AWARENESS OF FACTORS INFLUENCING POSTPARTUM DEPRESSION

AMONG WOMEN ATTENDING POST NATAL CLINIC AT LADOKE AKINTOLA

UNIVERSITY TEACHING HOSPITAL IN OGBOMOSO, OYO STATE, NIGERIA.

BY

BABATUNDE ESTHER IBUKUNOLUWA

INDEX NO: 2023/2922/151532/M

EXAMINATION NUMBER:

DEPARTMENT OF MATERNAL AND CHILD HEALTH NURSING;

FACULTY OF NURSING SCIENCES,

COLLEGE OF HEALTH SCIENCES

LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY,

OGBOMOSO, OYO STATE

SEPTEMBER, 2023
 AWARENESS OF FACTORS INFLUENCING POST NATAL DEPRESSION AMONG

WOMEN ATTENDING POST NATAL CLINIC AT LADOKE AKINTOLA UNIVERSITY

TEACHING HOSPITAL IN OGBOMOSO, OYO STATE, NIGERIA.

BY

BABATUNDE ESTHER IBUKUNOLUWA

INDEX NO:

EXAMINATION NO:

DEPARTMENT OF MATERNAL AND CHILD HEALTH NURSING;

FACULTY OF NURSING SCIENCES, COLLEGE OF HEALTH SCIENCES, LADOKE

AKINTOLA UNIVERSITY OF TECHNOLOGY, OGBOMOSO

IN PARTIAL FULFILMENT OF THE REQUIREMENT OF NURSING AND

MIDWIFERY COUNCIL OF NIGERIA FOR THE AWARD OF THE

“REGISTERD MIDWIFE” CERTIFICATE

SEPTEMBER, 2023
 DECLARATION

This is to declare that this research project titled “AWARENESS OF FACTORS INFLUENCING

POSTPARTUM DEPRESSION AMONG WOMEN ATTENDING POST NATAL CLINIC AT

LADOKE AKINTOLA UNIVERSITY TEACHING HOSPITAL IN OGBOMOSO, OYO STATE,

NIGERIA.” Was carried out by BABATUNDE, ESTHER IBUKUNOLUWA is solely the result of

my work except where acknowledged as being derived from other person(s) or resources

INDEX NO:

EXAMINATION NUMBER:

In the FACULTY OF NURSING SCIENCES, COLLEGE OF HEALTH SCIENCES, LADOKE

AKINTOLA UNIVERSITY OF TECHNOGY, OGBOMOSO.

SIGNATURE:

DATE:
 CERFICATION

This research project by BABATUNDE ESTHER IBUKUNOLUWA with examination

number .................... has been examined and approved for the award of Registered Nurse

Certificate

Carried out this research under my supervision

OJO SIMEON A.

(RN,RM, RPHN RNE, BNSc, Msc CRNA) _________________________

(PROJECT SUPERVISOR) SIGNATURE AND DATEE

DR.P.O MAKINDE _________________________

(RN, RM, RPHN, RNE, BNSC, MSc, Med, FWACN, PHD) SIGNATURE AND DATE

(HOD, maternal and child health)

CHIEF EXAMINER

SIGNATURE AND DATE

_____________________________

SCHOOL STAMP

ABSTRACT
Postpartum depression is a significant public health challenge and one of the serious psychiatric

morbidities affecting women of childbearing age. This study therefore aimed to determine the

awareness of factors influencing postpartum depression among postnatal women attending

Ladoke Akintola University Teaching hospital, Ogbomoso.

A descriptive cross-sectional design was adopted for the study. Sample size of 121 respondents

were chosen using simple sampling technique. Data was collected using a structured questionnaire

with reliability index of 0.847. Three research questions were answered, using descriptive statistics

of frequencies and percentages and one hypothesis were tested using inferential statistics of Pearson

correlation coefficient at 0.05 level of significance.

This study revealed that the overall knowledge about postpartum depression among respondent is

poor, whereas, their level of awareness about factors influencing its occurrence is good. Factors

identified include: lack of social support from family members and partner, physical or sexual

abuse as a child or in marriage; low level of education and knowledge of depression; unplanned

pregnant, stressful circumstances. From the hypothesis tested, there is no significant relationship

between the age of the respondents and their awareness of factors influencing postpartum

depression at (x2=2.068a, P=.558) whereas, there is significant relationship between their level of

education and awareness of factors influencing PPD with (x2= .164a, P=.003) at P< .050.

level was found to significantly influence the respondents’ knowledge and awareness about

postpartum depression. It is therefore recommended that proper education of pregnant women about

postpartum depression and their mental health generally be done, also, suitable social systems that

provide support for women before and after delivery should be instituted.

Key words: Awareness, Postpartum, Depression, Postnatal women.

Word count: 264 words

 ACKNOWLEDGEMENTS

This is to express my sincere gratitude to God almighty who in his mercy saw me through and for

his constant direction.

Firstly, I will like to acknowledge my supervisor, Mr Ojo Simeon, for his patience and effort in

correcting the manuscripts. His suggestions made before the submission and presentation of this

research, professional guidance and encouragements are highly appreciated.

Also, I appreciate Dr. O.Y Makinde who is the head of department. May God bless you ma.

Most significantly, special thanks goes to my parents Mr and Mrs Adesina. Thank you so much for

what you have done, for your financial, spiritual and emotional support, God will keep you safe and

sound and you will enjoy the fruits of your labor.

My heartfelt gratitude goes to my siblings thanks for all you do God will continue to provide for

you all and keep us together in love.

I appreciate all my friends and senior colleagues who has rendered help in numerous ways. Just to

mention but few (Nurse Agboola victoria, Nurse Olonade roseline, Nurse Olowu fisayomi)

Thanks to my respondents for their cooperation during the data collection.

In conclusion, I appreciate the entire NURSING CLASS’21 for their contribution throughout this

research.
 TABLE OF CONTENT

Content Page

Title page i

Declaration ii

Certification iii

Abstract iv

Dedication v

Acknowledgment vi

Table of content vii

List of Tables viii

List of Figures v

CHAPTER ONE

BACKGROUND TO THE STUDY

STATEMENT OF PROBLEM

1.2 Broad Objectives

1.3 Specific Objectives

1.4 Significance of study

1.5 Research question

1.6 Scope and the Delimitation of the study

1.7 Hypothesis

1.8 Operational definition

CHAPTER TWO

Introduction
2.1 Conceptual Literature Review

2.2 Definition

2.3 Types of Postpartum depression

2.4 Common factors influencing postpartum depression

2.5 Effects of Postpartum depression

2.6 Diagnosis of depression

2.7 Treatment of postpartum depression

2.8 Prevention of Postpartum Depression

2.9.1 Betty Neumann’s System Model

2.9 .2 Application of theory to the study

2.10 Empirical Literature Review

CHAPTER THREE

3.1 Research Methodology

3.2 Introduction

3.3 Research Design

3.4 Research settings

3.5 Target Population

3.6 Sampling Size Determination

3.6 Sampling technique

3.7 Instrument for data collection

3.8 Pilot study

3.8 Validity of the instrument

3.9 Reliability

3.10 Method of Data Collection

3.11 Method of Data analysis

3.12 Ethical Consideration

CHAPTER FOUR

4.0 Introduction

4.1 Presentation of results

4.2 Answering research questions

4.3 Hypothesis Testing

CHAPTER FIVE

5.0 Introduction

5.1 Discussion of Findings

5.2 Summary

5.3 Conclusion

5.4 Implication for nursing practice

5.5 limitation of study

5.6 Recommendation
5.7 Suggestion for further study

REFERENCES

APPENDIX 1: Questionnaires

APPENDIX 2: Letter of permission to collect data

APPENDIX 3: Results of pilot study showing the cronbrach’s alpha coefficient for

reliability of the research informant

 LIST OF TABLES

4.1 Socio demographic data of respondents

4.2 Respondent’s knowledge on postpartum depression

4.3 Awareness of respondents on factors influencing postpartum depression

4.4 Awareness on preventives measures to prevent postpartum depression

 LIST OF FIGURES

Fig 4.1 Socioeconomic status of the respondents

Fig 4.2 Overall Knowledge on postpartum depression among the respondents

Fig 4.3 Overall awareness on factors influencing postpartum depression among respondents

CHAPTER ONE
BACKGROUND TO THE STUDY

Postpartum depression is one of the serious psychiatric morbidities of women of childbearing

age and constitutes a significant public health problem globally (Florio and jones, 2022) Postpartum

depression (PPD) is a term applied to describe depressive symptoms occurring during the first year

of the postpartum period and is characterized by low mood, loss of enjoyment, reduced energy, and

activity, marked functional impairment, reduced self-esteem, ideas or acts of self-harm or suicide.

Women’s change into motherhood is a difficult period that involves significant changes in the

psychological, social and physiological aspects, and considered increase vulnerability for the

development of mental illness. It is a mood disorder that affects approximately 10-15% of adult

mothers yearly with depressive symptoms lasting more than 6 months among 25-50% of those

affected (Anokye et.al.2018). In a study carried out in surulere, Lagos, Nigeria the prevalence of

postpartum depression was study was 52.3 %( Slomian et.al 2019) meaning that PPD is on the

increase.

Postpartum disorders involve three phenomenons which include grief postpartum,

depression, and psychosis. Diagnostic Statistical Manual of Mental Disorders (DSM-IV) show that

the start of postpartum depression is in the first 4 weeks after childbirth. Depending on the severity

of the disorder, it can take 3 to 6 months and in rare cases may continue to 12 months after birth

(Hanach et.al. 2022).During pregnancy and childbirth, changes in mood of women occurred that

made them very sensitive to emotional stimuli and may sometimes lead to psychological problems

for them. The highest rates of psychiatric disorder in women with 15 to 44 years old occurs in the

first two months after delivery. In some cases, women may be suffering from postpartum

depression with symptoms such as depressed mood, confusion of thought, sleeping and eating

disorders, feelings of guilt and inadequacy of child care (Reynolds, 2019). It is noteworthy that

the cause of this disorder is not known yet; however, biological factors like estrogen level drop

suddenly after delivery, low progesterone, elevated urinary excretion of cortisol and antibodies
against thyroid, prolactin, oxytocin, and beta-endorphin are involved in this disorder On the other

hand, the most common risk factors of this disorder in multifarious studies have been reported,

such as maternal age, unwanted pregnancy, unstable income and employment status, marital

conflict and lack of spouse support, and crisis one year before birth(Mahezeri et.al 2014). Maternal

depression in the weeks and months after childbirth may lead to damage in the relationship

between mother and child as the symptoms may not be repeated, and can lead to subsequent

behavioral problems in childhood that can affect child's natural evolution process and the overall

mother life process. Research on postpartum depression has garnered momentum within the last

few years. However, the masses are still largely unaware of the disorder and its implications.

