenatal appointments			0.001^b
Up to 5	132 (40.0)	47.7 (39.3;56.3)
6 or more	198 (60.0)	29.3 (23.3;36.0)
Illness during pregnancy			0.031^b
No	256 (77.6)	33.6 (28.0;39.6)
Yes	74 (22.4)	47.3 (36.1;58.7)
Preference for baby’s sex			0.027^b
No	171 (51.8)	30.9 (24.5;38.4)
Yes	159 (48.2)	42.8 (35.2;50.6)
Type of delivery			0.949^b
Surgical	118 (35.8)	36.4 (28.2;45.5)
Vaginal	212 (64.2)	36.8 (30.5;43.5)
Number of pregnancies			0.584^b
1	126 (38.2)	34.1 (26.3;42.9)
2-3	147 (44.5)	36.7 (29.3;44.9)
4 or more	57 (17.3)	42.1 (29.2;55.3)
History of miscarriage			0.270^b
No	259 (78.5)	35.14 (29.5;41.2)
Yes	71 (21.5)	42.2 (31.2;54.1)
Wanting to abort			<0.001^b
No	277 (83.9)	30.3 (25.2;36.0)
Yes	53 (16.1)	69.8 (56.1;80.7)
Use of alcoholic beverage			0.001^b
No	296 (89.7)	33.8 (28.6;39.4)
Yes	34 (10.3)	61.8 (44.4;76.6)
Use of drugs			0.059^b
No	319 (96.7)	35.3 (30.6;41.2)
Yes	11 (3.3)	63.6 (32.4;86.4)
Use of cigarettes			0.005^b
No	298 (90.3)	34.2 (29.0;39.8)
Yes	32 (9.7)	59.4 (41.6;75.0)
Sexual violence before 15 years old			0.019^c
No	302 (91.5)	34.8 (29.6;40.3)
Yes	28 (8.5)	57.1 (38.3;74.1)
Intimate partner violence during lifetime			<0.001^b
No	180 (54.6)	22.2 (16.7;28.9)
Yes	150 (45.4)	54.0 (45.9;61.9)
Intimate partner violence during pregnancy			<0.001^b
No	291 (88.2)	32.0 (26.8;37.6)
Yes	39 (11.8)	71.8 (55.6;83.8)

Variables	Crude PR^a	95%CI^b	p-value^c	Adjusted PR^a	95%CI^b	p-value^c
Level 1 - Sociodemographic characteristics
Age (years)			0.013			0.329
14-19	1.00			1.00
20-29	0.72	(0.54;0.98)		0.86	(0.62;1.18)
30-44	0.55	(0.35;0.85)		0.70	(0.43;1.13)
Religion			0.057			0.547
No	1.00			1.00
Yes	0.75	(0.56;1.00)		0.92	(0.69;1.22)
Schooling			0.005
Up to complete elementary education	1.00			1.00		0.119
Up to complete high school education	0.58	(0.41;0.81)		0.69	(0.48;0.99)
Up to complete higher education	0.57	(0.17;1.90)		1.03	(0.28;3.86)
Marital status			0.008			0.012
Married	1.00			1.00
Common law marriage	1.36	(0.92;2.01)		1.24	(0.84;1.83)
Single/dating	1.88	(1.25;2.85)		1.75	(1.17;2.64)
Total family income (minimum wages)			0.006			0.012
Up to 1	1.00			1.00
2-3	0.68	(0.51;0.97)		0.70	(0.52;0.93)
4 or more	0.42	(0.20;0.88)		0.45	(0.21;0.96)
Level 2 - Obstetric and gynecological characteristics
Number of prenatal appointments			0.001			0.051
Up to 5	1.00			1.00
6 or more	0.61	(0.46;0.81)		0.75	(0.57;1.00)
Illness during pregnancy			0.024			0.219
No	1.00			1.00
Yes	1.40	(1.05;1.89)		1.19	(0.90;1.58)
Preference for baby’s sex			0.028			0.083
No	1.00			1.00
Yes	1.38	(1.03;1.84)		1.28	(0.97;1.68)
Wanting to abort			<0.001			<0.001
No	1.00			1.00
Yes	2.30	(1.79;2.96)		1.96	(1.50;2.56)
Level 3 - Behavioral characteristics
Use of alcoholic beverage			<0.001			0.047
No	1.00			1.00
Yes	1.83	(1.34;2.49)		1.37	(1.00;1.86)
Use of drugs			0.016			0.758
No	1.00			1.00
Yes	1.78	(1.11;2.85)		1.10	(0.61;1.98)
Use of cigarettes			0.001			0.312
No	1.00			1.00
Yes	1.73	(1.25;2.40)		1.18	(0.85;1.63)
Level 4 - Experience of sexual violence
Sexual violence before 15 years old			0.006			0.125
No	1.00			1.00
Yes	1.64	(1.15;2.35)		1.37	(0.92;2.03)
Level 5 - Lifetime history of intimate partner violence
Intimate partner violence during lifetime			<0.001			<0.001
No	1.00			1.00
Yes	2.43	(1.78;3.32)		1.94	(1.38;2.73)
Level 6 - History of intimate partner violence during pregnancy
Intimate partner violence during pregnancy			<0.001			0.016
No	1.00			1.00
Yes	2.25	(1.73;2.91)		1.41	(1.07;1.85)

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Dherik Fraga Santos - Rua Luiz Soares Nascimento, No. 14, Ilha das Flores, Vila Velha, ES, Brasil. CEP: 29115-510. E-mail: dherik@msn.com

Level 1	Sociodemographic characteristics	Age
		Religion
		Schooling
		Marital status
		Total family income
Level 2	Obstetric and gynecological characteristics	Number of prenatal appointments
		Illness during pregnancy
		Preference for baby’s sex
		Wanting to abort
Level 3	Behavioral characteristics	Use of alcoholic beverage
		Use of drugs
		Use of cigarettes
Level 4	Experience of sexual violence	Sexual violence before 15 years old
Level 5	Lifetime history of intimate partner violence	Intimate partner violence during lifetime
Level 6	History of intimate partner violence during pregnancy	Intimate partner violence during pregnancy