A months controlled prospective study on the pattern of postpartum mental illness in three Nairobi hospitals, Kenya

Abstract

During the period 1st March to 30th September, 1986, a controlled prospective study on postpartum mental illness was done in three hospitals in Nairobi - Kenyatta National Hospital, Pumwani Maternity Hospital and Mathari Psychiatric Hospital. By using simple selection criteria based on the symptomatology of major and minor psychiatric disorders (as detailed in the study protocol) and the operational definition,65 index cases were included, in the study. 65 normal puerperals (but only 59 records were available for analysis) matched for the place and period of delivery (within one month) were included in the study as a control group by random selection from Kenyatta National Hospital and Pumwani Maternity Hospital. The findings showed that all forms of postpartum mental illness reported elsewhere were encountered in the study. Manic depressive psychosis (33.8%) was the most predominant form of postpartum psychosis, followed by transient organic psychosis (24.6%) and schizophrenia (18.5%) in that order. Neurotic depression was the most predominant form of postpartum neurotic disorder (18.5%). Anxiety state and hysteria formed 3% and 1.6% of the total index cases respectively. The peak incidence of postpartum mental illness was in the first two weeks after delivery and the average stay in hospital was 4 weeks. It was found that symptoms of organic cerebral dysfunction occured in half of the patients with psychoses and over one third of all the patients experienced maternity blues. Physical, hereditary and psychological factors were found to play an important aetiological role in the psychoses. The role of these factors in neurotic depression was also important but the importance of hereditary factors was doubtful. Primiparity was predominant in the index cases and together with delivery at home, instrumental and operative delivery, seem to be risk predictors for the development of postpartum mental illness. It was found that the premorbid personality of patients was not different from normal puerperals. There was no association of postpartum mental illness with age, duration of labour, socioeconomic status, use or non-use of antenatal services. The author believes that the factors found to be positively associated with postpartum mental illness can be used as risk predictors. tfomen at risk can therefore be identified for preventive measures. The midwives and nurses in maternity units, hospitals, and maternal child health clinics are the primary health care workers available for preventive measures for postpartum mental illness which includes early identification and prompt treatment.