There is also an inadequacy of awareness of the risk factors of PPD. Therefore, this present study

aims to assess the knowledge of postnatal women on postpartum depression, to know there level

of awareness on risk factors influencing depression and to assess their level of awareness of

preventive measures available

1.1 Statement of problem

Having a baby can be one of the happiest and most important events in a women ’s life.

While life with a new baby can be thrilling and rewarding, it also can be hard and stressful at

times. Women handle things happening to them all alone as they don't want to put burden on other

people. Personally, my aunt went through a serious cold and malaria at 8months of pregnancy and

she kept it to herself all because she does not want to burden her family. After 3 days of delivery

we noticed moments of quietness from her, other times she sits alone crying and every one

thinking it was because of the pain (labor pain) but then she started a strong hate for the baby, she

was jealousy that her baby was getting more attention than her. There were bouts of unexplained

anger, sadness and hopelessness and she didn’t even want to breastfeed her baby. Yet, she kept all

these feeling to herself because she was scared of what people would say. She also was scared to

carry the baby as she was afraid of harming the baby. This continued for 2 weeks and she was
rushed to the hospital to be referred to the psychiatrist. She felt so overwhelmed with the new role

of being a mother and if she will ever be received back by her husband as a normal wife. This

arose my intense desire to assess women's knowledge on postpartum depression, their awareness

on the factors influencing postpartum depression, their awareness to various preventive measures

and to prevent postpartum depression.

This study is also set out to alert fathers, families, workplace, health care organizations,

non-governmental organizations and the nation as a whole to create appropriate sensitization on

their role and play their role by creating a safe environment for the promotion of good mental

health among women.

Broad Objectives

The researcher aims to understand the awareness of factors influencing postpartum depression

among postnatal women attending Ladoke Akintola University Teaching hospital, Ogbomoso

1.3 Specific Objectives

To assess post natal women on their knowledge of postpartum depression

To determine the women level of awareness of factors influencing postpartum depression

To determine the women’s awareness on the preventive measures to prevent postpartum depression

1.4 Significance of study

The findings from this study will help the women to be aware and recognize factors the influencing

depression and modify their behaviors to prevent this condition thereby decreasing the incidence of

the disease among them. It will help them to know various preventive measures in preventing PPD.

It will also help parents, guidance, health care institutions, Non- governmental organizations and

the nation to recognize and play supportive roles to the disease among the postnatal women in the

hospital and also directed those who may or may not later develop the condition to achieve an
 overall mental health. It will serve as a body of knowledge to any other researcher on the disease

condition.

1.5 Research question

1 What are post natal women’s knowledge of postpartum depression?

2 Are the postnatal women attending this facilities aware of factors influencing postpartum depression?

3 Are the women aware of the preventive measures available in preventing postpartum depression?

1.6 Scope and the Delimitation of the study

The research was carried out to find out the awareness of factors influencing postpartum

depression among women attending Ladoke Akintola university teaching hospital Ogbomoso,

Oyo state, Nigeria. It was delimited to respondents irrespective of the family structure, religion,

ethnicity, and socio-economic status of parents.

1.7 Hypothesis

There is no significant difference between socio demographic characteristics (Age, level of

education of the respondents and their awareness of factors influencing of postnatal depression in

postnatal women

1.8 Operational definition

Factors: A circumstance, or conditions that contributes to fact, or influence that contributes to

depression.

Influence: The capacity to have an effect on a character, development, or behavior of

someone or something, or the effect itself

Postpartum: The time that begins right after a woman gives birth and lasts about 6 weeks.
Depression: A group of conditions associated with the elevation or lowering of a person's

mood, such as depression or bipolar disorder

Postpartum/Postnatal depression: Postpartum depression is a type of depression that happens

after giving birth. It causes extreme sadness and despair.

Women: A student who is studying for their first degree at a college or university

LTH: Ladoke Akintola University Teaching hospital. A hospital in Ogbomoso, Oyo state.
 CHAPTER TWO

2.0 Introduction

This chapter review pertinent literature both on empirical and conceptual studies

2.1 Conceptual Literature Review

2.2 Definition

Postpartum depression (PPD), also called postnatal depression, is a type of mood disorder

associated with childbirth, which can affect both sexes. It is associated with various risk factors and

can have serious consequences for affected women and their infants. Postpartum depression is

diagnosed when at least five depressive symptoms are present for at least 2 weeks. In the

Diagnostic and Statistical Manual of Mental Disorders (DSM-5). By definition, it is defined as a

major depressive episode with the onset of pregnancy or within 4 weeks of delivery. The nine

symptoms are present almost every day and represent a change from the previous routine (Muhgal,

2021).

Depressed mood (subjective or observed) is present most of the day

Loss of interest or pleasure, most of the day

Insomnia or hypersomnia

Psychomotor retardation or agitation

Worthlessness or guilt

Loss of energy or fatigue

Suicidal ideation or attempt and recurrent thoughts of death

Impaired concentration or indecisiveness

 Change in weight or appetite (Raynolds, 2019)

2.3 Types of Postpartum depression

1. Postpartum Blues

Postpartum blues, also called baby blues, is the most common form of postpartum mood

disorder. It affects approximately 50% to 85% of women. Postpartum blues is the mildest form

of postpartum depression. It occurs few weeks after the delivery of the baby and last up to few

hours to few days (Marwha and Balaram, 2022). It goes away completely within about two

weeks. It differs from postpartum depression as it does not interferes with the woman ’s

everyday function. The symptoms pass quickly and do not leave a lasting impact on the mother

or family. Because postpartum blues symptoms are so common, it is considered normal and not

serious for postpartum women (Langdon, 2023)

2. Postpartum Anxiety

Postpartum Anxiety disorder is another common type of postpartum depression developed after

giving birth. It is excessive worrying that occurs after childbirth or adoption. It often goes

undiagnosed because many people believe that new mothers are naturally anxious (Johdle,

2019). Postpartum anxiety is different from other forms of PPD because its symptoms include

far more anxious behaviors than primarily depressed behavior including persistent fears and

worries, high tension and stress, inability to relax, avoiding certain activities, people or places,

being overly cautious about situations that aren't dangerous. These symptoms may persist for

few weeks and may also be longer depending on the woman’s underlying conditions

(Cleveland, 2022)

3. Postpartum Obsessive-Compulsive Disorder (OCD)

Postpartum Obsessive-Compulsive Disorder (OCD) is an anxiety mood disorder Symptoms of

postpartum OCD include intrusive and persistent thoughts. These thoughts usually involve

harming or even killing the baby. These thoughts are rarely acted upon because mothers with

postpartum OCD are aware of and horrified by the thoughts. (Langdon, 2023) Other behavioral

characteristics of postpartum OCD include compulsive habits, such as repetitive cleaning and

changing of the baby, ensuring feeding bottles and cups are properly sterilized. Because

mothers are embarrassed and ashamed by these thoughts and behaviors, postpartum OCD often

goes unreported and, therefore, undiagnosed and untreated. (Begum, 2021)

4. Postpartum Panic Disorder

Postpartum panic disorder is a postpartum mood disorder that involves severe levels of anxiety.

Postpartum panic disorder is characterized by symptoms of intense fear and worry that prevent

the person from function, shortness of breath, tightening of the chest, heart palpitations

consistent and excessive worry/fear

5. Postpartum Post-Traumatic Stress Disorder (PTSD)

Postpartum Post-Traumatic Stress Disorder (PTSD) is a unique form of postpartum depression.

It is characterized by anxiety, panic attacks, agitation, nightmares, and flashbacks(vazquez

et.al, 2021) Postpartum PTSD is usually associated with a traumatic birthing experience but

may also link to having a previous diagnosis of PTSD, experiencing infertility, or giving birth

to a baby with health complications, unplanned C-sections, other injuries the woman suffered

during delivery. Postpartum PTSD can be very difficult to live with, especially during the care

of one’s baby. (Wisner, 2021)

6. Postpartum Psychosis

Postpartum Psychosis is the most serious form of any postpartum mood disorder, though it is

extremely rare. Postpartum psychosis generally begins within the first few weeks after
 delivering the child. Symptoms of postpartum psychosis included hallucinations, delusional

thoughts, extreme agitation, hyperactivity, confusion and poor judgment. The behaviors of a

woman with postpartum psychosis are comparable to the manic behaviors of someone with

bipolar disorder. In fact, women with past histories of bipolar disorder and other psychotic

illnesses are at a greater risk of developing postpartum psychosis. Postpartum psychosis causes

mothers to be unaware of their actions and behaviors. Therefore, this disorder presents a

serious risk of suicide or infanticide. (Slivinski, 2021)

2.5 Signs and symptoms of Postpartum Depression

Emotional Symptoms of Postpartum Depression

Excessive and uncontrollable crying

Persistent feelings of sadness and hopelessness

Feeling numb or empty

Extremes in mood swings

Irritability and restlessness

Feeling anger and rage

Becoming easily frustrated

Anxiety and fear

Feeling guilt and shame(Raynolds, 2019)

Mental Symptoms of Postpartum Depression

Inability to concentrate

Trouble remembering details

 Difficulty making decisions

Doubting her ability to care for her baby

Thinking things are too overwhelming to handle

Thinking she has failed or is inadequate; feelings of worthlessness(Sorbo et.al 2018)

Physical Symptoms of Postpartum Depression

Changes in appetite such as eating too much or too little

Trouble sleeping

Oversleeping

Fatigue and loss of energy

Muscle aches and pains

Headaches

Stomach pains(Glavin,2017)

Behavioral Symptoms of Postpartum Depression

Acting distant with her partner

Withdrawing from loved ones and social activities

Inability to form a bond with the new baby

Unwilling to care for the baby out of fear of harming them

Not being able to enjoy time with friends and family members

Not wanting to be alone with the baby

 Exhibiting angry behavior toward others(Langdon.2021)

2.4 Common factors influencing postpartum depression

Genetic vulnerability

The Johns Hopkins researchers suspected that estrogen-induced epigenetic changes in cells in the

hippocampus, a part of the brain that governs mood. Kaminski (2019) and his team then created a

complicated statistical model to find the candidate genes most likely undergoing those epigenetic

changes, which could be potential predictors for postpartum depression.(Langdon,2022)

Education of the mother:

The education level of an individual is one of the most frequently used indices for socioeconomic

status with lower socioeconomic status being related to increased risks of psychiatric diseases

including depression schizophrenia anxiety disorders, and post-traumatic stress disorder this is

due to that they do not have appropriate knowledge of what is happening In their body and where

to seek care. In a research conducted by matsuumari and Bamako, (2019) they suggested a lower

education level was an independent risk factor for postpartum depression

Low socio-economic status

Socioeconomic status (SES) has a strong association with depression or physical and mental

health in general. The new mother may be overwhelmed with getting things for the baby and

herself and these may initiate symptoms of sadness, and sorrow especially if she is not financially

stable. Hospital bills, drugs, and food for the newborn, and other children. In a research conducted

by Goyal et.al (2022). Low SES was associated with increased depressive symptoms in late

pregnancy and at 2 and 3 months, but not at 1 month postpartum. Women with four SES risk

factors (low monthly income, less than a college education, unmarried, and unemployed) were 11

times more likely than women with no SES risk factors to have clinically elevated depression
scores at 3 months postpartum, even after controlling for the level of prenatal depressive

symptoms.(Keller et.al,2017)

