Prevalence of postpartum psychological distress among mothers of preterm neonates in Kenyatta National Hospital newborn unit

Abstract

Background: Preterm birth rates are high both locally and globally.In Kenya 10-15% of all babies born are preterm.Prematurity is the leading cause of newborn death, and many of the babies who survive face a lifetime of disability.Preterm birth and the associated perinatal problems is experienced by the mother as an acute emotional crisis characterized by depression, anxiety,stress and for some self-blame. Having increased maternal psychological symptoms is a risk factor for emotional attachment difficulties and decreased maternal responsiveness towards the baby. Objectives: To determine the prevalence of postpartum psychological distress i.e depression, anxiety and stress (according to DASS-21 scale) among mothers of preterm neonates in KNH newborn unit and the factors associated with psychological distress among these mothers. Methods: A hospital based cross-sectional study was done. All mothers with preterm neonates admitted in the KNH newborn unit, that met eligibility criteria and gave consent were enrolled. A questionnaire capturing maternal and neonatal history and the diagnostic screening tool DASS-21 was administered. Data collected was analyzed usingthe SPSS computer software.Chi-square analysis was used to establish association between psychological distress and the various risk factors, while logistic regression analysis was used to determine the factors independently associated with psychological distress among among mothers of preterm neonates. Results: The mean age of the mothers who took part in the study was 27±5.3 years. The mean gestational age at birth of the preterm neonates was 32±2.5 weeks. The prevalence of postpartum psychological distress (one or more of depression,anxiety or stress) among mothers of preterm neonates was 27.4%. The prevalence of depression, anxiety and stress was 17%, 21.5% and 10.4% respectively. Younger maternal age less than 25years, low level of maternal education, low monthly family income, being unmarried and having not planned to be pregnant were maternal factors significantly associated with postpartum psychological distress among mothers of preterm neonates (P=<0.05). Neonatal factors that were significantly associated with postpartum psychological distress among mothers of preterm neonates were oxygen therapy, a neonate with a low weight at the time of the interview or a neonate not on milk feeds (P=<0.05). However, at multivariate analysis the factors that remained significant were low family income (AOR=5.3, 95% CI 1.8-15.8, P=0.003), low level of maternal education (P=0.04), oxygen therapy (AOR=1.6, 95% CI 1.2-2.2, P=0.01), or a neonate not on milk feeds (AOR=3.5, 95% CI 1.2-10.2, P=0.022). Conclusion: Post partum psychological distress is a significant problem among the mothers of preterm neonates in the KNH newborn unit. Low maternal education, low family income, having a neonate on oxygen therapy or a neonate not on milk feeds are independent predictors of post partum psychological distress among mothers of preterm neonates. Health care workers in the newborn unit should have a high index of suspicion for psychological distress among mothers of preterm neonates, and support structures for these mothers need to be put in place.