Unwanted pregnancy

The shock and emotional weight of learning of an unplanned pregnancy can lead to an overactive

response from the body’s stress mechanisms. Coming to terms with an unplanned pregnancy can

create a great deal of stress. There are suddenly so many emotions to deal with, realities to face,

and decisions to make. And this type of acute stress can indeed lead to depression for some

women. Depression can also occur later in pregnancy and may go undiagnosed. In a research

conducted by Qui et.al (2022). A total of thirty studies involving 65,454 participants were

included in our meta-analysis. Overall, women who get pregnant unintendedly through means

such as rape compared with those who are intending to be pregnant were at a significantly higher

risk of developing PPD (Keller, 2017)

Occupation of the mother

Researchers found that most of the women with PPD symptoms held jobs before becoming

mothers a significant life-changing experience where they left behind their working identity in a

predictable and controlled environment where they felt competent, to the unpredictability of

caring for a newborn. This dramatic change could have been enough to catapult them into severe

postpartum depression compared with unemployment, employment was significantly associated

with a reduced risk of postpartum depression: (Stone, 2018)

History of previous depression

In the largest population-based study to date, researchers found that the risk of postpartum

depression was more than 20 times higher for mothers with a history of depression. The risk of

postpartum depression (PPD) is more than 20 times higher in women with a history of depression,
compared to women with no prior depression diagnosis, according to results from the largest

population-based study of postpartum depression risk factors to date. (Enwig, 2016)

Substance abuse

Women with a history of substance use before pregnancy may be at a higher risk of developing

postpartum depression. This is because they might not have established ways to cope with

negative moods and stressful situations. While this does not necessarily cause postpartum

depression, it does make women more vulnerable to developing postpartum depression.

(Gonzales, 2022). Between 19% and 47% of women with a history of substance use develop

symptom postpartum depression after giving birth. When postpartum depression and substance

abuse occur in the same women, at the same time, the condition is called co-occurring disorders.

(Turnbridge, 2022)

Prenatal anxiety

Antenatal anxiety as received increased attention with regards to both its impact on infant

outcomes and as a risk factor for postnatal depression. In one study a diagnosis of an anxiety

disorder in pregnancy was associated with a three-fold increase in PND at 6 weeks. While mild

worry during pregnancy is considered both normal and adaptive, excessive or uncontrollable

worry, regarding the delivery, the health and safety of the infant or the mother's concerns about

her ability to parent, is likely to be indicative of more clinically significant anxiety and to be

associated with negative outcomes, such as the development of an anxiety disorder or PND.

(Claeson et.al, 2010)

Family income

The prevalence of postpartum depression was 13.8%. Compared with unemployment,

employment was significantly associated with a reduced risk of postpartum depression (Ketunnen,

2016)
Pregnancy and birth complication

In women who had an uneventful pregnancy which they were sick most times of the pregnancy or

were into one problem or the other may feel anxious because of the unknown outcome of the

pregnancy and may lead to prenatal anxiety. Women who also planned to have a vaginal birth and

later had a Caesarian section may feel that they are not capable of having their delivery

themselves. Long stay at the hospital due to postpartum hemorrhage, postpartum sepsis may also

predispose women to postpartum depression as they may feel lonely, sad and inefficient bonding

with their baby.

Marital satisfaction

Postpartum mothers with less marital satisfaction and limited support from their husbands were

found to be at greater risk of PPD. Women who had arranged marriage or child marriage may feel

sad and lonely during the marriage as they were forced. Also women who receive little or no

support from their husbands in providing for the family, in house chores may feel neglected

during pregnancy which may be a risk factor for \ postpartum depression. In addition, a woman

experiencing a positive, stable, and secure relationship with her spouse may be better able to cope

with stress, and adopt positive health practices to improve her wellbeing. (Reynolds, 2021)

Unplanned or unwanted pregnancy

The study, conducted at the University of North Carolina prenatal clinics questioned participants

about pregnancy intention at 15-19 weeks gestational age, and women were classified as having an

intended, mistimed or unwanted pregnancy. There were 433 women (64%) with an intended

pregnancy, 207 (30%) with a mistimed pregnancy and 40 (6%) with an unwanted pregnancy.

Unintended pregnancy was defined as both mistimed and unwanted pregnancies (Willey, 2013)
Results show that postpartum depression was more likely in women with unintended pregnancies at

both three months (11% vs. 5%) and twelve months (12% vs. 3%). (Willey, 2013)

Childcare stress:

During childbirth, including premature delivery or having a baby with medical problems. Medical

problems such as baby with cleft palate, cleft lips, and prolonged hospital stay may weigh the

mother down with the overwhelming stress of having to take care of herself after delivery and also

stay with the child at the hospital. The women may be sad of seeing her child suffer and also the

bills of the hospital all these may predispose the woman to postpartum depression (Ketunnen,

2016)

Obesity

Pre-pregnancy overweight or obesity is associated with PPD independent of concurrent risk

factors. History of anxiety or depressive symptoms suggests a stress-induced link between pre-

pregnancy weight and PPD. ( Johar, 2020)

Sleep disturbances

Sleep deprivation is an unavoidable part of being a new mother. The sudden shifts in hormone

levels, accumulated fatigue from pregnancy, and round-the-clock demands of caring for a new baby

can take their toll, and it’s common for mothers to experience a dip in energy and mood during the

first few weeks after giving birth. (Vyas, 2022). While there are many factors at play, it does appear

that sleep deprivation can exacerbate symptoms of postpartum depression. This is true for

breastfeeding mothers, with of young babies are more likely to have depressive symptoms if the

mother sleeps poorly. Sleep deprivation is also linked to suicidal ideation in women with

postpartum depression. The relationship between sleep deprivation and postpartum depression is

likely bidirectional with depression often causing sleep problems as well. Furthermore, both of

these conditions often have roots in similar issues, such as stress, anxiety, and changing hormone
levels. After pregnancy, women experience a sudden drop in levels of estrogen, progesterone, and

thyroid hormones. This change affects the sleep cycle and lays the groundwork for depression.

Over time, if sleep doesn’t improve, this raises the likelihood of developing postpartum depression.

(Pacheco, 2022)

Breastfeeding

A recent study, published in the Journal of Women ’s Health (2020), has found positive

associations between breastfeeding and improved maternal mental health. While difficulties with

breastfeeding such as pain on breastfeeding, breast engorgement, inverted nipple can also impact

maternal mental health and potentially lead to postpartum depression. As this women long to

breastfeed their child, they feel sad as they are not able to perform their motherly roles and this

will impact their relationship the child and this may lead to postpartum depression

History of physical or sexual abuse Intimate partner violence

Those who suffered intimate partner violence in the form of physical or sexual abuse or stalking as

an adult were significantly more likely to develop postpartum depression than women who did not

experience any abuse. Women who said they were physically or sexually abused as a child also had

a higher risk of postpartum depression (Stone, 2022)

2.5 Effects of Postpartum depression

Left untreated, postpartum depression can interfere with mother-child bonding and cause family

problems.

For mothers.

Untreated postpartum depression can last for months or longer, sometimes becoming an ongoing

depressive disorder. Mothers may stop breastfeeding, have problems bonding with and caring for

their infants, and be at increased risk of suicide. Even when treated, postpartum depression

increases a woman's risk of future episodes of major depression.(Willey,2021)

 For the other parent.

Postpartum depression can cause emotional strain for everyone close to a new baby. When a new

mother is depressed, the risk of depression in the baby's other parent may also increase. And these

other parents may already have an increased risk of depression, whether or not their partner is

affected.(Smitha,2021

For children.

Children of mothers who have untreated postpartum depression are more likely to have emotional

and behavioral problems, such as sleeping and eating difficulties, crying too much, and delays in

language development.(Raynolds,2019)

2.6 Diagnosis of depression

Physical examination. Physical examination and questions about health including past

and present medical conditions. In some cases, depression may be linked to an underlying

physical health problem

Laboratory tests. Blood test called a complete blood count or thyroid function test.

Psychiatric evaluation. A mental health professional asks about symptoms, thoughts,

feelings and behavior patterns. Filling out a questionnaire may also help answer these

questions. The most commonly used instrument is the Edinburgh Postnatal Depression

Scale (EPDS), which is both sensitive and specific in detecting postpartum depression.

This easily readable questionnaire assesses a patient's mood over the past week.

(Mayo,2018)

2.7 Treatment of postpartum depression

According to Smitha (2021), there are various ways of treating postpartum depression the

choice of medication will depend on:

The severity of the condition

Whether or not the mother is breastfeeding

The medical history of the woman

Pharmacological therapy

Selective serotonin reuptake inhibitors (SSRIs. This generation of antidepressants is now the

most common class used for postpartum depression. Examples include citalopram (Celexa),

escitalopram (Lexapro), paroxetine (Paxil, Pexeva), fluoxetine (Prozac, Sarafem), and

sertraline (Zoloft).Side effects are generally mild, but can be bothersome in some people.

They include nausea, stomach upset, sexual problems, fatigue, dizziness, insomnia, weight

change, and headaches. (Fookes, 2018)

Tricyclic antidepressants (TCAs) were some of the first medications used to treat

depression.Examples are amitriptyline (Elavil), desipramine (Norpramin, Pertofrane),

doxepin (Adapin, Sinequan), imipramine (Tofranil), nortriptyline (Aventyl, Pamelor),

protriptyline (Vivactil), and trimipramine (Surmontil). Side effects include stomach upset,

dizziness, dry mouth, changes in blood pressure, changes in blood sugar levels, and nausea.

(Fookes,2018)

Monoamine oxidase inhibitors (MAOIs) were among the earliest treatments for depression.

The MAOIs block an enzyme, monoamine oxidase that then causes an increase in brain

chemicals related to mood, such as serotonin, norepinephrine and dopamine. Examples are

phenelzine (Nardil), tranylcypromine (Parnate), isocarboxazid (Marplan), and transdermal

selegiline (the EMSAM skin patch). Although MAOIs work well, they're not prescribed her
 yoften because of the risk of serious interactions with some other medications and certain

foods. Foods that can negatively react with the MAOIs include aged cheese and aged meats.

(Pathak,2020)

Other medications:Bupropion (Aplenzin, Wellbutrin).Esketamine (Spravato),Mirtazapine

(Remeron), Trazodone (Desyrel)

Other therapies include

Behavioral activation (BA)

BA is based on early functional descriptions of depression that emphasized the role of

positive and negative reinforcement in postpartum depression, suggesting that

Individuals with postpartum depression have deficient response-contingent positive

reinforcement and engage in problematic avoidance behaviors. (Halverson, 2019)

Cognitive behavior therapy

It is based on the premise that patients who are depressed exhibit the cognitive triad of

depression, which includes a negative view of themselves, the world, and the future. Related to

the cognitive triad, depressed mothers are believed to exhibit cognitive distortions that may

maintain these negative beliefs. Beck, Rush, Shaw, and Emery postulated that negative automatic

thoughts and distortions in thinking arise from problematic schemas, which are cognitive

structures that influence how information is interpreted and recalled. CBT for depression

typically includes behavioral strategies (i.e., activity scheduling), as well as cognitive

restructuring for the purpose of changing negative automatic thoughts and addressing

maladaptive schemas. (Mayo, 2018)

Interpersonal therapy (IPT)

Interpersonal therapy (IPT) is a time-limited (typically 16 sessions) treatment for Postpartum

depression. IPT draws from attachment theory and emphasizes the role of interpersonal

relationships, focusing on current interpersonal difficulties. Specific areas of emphasis include

grief, interpersonal disputes, role transitions, and interpersonal deficits by (Crane, 2019).

Electroconvulsive therapy (ECT)

Electroconvulsive therapy (ECT) is a procedure, done under general anesthesia, in which small

electric currents are passed through the brain, intentionally triggering a brief seizure. This is

usually used in treating severe postpartum depression.(Smitha,2021)

2.8 Prevention of Postpartum Depression

Living with symptoms of postpartum depression as postnatal mother (new mother), especially

if it is chronic or recurring, can make one feel exhausted, overwhelmed and helpless.

Recognizing that these negative thoughts are part of the depression is one step toward

recovery.

Education on postpartum depression

This will enable the woman to recognize the signs and symptoms of the condition if it occurs and

get help for it quickly. The woman will also be able to give your health-care practitioners the

information they need to help you recover. (Venis and mccloskey, 2022)

2. Sleeping And good diet

A nutritious diet and a sufficient amount of sleep are critical to a postnatal woman ’s health and

well-being. The woman is advised to eat right and get as much sleep as she can, both during her

pregnancy and postpartum period.(Rosen,2022)

3. Exercise
Exercise is a key component in reducing the risk for PPD. Exercise is good for both physical and

mental health, establishing a regular exercise routine will help maintain a healthy weight and reduce

stress levels, important for someone with postpartum depression (Mccloskey.2022)

5. Voicing out feelings In the Delivery Room

Women should not be afraid speak up and express their needs and wants in the delivery room. It's

important that the delivery be as comfortable as possible. Positions, foods must be allowed for the

patient without discrimination except medically contraindicated ( Vigura,2022)

6. Enlisting Good Support during Birthing

A network of family and friends can make all the difference for someone with depression. Making

sure to surround oneself with people who can give the support needed during childbirth. Which

maybe ones partner, mother, your partner, best friend. Also doing whatever it takes to feel

supported during delivery in order to have the best possible experience is a way of preventing

postpartum depression (Dennis,2022)

7. Adequate preparation for childbirth

Taking a childbirth education classes (ante-natal) is helpful, but it does not end there. Reading as

many books or articles on the topic can help keep one informed. Talking to other women about

their experiences may give sense of hope to the mother. Many childbirth classes skim over crucial

aspects of childbirth, like C-sections, and in which the woman must be well-informed on every

possible outcome in the delivery room so there will be no surprises. If the women are aware, they

will be less apt to have a traumatic childbirth experience.(Gomez,2022)

8. Enlisting Household Help during the Postpartum Period

A postnatal woman will be in no condition to cook meals and clean the house in the first few weeks

after the baby is born, especially if she underwent a C-section, so arranging for people in her

support system to help her is the best option. Having someone go shopping for her to stock up on

frozen entrees and easy snacks. Let her sister or husband clean the house for her. The support

system is there to help and must be available. (Viguera, 2022)

9. Finding a Strong Emotional Support

The support system is also there for the woman to lean on when feeling frustrated, overwhelmed, or

just plain tired. Talking to them about ones feeling and how one’s life is changing makes ones feel

better. (Gomez et.al, 2022)

10. Attending a PPD Support Group

The best support often comes from people who have been where ones is and know what one is

going through. Talking to the obstetrician, a therapist, pediatrician, or other moms can help relieve

postpartum anxiety and depression (Viguera,2022)

2.9.1 Betty Neumann’s System Model

Awareness of the factors influencing depression among postnatal women can be identified and

explained using Betty Neuman's Systern Model. The Neuman systems model is a nursing theory

based on the individual relationship to stress, the reaction to it, and reconstitution factors that are

dynamic in nature. The theory was developed by Betty Neuman, a community health nurse,

professor and counsellor. The Neuman Systems model is universal in nature, which allows it to be

adapted to a variety of situations, and to be interpreted in many different ways. The model provides

a comprehensive holistic and system-based approach to nursing that contains an element of

flexibility. The goal of the model was to provide a holistic overview of the physiological,

psychological, sociocultural, and developmental aspects of human beings the theory focuses on the

response of the patient system to actual or potential environmental stressors and the use of primary,

secondary and tertiary nursing prevention intervention for retention, attainment, and maintenance of

patient system wellness. (Gonzalo, 2021)

The basic assumption of the model are (Saghedi,2019)

Each patient system is a unique composite of factors and characteristics within a range of responses

contained in basic structure.

Many known, unknown, and universal stressors exist. Each differ in their potential for upsetting a

client's usual stability level.

Each patient has evolved a normal range of responses to the environment referred to as the normal

line of defense. It can be used as a standard by which to measure deviation.

The particular inter-relationships of patient variables can, at any point in time, affect the degree to

which a client is protected by the flexible line of defense against possible reaction to stressors.

The client is a dynamic composite of the inter-relationships of the variables, whether in a state of

illness or wellness. Wellness is on a continuum of available energy to support the system in a state

of stability.

Each patient has implicit internal resistance known as LOR, which function to stabilize and realign

the patient to the usual state of wellness.

Primary prevention is applied in patient assessment and intervention, in identification and reduction

of possible or actual risk factors.

Secondary prevention relates to symptomatology following a reaction to stressors, appropriate

ranking of intervention priorities and treatment to reduce their noxious effects.

Tertiary prevention relates to adjustive processes taking place as reconstitution begins, and

maintenance factors move them back in a cycle toward primary prevention.

The patient is in dynamic, constant energy exchange with the environment.

2.9 .2 Application of theory to the study

Neuman views nursing as a unique profession concerned with the variables that influence the

response the patient might have to a stressor. Nursing also addresses the whole person, giving the

theory a holistic perspective. The model defines as "actions which assists the individuals, families

and groups to maintain a maximum level of wellness, and the primary aim is stability of the patient-
client system, through nursing interventions to reduce stressors. Neuman also says that the nurse's

perception must be assessed in addition to the patient's, since the nurse's perception will influence

the care plan he or she sets up for the patient. The systems model view the role of nursing in terms

of the degree of reaction to stressors, as well as the use of primary, secondary and tertiary

interventions. In Neuman's Systems Model nursing process, there are six steps, each with specific

categories of data about the patient. . (Ahmadi, 2017)

Step 1: Assessment: this looks at: actual and potential stressors which can be work or school,

childhood trauma, drug or alcohol misuse, loss of loved ones, etc., condition and strength of basic

factors and energy sources, characteristics of flexible and normal lines of defense, lines of

resistance, degree of reaction and potential for reconstitution, interaction between patient and his or

her environment, life process and coping factors for optimal wellness, and the perceptual difference

between the caregiver and the patient.

Step 2: DIAGNOSIS: the nurse makes a diagnosis by interpreting the data collected. The data

includes health-seeking behaviors, activity intolerance, ineffective coping, and ineffective

thermoregulation. For instance, an individual that misuse alcohol and drugs or a student that failed a

test or an examination can be diagnosed of stress and depression from the data collected.

Step 3: OUTCOME: it is based on assessment and diagnosis. It refers to formulating and

documenting measurable, realistic client focus goal. The ultimate goal is to keep the client stable.

The goal of intervention for an individual that misuse alcohol and drug is to reduce or stop the

intake of alcohol and drug and hence make the individual stable.

Step 4: PLANNING: From the goals, a plan is created, which focuses on strengthening lines of

defense and resistance. A plan suitable for bringing out the outcome is employed; for the individual

misusing drug or alcohol, psychotherapy can be planned for the individual.

Step 5: IMPLEMENTATION: that plan is implemented using primary, secondary and tertiary

preventions. The plan created is then put into practice.

Step 6: EVALUATION: finally the nursing process is evaluated to determine whether or not

balance was restored, and a stable state maintained. The individual is then assessed to determine

whether the nursing process was effective or not. (Sadeghi, 2017)

2.10 Empirical Literature Review

Postpartum depression (PPD) is a depressive disorder that occurs after childbirth and can

last until a year after delivery. The global prevalence of PPD among mothers is between

0.5% and 63.3%. The aim of the study is to determine the prevalence of postpartum

depression within a year after birth among mothers in Semey (Kazakhstan) and identify the

factors associated with it.

Methods:A cross-sectional study covering 251 women within one year after delivery was

conducted in five Primary Healthcare Centers in Semey. The Edinburgh Postnatal

Depression Scale (EPDS) for assessing PPD was used. Data was analysed using the

Statistical Package for Social Sciences (SPSS), version 25. The statistical significance and

magnitude of the relationships between dependent and independent variables were

conducted using chi-square and bivariate and multivariate logistic regression analyses. A p-

value of less than 0.05 was considered to be significant. ResultsThe prevalence of PPD

within a year after delivery was estimated as 59.4%. Factors including accommodation type

(p = 0.021), satisfaction with living conditions (p = 0.001), relationship with mother-in-law

(p = 0.013), the interest of the patronage service about the psychological state of a woman

after childbirth (p = 0.001) and husband employment status (p = 0.04) showed significant

positive association with PPD. Conclusion: The high prevalence rate of PPD and associated

risk factors imply the need for strengthening and improving of postpartum care program in
country. Further research on the experiences and the level of antenatal depression among

women will be needed to understand and prevent any possible depressions in prenatal and

postpartum

In a study conducted by Peltzer 457 women were recruited, 35% exhibited depressive

symptomatology within the first 6 months postpartum. Younger women (< 25 years), part-

time employment, the receipt of financial support from the family, and difficulty in

managing monthly income were associated with a higher risk of postpartum depression.

Husband’s employment, husband’s support, and living in own house were associated with a

lower risk of postpartum depression. Maternity leave of more than 3 months increased the

risk of depression during the first 3 months postpartum. From 3 to 6 months postpartum,

Muslim women had a higher risk of depression whereas women who breastfed other

children and in the past 7 days, and perceived their infant as healthy had a lower risk of

depression. (Peltzer, 2013)

Another descriptive cross-sectional study was conducted in Gynecology / Obstetrics

and Pediatrics Outpatients Department, Hayatabad Medical Complex, Peshawar from

January to June 2019, on 150 postnatal women selected by convenience sampling.

Demographic profile of participants, and awareness regarding postpartum depression

were recorded by an indigenously developed, pretested, and translated questionnaire.

Microsoft Excel & SPSS version 23 was used for organizing and analyzing data for

descriptive statistics. Results: Majority, 90(60%) of postnatal women were aware of

postpartum depression, and 52% had experienced PPD previously. No formal

education on this subject was given to them, hence their beliefs about this phenomenon

were vague; 26.7% women agreed that they would not share their feelings of depression

with anyone because of guilt / shame, whereas 67% women would not disclose their

emotional experiences because such mothers were thought to be a liability for a family in
our society. Among the 90 aware women, 71(78.9%) were willing to seek treatment for this

problem. Conclusion: Despite its high prevalence, there are no formal educational or

awareness programs for postpartum depression in our society. The beliefs of women

regarding this phenomenon are vague and they are reluctant to share their mental and

emotional problems with their families (Aliyah et.al, 218)

 CHAPTER THREE

3.1 Research Methodology

3.2 Introduction

This chapter describes the methods employed in carrying out this research among women

attending post natal clinics in LTH hospital in ogbomoso. This aspect of the study will deal

with the research design, research setting, target population, sample and sampling technique,

an instrument of data collection, validity and reliability of instruments, data analysis and

ethical consideration.

3.3 Research Design

A descriptive research design was used in this study to explore the awareness of factors

influencing post natal depression among women attending post natal clinic in LTH gbomoso.

The design was adopted by the researcher as no variable was manipulated but variable was

described as occurred in the research.

3.4 Research settings

This research study was carried out at Ladoke Akintola University Of Technology

Teaching Hospital ,Ogbomosho , Oyo state . It is situated along Ogbomosho road.

Geographically, Lautech Teaching Hospital is located in Ogbomoso North Local

Government, Ogbomoso, Oyo State, Nigeria with geographical coordinate 8° 08' 0" North, 4°

15' 0" East region.It has the following unit : antenatal clinic, obstetrics and gynecology ward

, postnatal clinic, infant welfare clinic and much more.

3.5 Target Population

The research populations were the women attending postnatal clinics of Ladoke Akintola

University of Teaching hospital, Ogbomoso, Oyo State.

3.6 Sampling Size Determination

The sampling technique used was a simple random technique. Using Taro yamen (1975)

The formula is

N= N

1+N(e2)

Where:

n= desired sample size.

N= total population

=150

1= constant

e= level of precision= 0.05

Therefore,

N= 150

1+150(0.022)

N= 150
 1+0.375

N= 150

1.375

=109

109 students were randomly selected from the postnatal ward at Ladoke Akintola University of

Teaching hospital, Ogbomoso. Since the researcher was dealing with human beings, there a was

tendency for some of the respondents not to return the instrument or the instrument would have

been filled wrongly. By standard 10% attrition rate is sufficient.

Therefore, the researcher determines the attrition rate thus:-

Attrition Rate = Previous sample size × standard attrition Rate

Standard Attrition Rate – 1

N= 103× 10

N= 1030

= `121

Hence, the sample size is 121 approximately

3.6 Sampling technique

The sample consists of 121 respondents who were selected randomly in a postnatal clinic

day. The questionnaires was administered in a two-day visit to the clinic. On the firstday

of the visit, a total of 86 women were around and the questionnaire was shared to

everyone. On the second visit, 64 postnatal women were around for the clinic but the

questionnaire was administered to 35 women as the other women had to meet with the

health officials.

3.7 Instrument for data collection

The tool for data collection was a self-structured questionnaire after consultation with

relevant literature and supervisor which contains four sections for easy analysis:

SECTION A: This comprises of six question items of demographical data including age,

marital status, religion, educational level, ethnic group, Socio economic status. Mode of

delivery.

SECTION B: Knowledge on postpartum depression

SECTION C: Awareness of women on factors influencing postpartum depression

SECTION D: Awareness of preventive measures to prevent postnatal depression

3.8 Pilot study

A pilot study was carried out by administering 10% of the estimated sample size and this

equal to 12 questionnaires. They were administered to 12 women in the clinic. They are
 not part of the sample size. The result of the pilot study on analysis yielded a cronbach ’s

alpha score of 0.847. This was done to check for the reliability of the questionnaires.

3.8 Validity of the instrument:

To ensure that the research instrument measures what is intended to measure, the content

validity of the research instrument was given to the researcher ’s supervisor and, experts in

medical research to scrutinize and ascertain its validity. Their observations and suggestion

were revised

3.9 Reliability

To ensure that the research instrument maintains consistency in measuring what it intends to

measure, a pilot study of 10% of the sample size that is 12 questionnaires were carried out

among postnatal mothers attending a postnatal clinic at the Ladoke Akintola University of

teaching hospital Ogbomoso, Oyo state. The result of the pilot study using the crowbach

alpha is 0.847

3.10 Method of Data Collection

The close-end self-designed questionnaire were was administered to 121 women attending

postnatal clinics of Ladoke Akintola University teaching hospital, Ogbomoso alongside a

research assistant after gaining consent and explaining each item in the instruments to them.

They were encouraged to fill out the questionnaire faithfully and the right to withdraw from

participation was clearly stated to each respondent. It was attempted and returned within 24

hours of administration. It was well coordinated and the exercise was successful. The
 researcher did not fail to appreciate the respondents for their positive responses. The

questionnaire was collected by the researcher and the research assistant on the appointed day.

3.11 Method of Data analysis

The statistical package for social sciences (SPSS package) 21 st edition was used for the data

analysis and hypothesis testing. The data was presented in tables and charts and computed

using descriptive and inferential statistical tools variables and the generated hypothesis was

tested using Pearson’s correlation analysis and chi-square at 0.05 level of significance.

3.12 Ethical Consideration

A letter of permission was collected from the hospital, Ladoke Akintola University

Teaching hospital, Ogbomoso and was given to the ethical board of the institution for

approval. Each mother was informed about the purpose and benefits of the study at the

beginning of the interview and time throughout the oral consent was obtained from the

mothers before starting the data collection. Confidentiality was ensured throughout the

study process, where personal data were not disclosed, and the women were assured that

all data was used only for research purposes. There was no harm to the participants

CHAPTER FOUR

ANALYSIS AND PRESENTATION OF DATA

4.0 Introduction

This chapter deals with the analysis of collected data and presentation of results with the

use of percentages, frequencies and are displayed using charts and frequency tables. Data were
computer-analyzed using statistical package for social sciences (SPSS) 21.0 version with a total

of 121 respondents being recruited for the study.

4.1 Presentation of Results

Table 4.1 Sociodemographic Characteristics of Respondents

VARIABLES CATEGORIES FREQUENCY(N=121) PERCENT (%)

Age 18-25 10 8.3

26-30 62 51.2

31-36 41 33.9

>36 8 6.6

Mean age ±SD 27±3.5

Marital status Single 24 19.8

Married 83 68.6

Divorced 14 11.6

Religion Christianity 90 74.4

Islam 31 25.6

Total 121 100

Ethnic Group Yoruba 74 61.2

Igbo 30 24.8

Hausa 17 14.0

Level of education None 10 8.3

Primary 3 2.5

Secondary 11 9.1

Tertiary 97 80.2
 Total 121 100

Mode of delivery Caesarean delivery 44 36.4

Vagina Delivery 77 63.6

From table 4.1 above, the demographic characteristics of the respondents showed that majority

62(51.2%) were within the age range of 26-30years, 41(33.9%) 31-36years, 10(8.3%) 18-25years

while 8(6.6%) 36years and above. Most 83(68.6%) of the respondents were married, 24(19.8%)

were single while 33(20.5%) were divorced. With regards to religion, 90(74.4%) practice

Christianity while 31(25.6%) Islam. 74(61.2%) belong to Yoruba tribe, 30(24.8%) Igbo while

few 17(14%) were Hausa. 97(80.2%) of the respondents attained educational level up to tertiary,

11(9.1%) secondary school while 10(8.3%) primary school, 3(2.5%) primary. 63(39.1%) were

traders, 77(63.6%) had vagina delivery, while 44(36.4%) caesarean section.

Figure 4.1 showing the socioeconomic status of the respondents

Figure 4.1 above revealed that, more than half (71%) of the respondents are average with regards

to socioeconomic status, 17% low while (12%) are high.

Table 4.2: Respondents’ knowledge on postpartum depression

Variables Categories Frequency(n=121) Percent (%)

Types of postpartum I don't know 66 54.5

depression Postpartum anxiety 21 17.4

Postpartum blues 12 9.9

Posttraumatic stress 11 9.1

disorder

Postpartum psychosis 11 9.1

Yes No I Don’t know

PPD is a depressive 45(37.2%) 10(8.3%) 66(54.5%)

episode occurring within

4 weeks of delivery

Feeling unusually sad and 66(54.5%) 10(8.3%) 45(37.2%)

teary may be a symptom

of PPD

Sleeping too much or 48(39.7%) 13(10.7%) 60(49.6%)

little is a sign of PPD

Eating too much or losing 50(41.3%) 21(17.4%) 50(41.3%)

interest in food may be a

sign of PPD

Loss of interest or 50(41.3%) 21(17.4%) 50(41.3%)

pleasure in most things is

a symptom of PPD

PPD affects memory and 55(45.5%) 21(17.4%) 45(37.2%)

concentration

Symptoms and signs of 39(32.2%) 12(9.9%) 70(57.9%)

PPD last for a period of

at least 2 weeks

PPD can lead to women 50(41.3%) 20(16.5%) 51(42.1%)

having problems bonding

and caring for their

infants

Children of mothers with 43(35.5%) 25(20.7%) 53(43.8%)

PPD are likely to have

sleeping and eating

difficulties, and delay in

language development.

PPD causes emotional 43(35.5%) 25(20.7%) 53(43.8%)

strain for everyone close

to the mother

Table 4.2 above revealed that, majority 66(54.5%) of the respondents claimed not to know the

types of postpartum depression while 21(17.4%) agreed to postpartum anxiety, 12(9.9%)

postpartum blues, 11(9.1%) postpartum stress disorder and postpartum psychosis. Larger

percentage 66(54.5%) don’t know if postpartum depression is a depressive episode that occurs

within 4 weeks of delivery, 45(37.2%) agreed while 10(8.3%) did not. 66(54.5%) agreed that

feeling unusually sad and teary may be a symptom of PPD 45(37.2%) don’t know while
10(8.3%) did not. 60(49.6%) don’t know if sleeping too much or little is a sign of PPD,

48(37.2%) agreed while 13(10.7%) did not. Averagely, 50(41.3%) agreed that eating too much

or losing interest in food may be a sign of PPD, same claimed they don ’t know while 21(17.4%)

disagreed. 50(41.3%) agreed that loss of interest or pleasure in most things is a symptom of PPD,

same claimed they don’t know while 21(17.4%) disagreed. 55 (45.5%) agreed that PPD affects

memory and concentration, 45(37.2%) don’t know while 21(17.4%) disagreed. Majority

70(57.9%) claimed they don’t know if symptoms and signs of PPD last for a period of at least 2

weeks belong, while 39(32.2%) agreed 12(9.9%) did not. 51(42.1%) don’t know if PPD can lead

to women having problems bonding and caring for their infants, 50(41.3%) agreed while

20(16.5%) disagreed. 53(43.8%) don’t know if children of mothers with PPD are likely to have

sleeping and eating difficulties, and delay in language development, 43(35.5%) agreed while

25(20.7%) disagreed. 53(43.8%) claimed not to know if PPD causes emotional strain for

everyone close to the mother, 43(35.5%) agreed while 25(20.7%) disagreed.

Fig 4.2: Overall Knowledge on postpartum depression among the respondents

From Fig 4.2 above on the overall knowledge among the respondents showed that; majority

(57%) had poor knowledge about postpartum depression while (432%) had good knowledge.

Participants’ overall knowledge was determined based on responses to 11 knowledge-based

questions; participants with total scores between (11-6), and (0-5) were adjudged to have good

and poor knowledge of postpartum depression respectively.

Table 4.3: Awareness of respondents on factors influencing postpartum depression

Variables Strongly Agree Disagree Strongly

 Agree Disagree

PPD might be caused by genetics or 32(26.4%) 41(33.9%) 38(31.4%) 10(8.3%)

inherited problem

PPD can be caused by stressful 59(48.8%) 42(34.7%) 20(16.5%)

circumstances (such as death of

loved one or divorce)

Lack of social support from family 71(58.7%) 39(32.2%) 11(9.1%)

member and partner causes PPD

Risk of PPD is common with women 42(34.7%) 25(20.7%) 43(35.5%) 11(9.1%)

with previous history of depression

Women with history of substance 35(28.9%) 21(17.4%) 65(53.7%)

abuse are at risk of PPD

Women who get pregnant 64(52.9%) 46(38%) 11(9.1%)

unintendedly through means such as

rape, out of wedlock are at risk of

developing PPD

Women who had an eventful 51(42.1%) 48(39.7%) 22(18.2%)

pregnancy where they were sick

during the pregnancy feel anxious

because of unknown outcome may

lead to PPD

Difficulties with breastfeeding like 59(48.8%) 34(28.1%) 12(9.9%) 16(13.2%)

pain, breast engorgement, inverted

nipple can lead to PPD

Excessive worry about the safety 44(36.4%) 45(37.2%) 32(26.4%)

and delivery of the infant or the

mother's concern about her ability

to parent can lead to PPD

Breastfeeding mothers are more 35(28.9%) 17(14%) 59(48.8%) 10(8.3%)

likely to have depressive symptoms

if she sleeps poorly due to incessant

waking up

Women who were physically or 71(58.7%) 39(32.2%) 11(9.1%)

sexually abused as a child or in

marriage (domestic violence) are

predisposed to the risk of PPH

Low level of education and 65(53.7%) 35(28.9%) 21(17.4%)

knowledge of depression can lead to

postpartum depression

Table 4.3 above showed that, majority 41(33.9%) of the respondents agreed that PPD might be

caused by genetics or inherited problem while 38(31.4%) disagreed. 59(48.8%) agreed that PPD

can be caused by stressful circumstances (such as death of loved one or divorce) while

20(16.5%) disagreed. Larger percentage 71(58.7%) agreed that lack of social support from

family member and partner causes PPD while 11(9.1%) objected. 43(35.5%) of the respondents

disagreed that risk of PPD is common with women with previous history of depression while

42(34.7%) agreed. 65(53.7%) of the respondents disagreed that women with history of substance

abuse are at risk of PPD while 35(28.9%) agreed. 64(52.9%) opined that women who get
pregnant unintendedly through means such as rape, out of wedlock are at risk of developing PPD

while 11(9.1%) disagreed. 51(42.1%) were of the opinion that women who had an eventful

pregnancy where they were sick during the pregnancy feel anxious because of unknown outcome

may lead to PPD 22(18.2%) disagreed. Majority 59(48.8%) were positive about difficulties with

breastfeeding like pain in the breast, breast engorgement, inverted nipple leading to PPD while

few 16(13.2%) disagreed. 44(36.4%) agreed that excessive worry about the safety and delivery

of the infant or the mother's concern about her ability to parent can lead to PPD while 32(26.4%)

disagreed. 59(48.8%) disagreed that breastfeeding mothers are more likely to have depressive

symptoms if she sleeps poorly due to incessant waking up while 35(28.9%) agreed. 71(58.7%)

opined that women who were physically or sexually abused as a child or in marriage (domestic

violence) are predisposed to the risk of PPH, 43(35.5%) agreed while 25(20.7%) disagreed.

65(53.7%) agreed that low level of education and knowledge of depression can lead to

postpartum depression while 21(17.4%) disagreed.

Fig 4.3: Overall awareness on factors influencing postpartum depression among

respondents
From Fig 4.3 above on the overall awareness among the respondents showed that; majority

(59%) had good awareness about factors influencing postpartum depression while (41%) had

poor awareness.

Participants’ overall knowledge was determined based on responses to 11 knowledge-based

questions; participants with total scores between (11-6), and (0-5) were adjudged to have good

and poor knowledge of postpartum depression respectively.

Table 4.4: Awareness on preventives measures to prevent postpartum depression

Variables Strongly Agree Agree Disagree

Seeking help with tasks like infant care 98(81%) 14(11.6%) 9(7.4%)

and house hold chores from partners and

family members is helpful in the

prevention or management of PPD

Religious practices, prayer and going to 53(43.8%) 18(14.9%) 50(41.3%)

holy shrine are helpful for the prevention

or management of PPD

Having a balanced diet is helpful for the 48(39.7%) 25(21.5%) 48(38.8%)

prevention or management of PPD

Good sleep is helpful in prevention or 52(43%) 28(23.1%) 41(33.9%)

management of PPD

Taking a childbirth education, prenatal 57(47.1%) 29(24%) 35(28.9%)

classes help in reducing traumatic

childbirth experience also PPD

Physical activity is effective for the 47(38.8%) 34(28.1%) 40(33.1%)

prevention or management of PPD

Table 4.4 above showed that, majority 98(81%) of the respondents agreed that seeking help with

tasks like infant care and house hold chores from partners and family members are helpful in the

prevention or management of PPD while 9(7.4%) disagreed. Averagely, 53(43.8%) agreed that

religious practices, prayer and going to holy shrine are helpful for the prevention or management

of PPD while 50(41.3%) disagreed. 48(38.8%) agreed that having a balanced diet is helpful for

the prevention or management of PPD, same also objected. 52(47.1%) of the respondents agreed

that good sleep is helpful in prevention or management of PPD 35(28.9%) of the respondents

disagreed. 52(47.1%) opined that taking a childbirth education, prenatal classes help in reducing

traumatic childbirth experience also PPD while 35(28.9%) disagreed. 47(38.8%) were of the

opinion that physical activity is effective for the prevention or management of PPD while

40(33.1%) disagreed.

4.2 Hypotheses Testing

Decision rule: If the P-value is less than 0.05 the null hypothesis (HO) will be rejected and the

alternative hypothesis (HI) will be accepted otherwise null hypothesis be accepted and the

alternative will be rejected.

Hypothesis One
Ho – There is no significant difference between sociodemographic characteristics (age, level of

education) of the respondents and their awareness of factors influencing postpartum depression

(PPD).

Table 4.4: Relationship between age and level of education of the respondents and their

awareness of factors influencing postpartum depression

Level of awareness Total X2 df P-value

Poor Good

awareness awareness

Age 18-25 4 6 10 2.068a 3 .558

26-30 22 40 62

31-36 20 21 41

>36 4 4 8

Level of None 4 6 10 .164a 3 .003

education Primary 1 2 3

Secondary 5 6 11

Tertiary 40 57 97

Total 50 71 121

x2: Pearson chi square value, df: degree of freedom, P: Probability value, *: significant at

P< .050

Table 4.5 above revealed that there is no significant relationship between the age of the

respondents and their awareness of factors influencing postpartum depression at (x 2=2.068a,

P=.558) whereas, there is significant relationship between their level of education and awareness

of factors influencing PPD with (x2= .164a, P=.003) at P< .050.

4.3 Answering of Research Questions

Research Question One: What is the level of knowledge about postpartum depression

among the postnatal women?

The result of the analysis presented in Table 4.2 and Fig 4.2 showed that the overall knowledge

about postpartum depression among the respondent is poor (57%). Majority (54.5%) claimed not

to know the types of postpartum depression while (17.4%) agreed to postpartum anxiety, (9.9%)

postpartum blues, (9.1%) posttraumatic stress disorder and postpartum psychosis. Larger

percentage (54.5%) don’t know if postpartum depression is a depressive episode that occurs

within 4 weeks of delivery, (37.2%) agreed while (8.3%) did not. (54.5%) agreed that feeling

unusually sad and teary may be a symptom of PPD, (37.2%) don’t know while (8.3%) did not.

(49.6%) don’t know if sleeping too much or little a sign of PPD, (37.2%) is agreed while (10.7%)

did not. Averagely, (41.3%) agreed that eating too much or losing interest in food may be a sign

of PPD, same claimed they don’t know while (17.4%) disagreed. (41.3%) agreed that loss of

interest or pleasure in most things is a symptom of PPD, same claimed they don ’t know while

(17.4%) disagreed. (45.5%) agreed that PPD affects memory and concentration, (37.2%) don’t

know while (17.4%) disagreed. Majority (57.9%) claimed they don’t know if s ymptoms and

signs of PPD last for a period of at least 2 weeks belong, while (32.2%) agreed (9.9%) did not.

(42.1%) don’t know if PPD can lead to women having problems bonding and caring for their

infants, (41.3%) agreed while (16.5%) disagreed. (43.8%) don’t know if children of mothers with

PPD are likely to have sleeping and eating difficulties, and delay in language development,

(35.5%) agreed while (20.7%) disagreed. (43.8%) claimed not to know if PPD causes emotional

strain for everyone close to the mother, while (35.5%) agreed.

Research Question Two: What is the level of awareness of factors influencing postpartum

depression among respondents?

Regarding respondents’ awareness of factors influencing PPD (Table 4.3, Figure 4.3).

Generally, this study showed that majority (59%) of the respondents had good awareness about

factors influencing postpartum depression. Factors recognized include: lack of social support

from family member and partner causes (58.7%), same percentage for women who were

physically or sexually abused as a child or in marriage (domestic violence); low level of

education and knowledge of depression (53.7%); women who get pregnant unintendedly through

means such as rape, out of wedlock (52.9%); stressful circumstances (such as death of loved one

or divorce) (48.8%), same as women with difficulties with breastfeeding like pain in the breast,

breast engorgement, inverted nipple; women who had an eventful pregnancy where they were

sick during the pregnancy feel anxious because of unknown outcome (42.1%); additional factors

include: women with previous history of depression (34.7%); excessive worry about the safety

and delivery of the infant or the mother's concern about her ability to parent (36.4%); (33.9%)

agreed that PPD might be caused by genetics or inherited problem 65(53.7%) of the respondents

disagreed that women with history of substance abuse are at risk of PPD while 35(28.9%)

agreed.. 59(48.8%) disagreed that breastfeeding mothers are more likely to have depressive

symptoms if she sleeps poorly due to incessant waking up while 35(28.9%) agreed.

Research Question Three: Are the women aware of the preventive measures and programs

available in preventing postpartum depression?

The result of the analysis presented in Table 4.4 revealed that, majority (81%) of the respondents

agreed that seeking help with tasks like infant care and house hold chores from partners and
family members are helpful in the prevention or management of PPD; (43.8%) agreed to

religious practices, prayer and going to holy shrine are helpful for the prevention or

management; (38.8%) balanced diet is helpful for the prevention or management of PPD.

(47.1%) opined that good sleep is helpful in prevention or management of PPD respondents

disagreed. (47.1%) opined that taking a childbirth education, prenatal classes help in reducing

traumatic childbirth experience also PPD. (38.8%) agreed to physical activity as an effective way

for the prevention or management of PPD.

CHAPTER FIVE

DISCUSSION OF FINDINGS, SUMMARY, RECOMMENDATIONS IMPLICATIONS

TO THE NURSING PRACTICE, LIMITATIONS OF THE STUDY, SUGGESTIONS

FOR FURTHER STUDIES AND CONCLUSION

5.0 Introduction

This aspect of study deals with the discussion of findings, summary, conclusion, implication for

Nursing practice, limitation of study, conclusion, recommendations and suggestion for further

study.

5.1 Discussion of Findings

The demographic characteristics of the respondents revealed that majority (51.2%) were within

the age range of 26-30years and were married (68.6%), this is consistent with a study by

Adeyemi et al. (2020) showed that majority (57.6%) of the respondents were within the age

group 21 to 30yrs and married (91.6%). Most 83of the respondents, 24(19.8%) were single while

33(20.5%) were divorced. With regards to religion, most (74.4%) practice Christianity. (61.2%)
belong to Yoruba tribe. (80.2%) of the respondents attained educational level up to tertiary.

Larger proportion (63.6%) had vagina delivery. This finding is comparable to a finding by

Obioha, Balogun & Okafor (2021) which reported that the highest proportion (78%) of the

women had vaginal deliver

The result of the analysis presented in Table 4.2 and Fig 4.2 showed that the overall knowledge

about postpartum depression among the respondent is poor (57%). This is similar to a study by

Obazie and Usoro (2021) which revealed that majority of the participants (60.8%) had poor

knowledge of postpartum depression.

This finding of poor knowledge of postpartum depression among the respondents reflects an

unmet need for mental health literacy particularly postpartum depression among Nigerian

postnatal mothers and it’s in line with a study by Obioha et al. (2021) which reported a

widespread ignorance and misconceptions about mental illnesses especially depression among

adults in Nigeria.

Majority (54.5%) claimed not to know the types of postpartum depression while others agreed to

postpartum anxiety, postpartum blues, posttraumatic stress disorder and postpartum psychosis.

Larger percentage (54.5%) don’t know if postpartum depression is a depressive episode that

occurs within 4 weeks of delivery, (37.2%) agreed while (8.3%) did not. (54.5%) agreed that

feeling unusually sad and teary may be a symptom of PPD, (37.2%) don’t know while (8.3%) did

not. (49.6%) don’t know if sleeping too much or little a sign of PPD, (37.2%) is agreed while

(10.7%) did not. Averagely, (41.3%) agreed that eating too much or losing interest in food may

be a sign of PPD, same claimed they don’t know while (17.4%) disagreed. (41.3%) agreed that

loss of interest or pleasure in most things is a symptom of PPD, same claimed they don ’t know
while (17.4%) disagreed. (45.5%) agreed that PPD affects memory and concentration, (37.2%)

don’t know while (17.4%) disagreed. Majority (57.9%) claimed they don’t know if s ymptoms

and signs of PPD last for a period of at least 2 weeks belong, while (32.2%) agreed (9.9%) did

not. (42.1%) don’t know if PPD can lead to women having problems bonding and caring for their

infants, (41.3%) agreed while (16.5%) disagreed. (43.8%) don’t know if children of mothers with

PPD are likely to have sleeping and eating difficulties, and delay in language development,

(35.5%) agreed while (20.7%) disagreed. (43.8%) claimed not to know if PPD causes emotional

strain for everyone close to the mother, while (35.5%) agreed.

Regarding respondents’ awareness of factors influencing PPD (Table 4.3, Figure 4.3).

Generally, this study showed that majority (59%) of the respondents had good awareness about

factors influencing postpartum depression. Factors recognized included: lack of social support

from family member and partner causes (58.7%), same percentage for women who were

physically or sexually abused as a child or in marriage (domestic violence); low level of

education and knowledge of depression (53.7%); women who get pregnant unintendedly through

means such as rape, out of wedlock (52.9%); stressful circumstances (such as death of loved one

or divorce) (48.8%), same as women with difficulties with breastfeeding like pain in the breast,

breast engorgement, inverted nipple; women who had an eventful pregnancy where they were

sick during the pregnancy feel anxious because of unknown outcome (42.1%). Contrastingly, a

study by Adeyemo et al. (2020) revealed that more of the women who had more than 5 children

had PPD and this could be as a result of the stress that comes with having many children.

Additional factors include: women with previous history of depression (34.7%); excessive worry

about the safety and delivery of the infant or the mother's concern about her ability to parent

(36.4%); (33.9%) agreed that PPD might be caused by genetics or inherited problem. Most
(53.7%) of the respondents disagreed that women with history of substance abuse are at risk of

PPD, this finding is contrasting to a a study by which reported that substance abuse has being

linked with postpartum depression since it was found in this study users mothers were 7 times

more likely to have postpartum depression compared to the non-users. (48.8%) disagreed that

breastfeeding mothers are more likely to have depressive symptoms if she sleeps poorly due to

incessant waking up while 35(28.9%) agreed.

Majority (81%) of the respondents agreed that seeking help with tasks like infant care and house

hold chores from partners and family members are helpful in the prevention or management of

PPD; (43.8%) agreed to religious practices, prayer and going to holy shrine are helpful for the

prevention or management; (38.8%) balanced diet is helpful for the prevention or management of

PPD. (47.1%) opined that good sleep is helpful in prevention or management of PPD

respondents disagreed. (47.1%) opined that taking a childbirth education, prenatal classes help in

reducing traumatic childbirth experience also PPD. (38.8%) agreed to physical activity as an

effective way for the prevention or management of PPD.

Findings from Hypothesis

Result (table 4.5) revealed that there is no significant relationship between the age of the

respondents and their awareness of factors influencing postpartum depression at (x 2=2.068a,

P=.558), similarly, a study conducted in southeast Nigeria by Chinawa et al (2016) found no

significant association between mothers age and postpartum depression. However, there is

significant relationship between their level of education and awareness of factors influencing

PPD with (x2= .164a, P=.003) at P< .050.

5.2 Summary
This study was aimed to determine the awareness of factors influencing postnatal depression

among women attending postnatal clinic at Ladoke Akintola University Teaching Hospital in

Ogbomoso, Oyo State, Nigeria. Sample size of 121 respondents were chosen using simple

sampling technique. Pertinent literatures were reviewed which includes: textbooks, journals, past

research works and internet sources. The study revealed that the overall knowledge about

postpartum depression among the respondent is poor. Whereas, their level of awareness about

factors influencing its occurrence is good. Factors identified include: lack of social support from

family members and partner, physical or sexual abuse as a child or in marriage; low level of

education and knowledge of depression; unplanned pregnant, stressful circumstances (such as

death of loved one or divorce). From the hypothesis tested, there is no significant relationship

between the age of the respondents and their awareness of factors influencing postpartum

depression at (x2=2.068a, P=.558) whereas, there is significant relationship between their level of

education and awareness of factors influencing PPD with (x2= .164a, P=.003) at P< .050.

5.3 Conclusion

Generally, the level of knowledge of respondents about postpartum depression among the

respondent is poor (57%), contrarily their awareness of factors affecting its occurrence is good.

Based on the factors identified, adequate social systems that provide support for women before

and after delivery should be instituted. Simple screening methods applied early in the postpartum

period should be made routine for all women attending postnatal clinics and even up to a year or

two after delivery.

5.4 Implication for Nursing Practice

The level of knowledge of respondents about postpartum depression among respondent is poor,

as majority don’t know the types of postpartum depression, symptoms and duration. Contrarily,

their level of awareness about factors influencing its occurrence is good. Health education should

therefore be elaborately given during any contact with the women during the clinic, this will also

help to improve the identification and treatment of affected women. Various media of

communication can be used for adequate dissemination.

Measure should be taken to enhance mothers delivering at health centers with the help of well-

trained and skilled midwife or health attendant. Peer discussion support should be organized for

the women before, during and after child birth for optimal emotional and psychological support.

Mental health care component should be integrated with maternal care programs available to

work on prevention and control of motherhood related stress and depression among mothers who

are giving birth under the very difficult circumstances. Also, community awareness on family

planning should be done with the involvement of their husbands in their care.

A professional continuing education programmes should also be designed for nurses and

midwives, as well as in formulating policies to influence effective delivery.

5.5 Limitation of study

One of the limitations identified from this present study is the fact that the information obtained

were subjected to self-reporting by the respondents and could not be verified. This may influence

the validity of the research findings. Focus group discussions and in-depth interviews would

have improved the quality of the research findings. Others include:

 Funds: Financial constraint prevented the researcher to cover large population that could

have been used to generalize the findings and the unavailability of grants as at the time of

conducting the study.

Time factor: the researcher had limited time to combine the study with other academic

activities.

5.6 Recommendations

The following recommendations are made based on findings of the study:

Motherhood and parenting possess huge psychological transformation, peer discussion

support should be organized for the before, during and after child birth for optimal

emotional and psychological support.

Elaborate health education for pregnant women, such as the importance of an early

initiation of breastfeeding, a steady blood pressure and less exposure to mobile phone

during pregnancy is highly imperative.

Adequate social systems that provide support for women before and after delivery should

be instituted.

Simple screening methods applied early in the postpartum period should be made routine

for all women attending postnatal clinics and even up to a year or two after delivery.

Mental health care component should be integrated with maternal care programs

available in the country to work on prevention and control of motherhood related stress

and depression among mothers who are giving birth under the very difficult

circumstances in the country.

 Advocate for Government organizations to invest in educating the general public on

postpartum depression e.g. through the media.

Government, as well as non-governmental institutions, should carry out interventions and

support programmes for women with postpartum depression and unmarried pregnant

women who are more prone to post-partum depression.

Policy implementation of existing mental health policies is crucial in addressing issues of

postpartum depression.

5.7 Suggestion for Further Study

Further studies could be carried out on this same subject matter using a large number of

respondents at a different location. Studies could also be carried out on:

Prevalence of antenatal depression among women at a tertiary hospital in Oyo State,

Nigeria.

Screening for postpartum depression by health-care workers in selected primary health

centres in Oyo town: A cross sectional study.

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 FACULTY OF NURSING SCIENCE

COLLEGE OF HEALTH SCIENCES,

LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY, OGBOMOSO.

QUESTIONNAIRE ON AWARENESS OF FACTORS INFLUENCING POSTPARTUM

DEPRESSION AMONG WOMEN ATTENDING POST-NATAL CLINIC AT LADOKE

AKINTOLA UNIVERSITY TEACHING HOSPITAL IN OGBOMOSO, OYO STATE,

NIGERIA.

Dear Respondent,

I am a 500 level student of the above named institution, carrying out a research on the above

topic. This questionnaire is meant for data collection. The information given is purely for

academic purpose and will be treated with confidentiality. Your cooperation is highly

appreciated.

Please do not write your name. Thanks for your willingness to participate.

Yours Faithfully,

Adesina Oluwabukunmi M.

SECTION A: Demographic characteristics

Instruction: please tick the appropriate answer in front of the following questions
 Age: (a) 18-25years{ } (b) 26-30years { } (c) 31-36years { } (d) 36years & above

{ }

Marital Status: (a) Single { } (b) Married { } (c) Divorced { } (d) Others { }

Religion: (a) Christianity { } (b) Islam { } (c) Traditional { } (d) Others { }

Ethnic group: (a) Yoruba { } (b) Igbo { } (c) Hausa { } (d) Others (Specify) { }

Level of education: (a) None{ } (b) Primary { } (c) Secondary{ } (d) Tertiary {

} (e) other { }

Mode of delivery (a) Ceaserian delivery (b) Vagina delivery

Socioeconomic status: (a) low (b) Average (c) High

Section B: (Knowledge on postpartum depression)

1 1 postpartum depression is a major depressive episode with within 4 weeks of delivery:

(a) Yes { } (b) No { } (c)I don’t know

12. Types of postpartum depression

(a) Postpartum anxiety { } (b) Postpartum blues { } (c) postpartum posttraumatic stress

disorder{ } (d) Postpartum panic disorder{ } (e)postpartum psychosis{ }

13. Feeling unusually sad and teary may be a symptom of postpartum depression

(a) Yes { } (b) No { } (c)I don’t know

14. Sleeping too much or too little may be a sign of postpartum depression

(a) Yes { } (b) No { } (c)I don’t know

15. Eating too much or losing interest in food may be a sign of postpartum depression

(a) Yes { } (b) No { } (c)I don’t know

16. Loss of interest or pleasure in most things may be a symptom of postpartum depression

(a) Yes { } (b) No { } (c)I don’t know

17 Postpartum depression affects person’s memory and concentration

(a) Yes { } (b) No { } (c)I don’t know

18 Symptoms and signs of postpartum depression last for a period of at least 2 weeks

(a) Yes { } (b) No { } (c)I don’t know

19. Postpartum depression can lead to women having problems bonding with and caring for their

infants

(a) Yes { } (b) No { } (c)I don’t know

18. Children of mothers who have postpartum depression are more likely to have sleeping and

eating difficulties, crying too much, and delays in language development.

(a) Yes { } (b) No { } (c)I don’t know

19. Postpartum depression can cause emotional strain for everyone close to the mother of a new

baby

(a) Yes { } (b) No { } (c)I don’t know

SECTION 3: Awareness of women on factors influencing postpartum depression

INSTRUCTION: Please tick as appropriate

SA – Strongly agree, A – Agree, D- Disagree SD- Strongly disagree

S/N SD A D SD
20 postpartum depression might be caused by a genetic or

inherited problem(PPD) is inherited

21 Postpartum depression might be caused by stressful

circumstances in the life (such as the death of a loved one

or divorce)

22 Lack of social support from family members and partners

as intimate partner support influence postpartum

depression.

24 The risk of postpartum depression is common with women

with previous history of depression

25 Women with a history of substance abuse before

pregnancy are at risk of postpartum depression

26 women who get pregnant unintendedly through means

such as rape, out of wedlock compared with those who are

intending to be pregnant are at risk of developing PPD

27 Women who had an uneventful pregnancy which they were

sick most times of the pregnancy feel anxious because of

the unknown outcome of the pregnancy and may lead to

development of postpartum depression

28 Difficulties with breastfeeding such as pain on

breastfeeding, breast engorgement, inverted nipple can lead

to postpartum depression
29 Excessive or uncontrollable worry, regarding the delivery,

the health and safety of the infant or the mother's concerns

about her ability to parents can lead to development of

PPD

30 difficulties with breastfeeding such as pain on

breastfeeding, breast engorgement, inverted nipple can

impact maternal mental health and potentially lead to

postpartum depression as they feel sad as they are not able

to perform their motherly roles

31 Breastfeeding mothers with young babies are more likely

to have depressive symptoms if the mother sleeps poorly

due to incessant waking up

32 lower education level and no knowledge of depression can

lead to postpartum depression

33 Women who were physically or sexually abused as a child

or in marriage(domestic violence) are predisposed risk of

postpartum depression

Section 3: Awareness of women on preventives measures to prevent postpartum

depression

INSTRUCTION: Please tick as appropriate

SA – Strongly agree, A – Agree, D- Disagree SD- Strongly disagree

S/N SA A D SD

1. Seeking help with tasks like infant care and house hold chores

from intimate partners and family members is helpful for the

prevention or management of postpartum depression

2 Religious practices, prayer and going to holy shrine are helpful

for the prevention or management of postpartum depression

3 Having a balanced diet is helpful for the prevention or

management of postpartum depression

4 Good sleep is helpful in prevention or management of

postpartum depression

5 Taking a childbirth education, prenatal classes helps in reducing

traumatic childbirth experience thereby reducing postpartum

depression

6 Physical activity is effective for the prevention or management

of postpartum depression
 PILOT STUDY

AWARENESS OF FACTORS INFLUENCING POSTNATAL DEPRESSION AMONG

WOMEN ATTENDING POSTNATAL CLINIC AT LADOKE AKINTOLA

UNIVERSITY TEACHING HOSPITAL IN OGBOMOSO, OYO STATE, NIGERIA

The result of the pilot study on analysis yielded a Cronbach’s alpha score of 0.847, which shows

a true reliability index.

Reliability Statistics

Cronbach's Cronbach's alpha N of

Alpha based on Items

standardized items
 .847 .847 37

Scale Mean Scale Corrected Cronbach's

if Item Variance if Item-Total Alpha if

Deleted Item Correlation Item

Deleted Deleted

Age 69.5041 161.202 -.027 .851

Marital status 69.9752 163.108 -.153 .852

Religion 70.6364 163.250 -.196 .851

Ethnic Group 70.3636 159.167 .084 .849

Level of Education 68.2810 158.020 .109 .849

Mode of Delivery 70.2562 159.875 .093 .848

Socioeconomic Status 69.9339 160.196 .056 .849

Postpartum depression is a 69.7190 145.370 .657 .835

major depressive episode with

within 4 weeks of delivery

Types of postpartum 70.7934 163.182 -.110 .866

depression

Feeling unusually sad and 70.0661 146.912 .586 .837

teary may be a symptom of

postpartum depression

Sleeping too much or too little 69.7934 147.082 .580 .837

may be a sign of postpartum

depression

Eating too much or losing 69.8926 150.597 .438 .841

interest in food may be a sign

of postpartum depression

Loss of interest or pleasure in 69.8926 146.830 .614 .836

most things may be a

symptom of postpartum

depression

Postpartum depression affects 69.9752 151.641 .392 .842

person’s memory and

concentration

Symptoms and signs of 69.6364 148.567 .529 .838

postpartum depression last for

a period of at least 2 weeks

Postpartum depression can 69.8843 148.820 .518 .839

lead to women having

problems bonding with and

caring for their infants

Children of mothers who have 69.8099 150.555 .453 .841

postpartum depression are

more likely to have sleeping

and eating difficulties, crying

too much, and delays in

language development.

Postpartum depression can 69.8099 150.555 .453 .841

cause emotional strain for

everyone close to the mother

of a new baby

postpartum depression might 69.6777 152.054 .362 .843

be caused by a genetic or

inherited problem (PPD) is

inherited

Postpartum depression might 70.0496 146.814 .515 .838

be caused by stressful

circumstances in the life (such

as the death of a loved one or

divorce)

Lack of social support from 70.3884 149.090 .727 .836

family members and partners

as intimate partner support

influence postpartum

depression.

The risk of postpartum 69.7025 146.611 .551 .837

depression is common with

women with previous history

of depression

Women with a history of 69.6446 152.164 .384 .842

substance abuse before

pregnancy are at risk of

postpartum depression

women who get pregnant 70.2397 146.950 .632 .836

unintendedly through means

such as rape, out of wedlock

compared with those who are

intending to be pregnant are at

risk of developing PPD

Women who had an 70.1322 151.649 .495 .840

uneventful pregnancy which

they were sick most times of

the pregnancy feel anxious

because of the unknown

outcome of the pregnancy and

may lead to development of

postpartum depression

Difficulties with breastfeeding 70.0165 146.400 .539 .838

such as pain on breastfeeding,

breast engorgement, inverted

nipple can lead to postpartum

depression

Excessive or uncontrollable 69.9917 155.825 .243 .846

worry, regarding the delivery,

the health and safety of the

infant or the mother's concerns

about her ability to parents can

lead to development of PPD

difficulties with breastfeeding 69.4380 148.898 .474 .840

such as pain on breastfeeding,

breast engorgement, and

inverted nipple can impact

maternal mental health and

potentially lead to postpartum

depression as they feel sad as

they are not able to perform

their motherly roles

Breastfeeding mothers with 69.5289 160.801 -.021 .854

young babies are more likely

to have depressive symptoms

if the mother sleeps poorly

due to incessant waking up

Women who were physically 70.3884 149.090 .727 .836

or sexually abused as a child

or in marriage(domestic

violence) are predisposed to

risk of postpartum depression

lower education level and no 70.2562 150.942 .518 .840

knowledge of depression can

lead to postpartum depression

Seeking help with tasks like 70.6281 155.752 .351 .844

infant care and household

chores from intimate partners

and family members is helpful

for the prevention or

management of postpartum

depression

Religious practices, prayer, 69.9174 158.410 .085 .850

and going to holy shrines are

helpful for the prevention or

management of postpartum

depression

Having a balanced diet is 69.9008 158.107 .105 .850

helpful for the prevention or

management of postpartum

depression

Good sleep is helpful in the 69.9835 155.133 .245 .846

prevention or management of

postpartum depression

Taking childbirth education, 70.0744 156.503 .187 .847

and prenatal classes in

reducing traumatic childbirth

experiences thereby reducing

postpartum depression

Physical activity is effective 69.9504 155.814 .222 .847

for the prevention or

management of postpartum

depression